Facial nerve pointers

Q) The most consistent anatomical landmark of the facial nerve is the
A. Anterior border of the posterior belly of the digastric muscle.
B. Posterior border of the posterior belly of the digastric muscle.
C. Superior border of the posterior belly of the digastric muscle.
D. Inferior border of the posterior belly of the digastric muscle

Ans c

Facial nerve identification:

  •  Posterior belly of the digastric
  • Mastoid tip
  • Tragal pointer
  • Tympanomastoid suture line are key anatomical landmarks.
  • The nerve lies 2 to 4 mm inferior to the tympanomastoid suture line. The most consistent intraoperative landmark is the superior aspect of the posterior belly
    of the digastric.

Inoperability criteria of ca oral cavity

Q) Inoperability criteria in ca oral cavity is  ( MCH Onco 2020) 

a) Pterygoid plate involvement

b) Tooth socket involvement

c) Cheek involvement


Ans a) Pterygoid

T4b in oral cancer is Very advanced local disease.

Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery, skull base and/or encases the internal carotid artery.

Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify as T4

Tumour involvement of the following structures are considered technically unresectable

Erosion of pterygoid plates, sphenoid bone, widening of foramen ovale

Extension to superior nasopharynx or deep extension into Eustachian tube or lateral nasopharyngeal wall

Encasement of internal carotid artery, defined radiologically as tumor surrounding the carotids> 270 degrees.

Involvement of mediastinal structures

Involvement of prevertebral fascia or cervical vertebrae

Ref is here 


Adenoid Cystic Tumors

Q) All are true for adenoid cystic tumor of the hard palate except

a) Perineural invasion

b) Lung metastasis

c) Lymph node metastasis

d) Increased risk of local recurrence

Ans c 

Adenoid cystic carcinoma is a rare tumor arising from the minor salivary glands;, the palate being the commonest site.

Distant metastasis and perineural invasion are common in adenoid cystic carcinoma.

The lesion is uncapsulated and infiltrative; invasion of underlying bone is common.

Incidence of cervical metastasis is low.

Distant metastasis occurs through blood stream to lung and bones. Direct extension of lesion of the base of skull has been reported as a cause of death.

Ref - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633292/

2nd primary tumors

Q) In buccal mucosa cancer after surgery and CRT, after 2 year patient developed cancer at base of tongue with N3 nodes positive. Best line of management

A Palliative RT
c. Rehabilitation
D.  Surgery followed CTRT

There are two parts to this questions 

a) Second Primary tumor (SPM)

b) Management of Base of tongue tumors with N3

Both are discussed here ---


Lymphoma Head and NECk

Q) Lymphoma of the head and neck - False statement is 
A. Hodgkin’s disease is common in the oropharynx.
B. Most are of the B-cell type .
C. FNAC of neck lymph nodes is now mandatory.
D. For disseminated non-Hodgkin’s lymphoma, systemic chemotherapy is preferred.