Head and Neck Onco 18-40

Onco Head and NEck 1-5



Q21) In Nasopharyngeal carcinoma, Petrosphenoidal syndrome involves which cranial nerves ( Aiims onco 2020) ?

a) VII- X

b) I-III

c) II-Vi

d) Viii- X

Ans 21 ) c II - VI

 Petrosphenoidal syndrome of Jacob – includes unilateral trigeminal neuralgia ( v) , unilateral ptosis(III)  complete ophthalmoplegia ( III, IV, VI)  and amaurosis – ( CN II)  by IC extension

Q22) A patient is diagnosed with Pleomorphic Adenoma of Submandibular Gland all of the nerve can be damaged during surgery except?

a) Marginal Mandibular Nerve

b) Inferior Alveolar Nerve

c) Hypoglossal Nerve

d) Lingual Nerve

Ans 22) b Inferior Alveolar nerve

Complications of submandibular gland excision
● haematoma;
● wound infection;
● marginal mandibular nerve injury;
● lingual nerve injury;
● hypoglossal nerve injury;
● transection of the nerve to the mylohyoid muscle producing submental skin anaesthesia.

Q23) Prophylactic lymph node dissection is done in
a. Carcinoma tongue
b. Carcinoma buccal mucosa
c. Carcinoma gingivo buccal sulcus
d. Carcinoma lip

Ans 23) a

Oral tongue SCC is increasingly regarded as a biologically different entity compared with cancer affecting other oral sites, with it  being more aggressive and generally associated with a higher rate of metastasis.

The high propensity for subclinical occult nodal metastasis associated with early tongue cancer has been well studied. The incidence of subclinical occult nodal metastasis on initial presentation in patients with cT1N0 or cT2N0 OTSCC who underwent END ranged from 8.2% to 46.3%, with a mean incidence of 25.9%

See this Ref 

For all  oral cavity 

Management of the neck for oral cavity cancer depends on the presence or risk of regional metastases;

early-stage oral cavity SCC, when the DOI is larger than 3 mm, an elective neck dissection

The extent of neck dissection can be either a selective supraomohyoid neck dissection (levels I–III) for a clinically N0 neck or up to a modified RND (sparing all muscular and neurovascular structures if possible) for cN+ disease.

If the primary tumor crosses the midline, bilateral neck treatment should be performed.

Sabiston 21 page 788

Q 24) Not a premalignant condition of oral cavity
a) Chronic candida infection
b) Oral submucosal fibrosis
c) Iron deficiency conditions
d) Zinc deficiency conditions

Ans  24

Zinc deficiency

Sideropenic dysphagia (Plummer– Vinson and Paterson–Kelly syndromes)
There is a well-known relationship between sideropenia (iron deficiency in the absence of anaemia) and the development of oral cancer.

1st two choices are also pre malignant

Ref bailey 763

Q25 ) 67 year old male with edentulous mandible  with oral mucosal cancer with infiltration to alveolus. What is the best management

a) Radiotherapy

b) Observe

c) Marginal Mandibulectomy

d) Segmental mandibulectomy

Ans 25 c

Rim resection or ‘marginal mandibulectomy’ involves removing a partial thickness of
mandible such that continuity of the lower border remains.

Segmental resection involves removing the full height of the invaded section of the mandible such that there is loss of continuity of the lower border

Here there is infiltration and no definite invasion, so answer is c 

Bailey 821

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