TQs Flashcards
Once a patient with oral cancer has metastasis to cervical lymph nodes, he automatically enters what stage of disease?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
Stage 3
Before a patient is to begin radiation therapy for an oral malignancy, teeth with questionable or poor prognosis should
a. Be saved at all costs
b. Undergo RCT and amputation
c. Be extracted
d. Be left alone, as all these patients need radiation right away
Be extracted
Which of the following are side effects of radiation?
a. mucositis
b. xerostomia
c. dermatitis
d. radiation caries
e. all of the above (also osteoradionecrosis)
All of the above
Xerostomia is a result of effects of radiation on salivary glands including
a. Fibrosis
b. Atrophy
c. Degeneration
d. All of the above
All of the above
Decreased salivary flow can often lead to
a. Periodontal disease
b. Root caries
c. Dysphagia
d. A and b only
e. All of the above
All of the above
(in ppt said Dysphonia and Dysguesia, just in case they add this two
Patients undergoing radiation therapy to the head and neck should have a home regimen including
a. Topical fluoride application
b. Sensodyne tooth paste
c. Hydrogen peroxide rinses
d. Only pureed diet
Topical fluoride application
When performing extractions on a patient who will soon undergo radiation therapy to the head and neck, the dentist should
a. Perform coronectomies whenever possible
b. Be as atraumatic as possible
c. Perform the extractions as close of possible to the initiation of radiation treatments.
d. Never attempt primary closure of extraction site
Be as atraumatic as possible
Healing time after extractions and initiation of radiation therapy should be approximately
a. 1-2 days
b. 2-3 months
c. 2-3 weeks
d. None of the above
2-3 weeks
Marx protocol for extractions in a patient at the risk for osteoradionecrosis is (referring to hyperbaric oxygen):
a. 10 dives preop followed by 10 dives postop
b. 20 dives preop followed by 20 dives postop
c. 20 dives preop followed by 10 dives postop
d. 10 dives preop followed by 20 dives postop
20 dives preop followed by 10 dives postop
Management of osteoradionecrosis includes all of the following except:
a. Saline irrigation
b. Local debridement
c. Antibiotics
d. Topical Fluoride
Topical fluoride
Radial forearm free flaps
a. This is the best flap for reconstructing the oral cavity
i. the “work horse” of head and neck reconstruction
b. constant anatomy, easy surgical access
c. thin, pliable skin ; large size
d. great versatility in design due to septocutaneous blood supply
e. all of the above
All of the above
What is/are characteristics of anterolateral thigh flap:
i. provides BULK & VOLUME
ii. limitation: variations in anatomy
iii. multiple skin paddles
iv. All of the above
All of the above
Anterolateral thigh flap…what is the blood supply to this?
a. descending branch of lateral circumflex femoral artery
b. ascending branch of lateral circumflex femoral artery
c. Superior iliac artery
d. Fibular artery
Descending branch of lateral circumflex femoral artery
What is the most popular flap for mandibular reconstruction?
Microvascular free fibula flap
Head and neck cancer associated in young patients associated with which virus?
a. HPV 16
b. HPV 7
c. HPV 6
d. HPV 4
HPV 16
Also 18, 31, and 33
What percentage of intraoral cancers are oral tongue carcinomas?
20-30%
Of those, 75% is in the anterior 2/3 and 25% is in the posterior 1/3.
What is the Vignette classification of a patient that has a tumor greater than 4 cm (TNM classification)?
T3
What is the Vignette classification of a patient that has a tumor between 2 and 4 cm (TNM classification)?
T2
What is the Vignette classification of a patient that has a tumor that invades near-by structures (TNM classification)?
T4
What is the Vignette classification of a patient that has a tumor 2 cm or less (TNM classification)?
T2
What is the Vignette classification of a patient that has a lymph node involved
N1
What is the Vignette classification of a patient that has a lymph node involved > 3 cm in diameter but
N2
What is the Vignette classification of a patient that has no distant metastasis (TNM classification)?
M0
What is the Vignette classification of a patient that has distant metastasis (TNM classification)?
M1
Oral cancer makes up which percentage of NEW cancer cases in USA every year?
2-3%
Prognosis in oral cancer - know greatest single indicator of prognosis aka what will you look at in a patient to give you the idea they will do well?
a. Staging determines tx….
b. The status of the prognosis depends on the cervical lymph nodes…..
c. Diet and exercise
STAGING
What percent of patients receive radiation therapy?
60-70%
When getting radiation therapy for SCC for head and neck, what is the dosage for:
- Subclinical disease
- Skin and lips
- Gross Disease
- Naso/oropharynx
- Subclinical Disease: 50 to 55 Gy in 5 to 6 weeks
- Skin & Lip: 60 Gy in 4 week
- Gross Disease: 1.8-2.0 Gy/fraction x 5 days/week for 6-7 weeks = 65-66Gy
- Naso Oro/Hypopharynx & BOT: 70 to 72 Gy
Know about dentist role as part of multidisciplinary team of managing cancer
a. Restorations/ Extractions
b. OH program
c. Diet advice
d. Use/make FL trays
e. Smoking cessation
f. dental oncology/maxillofacial prostho
g. All of the above
All of the above
What are the effects of ACUTE toxicity due to radiation?
acute skin reactions, hyperemia, reduced salivary gland function, mucositis, hypogeusia
What are the effects of LATE toxicity due to radiation?
Seems not to occur when tissues are exposed to less than 45 gy; chronic damage to skin, muscle, nerves/bone
Hypoxia reperfusion theory accepts all of the following Except:
a. Trauma posteriorly results in obstructed vascular supply
b. Increase in joint pressure in decrease flow posteriorly
c. Hypoxic condition increases free radical breakdown of healthy joint
d. Increased pressure physically pushes the disc anteriorly allowing more space for free radical degeneration
d. Increased pressure physically pushes the disc anteriorly allowing more space for free radical degeneration
What year was Orthognatic surgery to US?
1965
What is the most common surgical procedure in mandible?
Bilateral sagittal split osteotomy
What is NOT removed in radical neck dissection?
a. Jugular vein
b. SCM muscle
c. Spinal Accessory Nerve
d. All lymph nodes on the affected side
e. None of the above
None of the above - all are removed during radical neck dissection
What IS removed in modified radical neck dissection?
All lymph nodes are removed but you have preservation of one or more of the non-lymphatic structures (jugular, dcm, or spinal accessory n.)
Your patient is a 65 year old white male, who has smoked two packs a day for 45 years. He has a 2.3cm ulceration, which he noticed in the mirror. Patient reports no symptoms. Upon your examination, you determined the presence of two involved lymph nodes, bilaterally. What is his TNM classification?
a. T2N2bM0
b. T2N2cM0
c. T1N2cM0
d. T1N2bM0
T2N2cM0
N2c = bilaterally involved lymph nodes
The microvascular free fibula flap has been shown to be thin, faciolingually and in relationship to the surrounding bone, to support dental implants.
a. True
b. False
False
What are the disadvantages to microvascular flaps such as anterolateral thigh and latissimus dorsi flap?
a. Both flaps are relatively large and are usually not required for most microvascular reconstructions
b. Ablative concerns need to be addressed before others.
Both flaps are relatively large and are usually not required for most microvascular reconstructions
What are the benefits of radial forearm free flaps?
a. Best for reconstructing oral cavity
b. Thin, pliable skin
c. Great versatility in design due to septocutaneous blood supply
d. All of the above
All of the above
What important factors will the surgeon will take into account when evaluating a patient for reconstruction?
a. Patient medical history and physical
b. The type of ablative surgery to be performed
c. Patient habits
d. All of the above
All of the above
Head and neck cancer associated in young patients who don’t smoke and drink is associated with which virus
a. HPV
b. HIV
c. Mononucleosis
d. Herpes
HPV
According to statistics, 20-30% of all oral cancers develop where?
a. Lateral border of the tongue
b. Parotid
c. Oropharynx
d. Floor of mouth
Lateral border of the tongue
What is the greatest single indicator of prognosis in oral cancer?
Metastasis to cervical lymph nodes
When getting radiation therapy for SCC for head and neck, what is the dosage?
a. 5000-7200 cGy
b. 5000-7000 Gy
c. 80-90 Gy
5000-7200 cGy
What percent of patients that have head and neck malignancies receive radiation therapy?
a. 70%
b. 100%
c. 30%
d. 10%
70%
Which orthognathic surgery is the most stable skeletal movement?
a. Maxilla up
b. Maxilla down
c. Mandible back
d. Maxilla expansion
Maxilla up
Which of the following arteries is not one of those associated with vertical ramus ostectomies:
a. Maxillary a.
b. Masseteric a.
c. Descending inferior alveolar a.
d. Superior thyroid artery
Superior thyroid artery