Head and Neck Surgery — MCQs

Head and Neck Surgery Indian Medical PG Practice Questions and MCQs

Question 521: All of the following statements about Zenker's diverticulum are true except.

A. It is a true diverticulum. (Correct Answer)
B. Acquired diverticulum
C. Lateral X-rays on Barium swallow are often diagnostic.
D. Outpouching of the posterior pharyngeal wall, just above the cricopharyngeus muscle.

Explanation: ***It is a true diverticulum.*** - A Zenker's diverticulum is a **false diverticulum**, meaning it involves an outpouching of only the **mucosa and submucosa** through a defect in the muscular layer, not all layers of the esophageal wall. - **True diverticula** contain all layers of the esophageal wall (mucosa, submucosa, and muscularis propria), whereas a Zenker's diverticulum lacks the muscular layer in its wall. *Acquired diverticulum* - Zenker's diverticulum is an **acquired condition**, typically developing later in life due to increased pressure and discoordination of the pharyngeal muscles. - It results from a herniation of the pharyngeal mucosa through a weak point, the **Killian's triangle**, due to prolonged high intraluminal pressure. *Lateral X-rays on Barium swallow are often diagnostic.* - A **barium swallow** is the diagnostic procedure of choice, clearly visualizing the posterior outpouching of the pharyngeal wall. - **Lateral views** are particularly effective in demonstrating the location and size of the diverticulum, distinguishing it from other esophageal abnormalities. *Outpouching of the posterior pharyngeal wall, just above the cricopharyngeus muscle.* - Zenker's diverticulum is specifically located in the **Killian's triangle**, a weak area in the posterior wall of the pharynx superior to the **cricopharyngeus muscle**. - This anatomical position explains why it causes symptoms such as **dysphagia**, regurgitation of undigested food, and halitosis due to food accumulation.

Question 522: The most common site of metastasis from the mandibular sarcoma is

A. Lung (Correct Answer)
B. Liver
C. Spleen
D. Heart

Explanation: ***Lung*** - The **lungs** are the most common site for distant metastasis of sarcomas, including those originating from the **mandible**. - This is due to the **hematogenous spread** of tumor cells, which travel through the bloodstream and often lodge in the pulmonary capillaries. *Liver* - While the liver can be a site of metastasis for some cancers, it is less common for **sarcomas** compared to the lungs. - Liver metastases are more frequently seen with carcinomas of the **gastrointestinal tract**. *Spleen* - The **spleen** is a rare site for metastasis from any type of cancer, including sarcoma. - Its rich lymphoid tissue and unique vasculature may contribute to its relative resistance to metastatic colonization. *Heart* - Metastasis to the **heart** is also very rare, often occurring in advanced-stage cancers. - When it does occur, it is usually from cancers like **melanoma** or **lung carcinoma**, not typically sarcomas from the mandible.

Question 523: The Abbe-Estlander flap is primarily based on which artery?

A. Lingual artery
B. Facial artery
C. Labial artery (Correct Answer)
D. Internal maxillary artery

Explanation: ***Labial artery*** - The **Abbe-Estlander flap** is a **lip switch flap** used in lip reconstruction, and it relies primarily on the **labial artery** for its vascular supply. - This **axial pattern flap** ensures robust blood flow, which is crucial for the flap's viability when transferring tissue from one lip to the other. *Lingual artery* - The **lingual artery** primarily supplies the **tongue** and floor of the mouth, not the lips directly. - While it originates from the **external carotid artery** like the labial artery, its branching pattern does not typically contribute to the primary blood supply of lip flaps. *Facial artery* - The **facial artery** is the main artery of the face, giving rise to the **superior and inferior labial arteries** that directly supply the lips. - Although the labial arteries are branches of the facial artery, explicitly stating the "labial artery" is more precise for the direct blood supply of this specific flap. *Internal maxillary artery* - The **internal maxillary artery** (part of the larger maxillary artery) supplies deep structures of the face, nasal cavity, and palate. - It does not directly supply the lips or contribute to the primary vascular basis of the **Abbe-Estlander flap**.

Question 524: What is the most effective management strategy for osteoradionecrosis?

A. Hyperbaric oxygen therapy
B. Fluoride treatment
C. Combination of hyperbaric oxygen therapy and surgical removal of necrotic bone (Correct Answer)
D. Surgical removal of necrotic bone

Explanation: ***Combination of hyperbaric oxygen therapy and surgical removal of necrotic bone*** - This combined approach is the most effective strategy for **osteoradionecrosis** as it addresses both the underlying tissue damage and the removal of compromised bone. - **Hyperbaric oxygen therapy** promotes angiogenesis and increases oxygenation in damaged tissues, while **surgical debridement** removes non-viable bone to facilitate healing. *Hyperbaric oxygen therapy* - While beneficial for promoting tissue healing and angiogenesis, **hyperbaric oxygen therapy alone** may not be sufficient to resolve established osteoradionecrosis, particularly in cases with significant bone sequestration. - It works by increasing the **partial pressure of oxygen** in tissues, which can improve blood supply and support cellular repair, but often needs debridement of necrotic tissue to be fully effective. *Fluoride treatment* - **Fluoride treatment** is primarily used to prevent dental caries and manage **dentin hypersensitivity**, not to treat established osteoradionecrosis. - It has no direct therapeutic role in revascularizing necrotic bone or promoting the healing of radiation-damaged tissue. *Surgical removal of necrotic bone* - **Surgical debridement** is crucial for removing non-viable bone tissue, which acts as a barrier to healing and can harbor infection. - However, without adjunctive therapies like **hyperbaric oxygen**, simple debridement may not adequately address the underlying **hypoxia and hypovascularity** of the irradiated tissue, leading to persistent or recurrent necrosis.

Question 525: In lateral nasal bone fractures with displacement, which mechanism of trauma is most commonly associated with this type of fracture?

A. Blow from the side (Correct Answer)
B. Blow from below
C. Blow directly from the front
D. Any of the above

Explanation: ***Blow from the side*** - A **lateral force** applied to the nose is most likely to cause a **lateral nasal bone fracture** with displacement in the direction of the force. - This type of impact directly pushes one side of the nasal bones inward, leading to **asymmetric displacement**. *Blow from below* - A blow from below typically causes an **upward force** on the nose, often leading to fractures of the **septum** or the lower parts of the nasal bones, not primarily lateral displacement. - This mechanism is more associated with **septal hematomas** or **nasal pyramid telescoping** rather than lateral fractures. *Blow directly from the front* - A direct frontal blow usually results in a **symmetrical fracture** pattern, often involving **depressed nasal bones** or a **keystone fracture** if the force is sufficient. - This mechanism is less likely to cause a **lateral displacement** of the nasal bones. *Any of the above* - While various forces can cause nasal fractures, specific fracture patterns are generally associated with particular **mechanisms of injury**. - Lateral displacement is distinctively linked to a **lateral impact**, making "any of the above" an inaccurate generalization for this specific fracture type.

Question 526: What is the most common malignancy found in the maxillary antrum?

A. Mucoepidermoid Carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma (Correct Answer)
D. Adenoid Cystic Carcinoma

Explanation: ***Squamous cell Ca*** - **Squamous cell carcinoma** (SCC) accounts for the vast majority (approximately 80%) of all malignancies arising in the **maxillary antrum** (or maxillary sinus). - Its high prevalence is often linked to chronic inflammation, environmental factors, and a higher density of **squamous epithelium** or metaplasia in the region. *Mucoepidermoid Carcinoma* - This is a common salivary gland malignancy but is **rare in the maxillary antrum**, where glandular tissue is less predominant. - While it can occur in sinonasal tracts, it is not the most frequent primary malignancy there. *Adenoid Cystic Carcinoma* - **Adenoid cystic carcinoma** is a common malignancy of the salivary glands and can occur in the sinonasal tract, but it is **much less frequent than SCC** in the maxillary antrum. - It often exhibits a **perineural invasion** pattern and a slow, but aggressive growth. *Adenocarcinoma* - While adenocarcinomas can arise from the **glandular epithelium** of the maxillary antrum, they are considerably **less common than squamous cell carcinoma**. - They are often associated with specific occupational exposures, such as **wood dust** or leather dust.

Question 527: If posterior epistaxis cannot be controlled, which artery is ligated?

A. Sphenopalatine artery (Correct Answer)
B. External carotid artery
C. Posterior ethmoidal artery
D. Maxillary artery

Explanation: ***Sphenopalatine artery*** - The **sphenopalatine artery** is the primary blood supply to the posterior nasal cavity, making its ligation highly effective for persistent **posterior epistaxis**. - It is a terminal branch of the **maxillary artery** and enters the nasal cavity through the sphenopalatine foramen. *Maxillary artery* - While the **maxillary artery** is the parent vessel of the sphenopalatine artery, ligating it further upstream can be more invasive and carry higher risks. - Ligation of the **sphenopalatine artery** directly addresses the most common source of posterior bleeding with less morbidity. *External carotid artery* - The **external carotid artery** is the main source of blood for the internal maxillary artery which gives origin to the sphenopalatine artery. - Ligation at this level is a more proximal and generalized intervention that might not be specific enough for intractable posterior epistaxis and can affect other vascular territories. *Posterior ethmoidal artery* - The **posterior ethmoidal artery** supplies a smaller, more superior portion of the posterior nasal cavity and is less frequently the primary source of severe posterior epistaxis. - Ligation of the ethmoidal arteries is typically reserved for cases where anterior or superior bleeding is refractory, not standard posterior epistaxis.

Practice by Chapter

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Parathyroid Gland Disorders

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Laryngeal Disorders

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Head and Neck Cancer

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Airway Management in Head and Neck Surgery

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Surgical Approaches to the Neck

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Neck Dissection Techniques

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