Head & Neck

Question 1

Cancer maxilla spreads to….LNs

Answer 1

Upper deep cervical & retropharyngeal

Question 2

In case of cancer maxilla, pt CO…..

Answer 2

Early: dull aching pain, referred to teeth
Late: medial: unilateral masal obstruction, epistaxis
Ant: swelling of cheek
Sup: epiphora & proptosis

Question 3

Mention 2 cystic dental tumors, their age & site

Answer 3

Periodontal cyst, adult, upper jaw
Dentigerous, children, lower jaw

Question 4

MC site for ameloblastoma is….

Answer 4

Molar area of mandible

Question 5

List comp of ameloblastoma

Answer 5

1. Infection, ulcer, bleeding, fall of teeth
2. Rare: pathological fracture
3. Recurrence
4. Malignant transformation (mixed tumor)

Question 6

Mention INV & TTT for ameloblastoma

Answer 6

Inv: X ray (soap bubble, honey comb)
CT/MRI
Biopsy
TTT: excsion with a 1 cm tumor free margin & bone grafting

Question 7

2nd MC congenital anomaly is….

Answer 7

Cleft lip/palate anomalies

Question 8

Inv for CL/P is….

Answer 8

Antenatal diagnosis by US >18 wks gestation + CP

Question 9

Describe timing for intervention in CL

Answer 9

In isolation, 6wks to 3mon
In syndromic ots, may be delayed upto 6 months
Alveolar repair can be done w/ the 1ry lip repair or at another stage

Question 10

List goals of repair of CL

Answer 10

1. Correct all lip defects
2. Reconstitute orbicularis oris
3. Restore anatomical landmarks
4. Correct nasal defirmity
5. Achieve symmetry in bilateral cases

Question 11

Describe C/P of CP

Answer 11

1. Impaired suckling, dentation
2. Impaired speech: hearing loss, inadequate VP mech
3. Recurrent infections due to aspiration
4. Inadequate emptying of middle ear (abnormal levator palate insertion) recurrent otitis media+hearing loss
5. Distorted facial growth

Question 12

List goals of repair in CP operation & timing of operation

Answer 12

A. Closure of cleft: separate oral & nasal cavities, prevent aerophagia & reflux of oral contents into nasopharnyx
B. Speech/VP competence, inc palatal length & muscle repositioning, prevent maladaptive compensatory misarticulations
C. Facial growth: early palate repair adversely affect maxillary growth, outweighed by improvement in speech achieved by early correction
Early repair at 6-9 months is preferred to improve hearing & speech outcomes

Question 13

Describe CP surgery

Answer 13

Paring edges
Suturing in 3 layers: nasal m, ms layer, oralm
Lateral relaxation incisions & fracture pterygoid hamulus to relax tenor palati

Question 14

List muscles of soft palate

Answer 14

Levator veli palatini, tensor veli palatini, palatopharyngeus, palatoglossus, musculus uvulae

Question 15

Mention INV for neck injury

Answer 15

Plain X-ray (FB, wide mediastinum, subcut emphysema, fracture), duplex, CT of skull, brain, angio, laryngoscopy, gastrograffin swallow

Question 16

Describe TTT of neck injuries

Answer 16

1. ABCDE
2. Tnsion pneomothorax: insert needle in 2nd intercostal space
3. Minor bleeding: compression
4. Major bleeding: exploration & vascular repair
5. Neurological damage: neck support & patient evaluation
6. Esophageal & larngo-tracheal injury: surgery repair

Question 17

Describe block neck dissection

Answer 17

Remove ALL LNs on one side of neck in one mass, also remove carotid sheath, IJV, Sternomastoid, lower part of parotid & submandibular salivary glands
We preserve carotid a, vagus n, accessory n.

Question 18

In modified radical neck dissection…..are preserved.
Mention its indications

Answer 18

IJV & SMK
in thyroid carcinoma & bilateral BND IJV is preserved on less affected side to enable drainage of brain

Question 19

List ind for suprahyoid block dissection

Answer 19

Cancer of lower lip, & early tip of tongue or floor of mouth

Question 20

How to determine the depth of burn?

Answer 20

By type & sensibility of area

Question 21

Mention signs of BCC conversion to SCC

Answer 21

Edges become everted rapid growth. LNs are hard & fixed

Question 22

Mention disadv of radiotherapy in tongue cancer

Answer 22

Mucositis, dysphagia, osteonecrosis

Question 23

Time for VP repair is…., but alveolar repair is…..

Answer 23

2-3yrs
7-10 yrs