Maxillofacial

1. Earliest accounts of reconstructive surgery. Reconstruction of an amputated nose

with a pedicled forehead flap/ reconstruction of ear with cheek flaps
SUSHRUTA SAMHITA
2. Book describes reconstruction of the nose with pedicled arm flap.
GASPARA TAGLIACOZZI
3. Masterminds in proliferative healing phase populate on the third day
MACROPHAGES
4. Skin constitution- Epidermis 5% Dermis 95%
5. Acceleration of clotting cascade- FACTOR 3 THROMBOPLASTIN
6. Graft with low primary contraction, high secondary contraction
THIN SPLIT GRAFTS
7. Graft with high primary contraction and low secondary contraction
THICK SPLIT GRAFTS
8. Reconstruction of the nose requires appreciation of the NINE aesthetic subunits
9. Arteries that supply the lips
FACIAL ARTERY, and its branches- superior/ inferior labial arteries
10. There are five layers to the scalp: the skin, connective tissue layer, galea
aponeurotica, loose areolar connective tissue, and the pericranium
11. if parents have cleft lip chance of offspring being affected :- 4%
12. cleft palate repair- should be performed before development of speech
13. The most common orbital fracture is the orbital floor blow-out fracture caused by
direct pressure to the globe and sudden increase in intra-orbital pressure.
14. First line treatment hemangiomas: systemic corticosteroids
15. Best surgery pattern for cleft palate- double apposing Z plasty
16. Most common birthmark- hemangioma
17. Skin growth external factor- gravity

19) Injury to forehead and face causes :- Zygomatic bone fractures

11) in que :- Graft :- has no vascular pedicle /supply
14) lateral side damage of orbital fissure :- Zygomatic bone

What kind of grafts include the whole entire epidermis and dermis?
Full dermis
Who established a centre in France for the treatment of facial injuries incurred in ww2?
V.H.kazanijan

the autosomal dominant disorder with variable penetrance has following manifestations:
hypoplasia of the zygomas, asymmetry and hypoplasia of the mandible, ear anomalies
colobomas of the lower eyelids. Which syndrome is described?

treacher
Romberg’s disease is a disorder of unknown etiology,
beginning in childhood or adolescence, in which hemifacial
atrophy of the skin, subcutaneous fat, muscle, bone, and
cartilage progresses
for a variable period of time before spontaneously ceasing
or “burning out” 2 to 10 years after beginning. Most believe
treatment should be delayed until at least 1 year after the
process of
atrophy has ceased.

atrophy and hypoplasia is Romberg’s progressive hemifacial

atrophy, also known as Parry-Romberg syndrome.

Treacher, also known as mandibulofacial dysostosis, is a type

of craniofacial clefting disorder representing bilateral 6-7-8
clefts. This autosomal dominant disorder with variable
penetrance has the following manifestations: hypoplasia of
the zygomas, asymmetry and hypoplasia of the mandible,ear
anomalies, and colobomas of the lower eyelids.

Macrophages become the major

population by the third day after injury.
These cells then dominate the wound
region for days to weeks.
• Macrophages are the “masterminds”
behind the finely tuned array of repair
events that characterizes the
proliferative phase of healing.

Full-thickness skin grafts include the epidermis and the

complete layer of dermis.
❖ The subcutaneous tissue is carefully removed from the
deep
surface of the dermis to maximize the potential for
engraftment. Full-thickness grafts are associated with the
least secondary contraction upon healing, the best
cosmetic appearance, and the highest durability.
❖ As a result, they are frequently used in reconstructing
superficial wounds of the face and the hands.

Hemangioma- most common birth mark. Usually in first 2 weeks of life.

Skin incisions-
Human skin exists in a state of tension created by internal and external factors. Externally,
skin and underlying subcutaneous tissue are acted on by gravity and clothing. Internally, skin
is subjected to forces generated by underlying muscles, joint extension and flexion, and
tethering of fibrous tissues from zones of adherence.

ENT
1. Anosmia (loss of smell) common finding in all EXCEPT- acute otitis media
2. What is the acoustic neuroma feature EXCEPT- it is a fast growing tumor
3. Types of hearing loss- conductive, sensory neuro, mixed
4. The ear has three parts
5. Acute tonsilitis- tx sprays
6. Acute OM main sx- pain/ hearing loss
7. Change in tympanic membrane OM- red, perforation, discharge
8. Types of sinsus- maxillary, ethmoid, sphenoid, and frontal
9. Fungal infection otitis externa- aspergellis/ candida
10. Acute laryngitis- voice change
11. Otitis- viral, bacterial, fungal
12. what is true regarding inner ear except :- Cochlear part of the temporal bone
13. otosclerosis causes :- males are more affected
14. scala media is filled with perilymph

27) plastic

28) pir robins /Addison

Pierre Robin sequence is characterized by three
pathognomonic
findings: microretrognathia, glossoptosis, and respiratory dis-
tress. Pierre Robin sequence may or may not be associated
with
a palatal cleft.

29) complete bilateral /unilateral

32) enlarged adenoids

33) 8-10 cm

34) less than 25

35) less than 20

There are four paranasal sinuses, each corresponding with the respective bone from
which it takes its name: maxillary, ethmoid, sphenoid, and frontal

Otosclerosis is a hereditary localised

disease of the bone characterised by
alternating phases of bone resorption
and new bone formation. The
mature lamellar bone is removed by
osteoclasis and replaced by woven
bone of greater thickness, cellularity
and vascularity
The primary pathological change occurs in
the bony labyrinth with secondary effects
upon middle ear and inner ear
function. The otosclerotic focus may be
asymptomatic, or if present in the area of
foot plate of stapes it may give rise to
ankylosis of foot plate with resultant
conductive hearing loss or deafness.
Otosclerotic foci may involve other
portions of labyrinth causing sensori
neural hearing loss and vestibular
abnormalities.
Many theories have been proposed to
explain the etiological factors of
otosclerosis. They are:
1. Metabolic
15. Immune disorders
 16. Vascular disease
17. Infection (Measles) currently
18. Accepted
19. Trauma : The petrous bone doesnot have
20. Temporal bone abnormalities
21. (congenital)
Otosclerosis is a condition in which there's abnormal bone growth inside the
ear. It's a fairly common cause of hearing loss in young adults. There are 3 tiny
bones deep inside the ear that vibrate when sound waves enter
More common in woman

What causes anosmia?

 Nasal polyps.
 Common cold.
 Influenza (flu).
 Nasal congestion.
 A deviated septum.
 Sinus infection (sinusitis).
 Hay fever or other allergies
Anosmia is the medical term for a loss of sense of smell

An acoustic neuroma is a type of non-cancerous (benign) brain tumour. It's also
known as a vestibular schwannoma. A benign brain tumour is a growth in the brain
that usually grows slowly over many years and does not spread to other parts of the
body

What three regions is the Pharynx or throat divided into? Nasopharynx,

Oropharynx, Laryngopharynx/ hypopharynx

Glue ear is where the empty middle part of the ear canal fills up with fluid. This
can cause temporary hearing loss. 2 main treatments are temporary hearing aids
or grommets (small tubes implanted in the ear). Occasionally, surgery may be
recommended to remove some glands at the back of the nose (adenoids). This is
known as an adenoidectomy

-
-
- Acute tonsilitis- pain on swallowing/ swallowing problem

1. How many parts has pharynx? 3

2. Symptoms of acute tonsilitis? Pain during swallowing
3. Which is the most common symptom of acute tonsilitis? Swallowing problems
4. What kind of hearing loss do we know? All of the above – acute and chronic
5. What kind of hearing loss do we know? All of the above – conductive, sensory neuro,
mixed
6. How many parts does the ear have? 3
7. What is the best choice for acute tonsilitis? Pharyngeal spray
8. What is the main symptoms of acute otitis media? Ear pain
9. What is the main symptoms of acute otitis media? Hearing loss
10. What change will we find on the tympanic membrane during acute otitis media?
11. All of the above – discharge, perforation, redness
12. Types of sinuses? All of the above – maxillary, frontal, ethmoid, sphenoid
13. Main function of deep and anteriormuscle of neck? Move the head
14. While wound healing regeneration process which materials attract epidermal cells?
Cytokines.
15. How many classifications of neck dissection these are? 4
16. Which level of lymph nodes are removed during radical neck dissection? I-V
17. Muscle of the neck that moves the head is: sternocleidomastoid
18. Sternocleidomastoid muscle is inserted in? mastoid process
19. Which one is a classification of neck dissection? Selective, modified, and radical
20. If there is an orbital wall fracture, which area will also be damaged? Zygomatic
21. Which one are different types of selective neck dissections based on nodal levels
removed?
22. Which technique is the best for cleft palate correction? Furlow palatoplasty
23. Which external tensions affect the skin? Gravity and clothing
24. Which muscle makes you smile? Zygomaticus major
25. What is the name of a bridge of tissue connecting the central and lateral lip elements
of uncomplete cleft? Simonarts band
26. This is a disorder of unknown aetiology, beginning in childhood or adolescence, in
which hemifacial atrophy of the skin subcutaneous fat, muscle, bone and cartilage
progresses for a variable period of time before spontaneously ceasing or burning out 2
or 10 years after beginning. What is the disease? Rombergs
27. Which is not a part of the 3 semispinalis muscles?
28. What kind of grafts include the whole entire epidermis, dermis and subcutaneous
tissue? Composite graft
29. Contraindication of bilateral SOHND is?
 What kind of surgical treatment was described in suhruta samihtas writing?  the
reconstruction of an amputated nose with a pedicled
forehead flap and the reconstruction of the ear with cheek
flaps
30. What’s the type of incisions of snd? Extended
31. Which material is released by injured cells in the wound firstly? Factor 3
thromboplastin
32. What dosent removed in a modified radical neck neck dissection? Lymph nodes from I-
V
33. Which one is not a part of the four strap muscles? Levator scapula
There are four strap muscles:
 thyrohyoid: deep and lateral.
 omohyoid: superficial and lateral.
 sternohyoid: superficial and medial.
 sternothyroid: deep and medial.

34. In which anatomic areas are incisions oriented less for aesthetic reasons and
more with the goal of avoiding scar contractures and subsequent functional
compromise? Neck

In areas of anatomic mobility, such as

the neck or over joints, incisions are oriented less for
aesthetic reasons and more with the goal of avoiding scar
contractures and subsequent functional compromise. In
general, incisions are placed perpendicular to the action of the
joint.

35. How many muscles create facial expressions? 4

36. Which one isn’t the four muscles of facial expression?
Sternocleidomastoid.

Lefort 1- 42%
Lefort 2 – 30.6%
Lefort 3- 27.4%

In childhood vocal cord is 6mm in females and 8mm in

males.
Adult males= 15-19mm
Adult females=17-23 mm

Glottic cancer- 65%

Supraglottic cancer-30%
Subglottic cancer-5%
the term plastic surgery can be found in several medical writings
from the eighteenth and nineteenth centuries, it was John Staige
Davis who established
the name of the specialty with the 1919 publication Plastic
Surgery—Its Principles and Practice.

The procedure uses four triangular flaps, two oral and two

Z plasty-
nasal, with the posteriorly based flaps containing the released
levator muscles. 
The Z-plasty lengthens the soft palate,prevents longitudinal scarring
from a straight-line repair, and produces a secondary pharyngoplasty
effect by narrowing the velopharyngeal port

Complications of surgeries in ent- adenoidectomy, tonsillectomy all opf the above

Larynx has 9 cartilages

Larynx is voice box

axillofacial question on facial deformity lasting 2–10-years:

a. Fibrousdysplasia

b. Parry-Rombergsyndrome

c. Pierre-robinsequence

d. Treacher-collins

What is the major cause of upper airway obstruction in children?

adenoids and tonsils

Pharynx is divided in

nasopharynx, oropharynx an hypopharynx

The most common cause of bacterial infection in the pharynx is: group A 3-hemolytic
streptococcus (GABHS)
Cavity of Larynx is:

cavity from laryngeal inlet above to lower border of cricoid cartilage

Types of acute Tonsillitis are:

acute catarrhal/superficial

Contraindication for Tonsillectomy is:

systematic diseases (diabetes, TB)

indication for Tonsillectomy is:

persistent or recurrent tonsillar hemorrhage

Lymphoid tissue of Waldeyer ring is most immunologically active between:

4 and 10 yrs of age

Which 3 masses of tissue are tonsils?

lingual, pharyngeal and palatine

tonsils

pharynx has 3 parts

pain during swallowing is a symptom of acute tonsillitis

ear has 3+ parts

pharyngeal spray is the best choice for acute tonsilitis

main symptom of acute sinusitis is ear pain

main symptom of acute otitis media is hearing loss

what change will we find on tympanic memb during acute otitis media? Discharge,
perforation and redness

types of sinuses? Maxillar,frontal,ethmoid

aspergillus is the common fungal infection for pts with otitis externa

-  What is the most common infection for tonsilitis?

  Beta haemolytic strep
11. What is the main symptom of acute laryngitis?
 Voice change

10. What kind of symptoms do patient have with acute laryngitis

• Redness of vocal cord, Changed voice , fever

15.  What type of otitis do you know?

 Viral
 Bacterial
 Fungal
16. which kind of tonsil test do you know?
 Viber
 Rinne
 All of the above + SP
17. Which of the following conditions represent an indication for vocal cord
medialisation procedure?
A: unilateral nerve palsy
18. Which of the following group of patients are more susceptible for injury to the apex
of lung during tracheostomy
A: obese patient
19. following condition are more likely to be suspected in patient with recurrent
ulceration of vocal cords?
A: Leucoplakia
20. Following signs can be present due to complication after thyroidectomy?
21. Which of the following conditions usually are asymptomatic and mostly present
during autopsy?
A: laryngocele
22. Which of the following represent the best treatment option for laryngeal
granulomas which reduce glottic space?
A: Microlaryngoscopic resection
23. Which of the following condition are associated with the musicians who
predominantly play on blowing instruments?
A: laryngocele
24. Which of the following drugs can be used to reduce thyroid vascularity before
operation?
A: propranolol
25. What is the most common cause of secondary hyperparathyroidism?

A: chronic renal failure

65-year-old smoker was identified with 9 cm pulmonary nodule in the base of the right lung.
The biopsy sample was obtained identifying a lesion as squamous cell lung cancer. Which of
the following TNM criteria can be established from given information?
A: T4
Which muscles are necessary to raised arm above the shoulder? A: supraspinatus, deltoid, and
serratus anterior

types of chronic tonsillitis include:

A: Chronic Paranchematous

typical of chronic tonsillitis is:

A: more than 3-4

types of acute tonsillitis:

A: acute membranous

Pharynx is divided in

  Nasopharynx, oropharynx, and hypopharynx

1. Indication of tonsillectomy is
o   Persistent or recurrent tonsillar haemorrhage
2. Which 3 masses of tissue are tonsils?
o   Lingual, pharyngeal, and palatine
3. what is the major cause of upper air obstruction in children?
o   Adenoids and tonsils
4. Cavity larynx is:

  Cavity from laryngeal inlet above to lower border of cricoid cartilage

Larynx is a cartilaginous structure

1. A 50-year-old male patient complained of right earache of 2 days

duration. The pain was especially severe on chewing food and during
speech. There was also marked edema of the right side of the face. On
examination, pressure on the tragus was painful; and there was red
swelling of external meatus walls. Rinne test was positive in the right
ear. The patient gave a history of 2 previous similar attacks in the same
ear during the last six months but less severe. What is approximately
diagnose?

1. Diffuse otitis externa

2. A 10 year old child complained of a right mucopurulent otorrhea for the

last 2 years. He suddenly became feverish and this was associated with
diminution of the ear discharge. There was also tenderness on pressure
behind the auricle. The retro auricular sulcus was preserved. There was
no retro auricular fluctuation. What is approximately diagnose?
 1. Chronic otitis media and mastoiditis

3. A 9-year-old child has been complaining of right continuous offensive ear

discharge for the last 3 years. Discharge is foul smelling. By otoscopy
mucopurulent discharge and marginal perforation of tympanic membrane.
What is approximately diagnose?

2. Atticoantral chronic otitis media

4. A 6-year-old child developed severe pain in both ears together with a

rise of temperature (39 C) following an attack of common cold. By
Otoscopy tympanic membrane in both sides are redness. Rhine test is

2. Acute otitis media

5. A 3 year old boy presented to the ENT specialist because of an inability

to

close the right eye and deviation of the angle of the mouth to the left
side upon crying of 2 days duration. His mother reported that he had
severe pain in the right ear 5 days prior to his present condition.

3. Chronic otitis media and facial nerve palsy 4.

6. A 30 year old female complained of bilateral hearing loss more on the right
side following the delivery of her first child; hearing loss was marked in quiet
places but hearing improved in a noisy environment. Both tympanic
membranes showed a normal appearance. Rinne tuning fork test was negative.
What is approximately diagnose?

2. Otosclerosis

7. A 28 year old male has been complaining of hearing loss in the left ear for
the last 6 years. The hearing loss was progressive in nature and accompanied
by tinnitus. During the last 6 months there was swaying during walking to the
left side and an inability to close the left eye with deviation of the angle of the
mouth to the right side. Otologic examination showed no abnormality. What is
approximately diagnose?

A]Acoustic neuroma
8. A 35-year-old female suddenly complained of an attack of bleeding from her
right ear. An ENT specialist packed the ear and after removal of the pack found
an aural polyp. The patient also complained of pulsatile tinnitus in the right ear
of 2 years duration. What additional examination method need for diagnosis?

2. Biopsy

3. Temporal bone CT scan

9. After a car accident a young male complained of inability to close the right
eye

and deviation of the angle of the mouth to the left side together with dribbling
of saliva from the right angle of the mouth. There was also a right hearing loss
and a blood clot was found in the right external auditory canal. What
additional examination method need for diagnosis?

2. Pure Tone Audiometry 3. Temporal bone CT scan

10. A 9 year old child has been complaining of right continuous offensive ear
discharge for the last 3 years. Discharge is foul smelling. By otoscopy
mucopurulent discharge and marginal perforation of tympanic membrane.
What is method of treatment?

1. Antibiotic therapy

3. Radical mastoidectomy

11. Patient 34-year-old man. Complains of mild, periodic pain in the left ear,
hearing loss. Start 1 mouth ago from periodic itching and hearing was normal.
Used ear drops with antibiotic during 7 days. After treatment felt worse.
Started hearing improvement and pain. Debris from ear is coloured. What is
approximate diagnosis?

1. Otitis media with effusion

12. Patient 30 years old women, presents with severe right ear ache, which
started yesterday morning, normal hearing, temperature 37.8-38.0. Some days
ago, patient had ear itching and used car keys. Objective signs: Tragus
palpation is painful. Otoscope pictures: swelling and hyperaemia of external
meatus walls. What is approximate diagnosis?
1. Acute otitis externa

13. Patient 25 years old present with ear pain, hearing loss, tinnitus,
temperature 38. This complains start 3 days ago. Before patient had purulent
discharge from nose. Otoscopic signs: Hyperaemia of eardrum. What is
approximate diagnosis?

2. Acute otitis media

14. Patient 60 years old have hearing loss during last two months in left side.
Tympanic membrane is yellow, corn of light absent, by Weber test sound is
lateralized on left ear. Patient have some difficulties with breathing from left

part of nose. Seldom has bleeding left side of nose. What additional
examination method is necessary?

Endoscopy of nose

15) Patient 70 years old come with severity pain on left ear,
hearing loss, facial nerve peripheral palsy on same side, t-38°C. By
otoscopy external auditory canal is normal, tympanic membrane is
redness and bulging. What is right treatment method?

4. Antibiotics, steroids and myringotomy

16) Patient 2 years old boy. Three days ago, got nose trauma at
home during play. Patient presents with fever 38.5, bilateral nasal
obstruction and nasal pain. Skin over the nose red and swollen.
Fluctuation is in this swelling. Submandibular lymph nodes
enlarged and painful. What is approximate diagnosis

4. Sinusitis

17) Patient 65 years old man presents with nasal obstruction

mucoid discharge, postnasal discharge. This signs patient has
more than 1 year after upper respiratory infection. By anterior
rhinoscopy: Nasal mucosa and inferior turbinates are red and
swollen. What is approximate diagnosis?
 3. Chronic simple rhinitis

18. Patient 70 years old woman presents with nasal obstruction, anosmia,
collect crusts in nasal cavity and epistaxis after removing the crusts. This signs
had long time. Clinical features: foul small from nose, wide nasal chambers, lot
of crusts on the mucosa. What is approximate diagnosis?

2. Atrophic rhinitis

19.Patient 55 years old woman present with watery rhinorrhoea from left
side of nose. Endoscopic surgery was performed two weeks ago with a
diagnosis hemi sinusitis. Discharge started after removing of nasal
tampon. Breathing is normal. What additional examination we need for
conform the diagnosis?

4. Posterior rhinoscopy

20.Patient 28 years old woman present with nasal obstruction during about
1 year. The patient began to use decongestants and in the beginning she
had a result. Last time this nasal drops had not result. By anterior
rhinoscopy : inferior turbinates are hypertrophied . What is approximate
diagnosis?

2. Hypertrophic rhinitis