DNB Plastic Surgery MCQs 

Questions 1-5 (free)            Questions 6-10           Questions 11-14                 Burns (6 questions)

Q15 )  Neurovascular  preserving flap in lip
A. Abbe flap
B. Webster flap
C. Karapandzic flap
D. Johansen flap

Q16) Submucosal Cleft soft palate : True is 
A. Velopharyngeal insufficiency
B. Normal feeding
C. Normal Uvula
D. Cleft of hard palate remains attached to the vomer and nasal septum

Answer 15) 

c, Karapandzic flap

Abbe flap-  flap based on the labial branches of the facial artery was popularized by Dr Robert Abbe. They are full thickness rotation flap

Karapandzic flap is musculocutaneous rotation advancement flap that uses portion of the lip for reconstruction with preservation of neurovascular supply

The Karapandzic flap is suitable for defects that take 1/3 to 2/3 of the length of the lower lip.  It causes microstomia.

With bigger defects, Bernard-Burrow-Webster flap is a good option for reconstruction.

Webster flap -  not a neurovascular defect mostly used for lower lip defects greater than 80% of the lip; however, resulting scars in the chin area (Schuchardt flap, a half-circle scar

Johanson staircase flap technique, which is used to reconstruct lower lip defects of up to two thirds of the lip, results in relatively inconspicuous scarring and prevents trapdoor deformity

16) a

Submucus cleft palate

Oral mucosal lining is intact but the muscles deep to the lining are not aligned correctly. It  may lead to the same difficulties with speech and feeding as visible clefts 

It can present with

1.Bifid uvula with two separate tags (fairly common and not always indicative of a submucous cleft palate)

2. Hypoplastic (short and stubby) uvula

3. Zona pellucida (a bluish area in the middle of the velum) due to a thin and transparent velum

4. Inverted V-shape of velum during phonation due to muscles inserting vertically into the hard palate versus horizontally into each other

Velopharyngeal insufficiency (VPI) is a failure of the body's ability to temporarily close the communication between the nasal cavity and the mouth, because of an anatomic dysfunction of the soft palate or of the lateral or posterior wall of the pharynx.

Velum does no close
Velum means soft  palate

The effect of such a dysfunction leads to functional problems with speech (hypernasality), eating (chewing and swallowing), and breathing.[1] This gap can be treated surgically, although the choice of operational technique is still controversial.

Cleft palate can also be complete or incomplete. The goals of
palatal repair are the development of normal speech and prevention of regurgitation of food into the nose. Normal speech requires velopharyngeal competence to close the oral cavity off from the nasal cavity to produce pressure consonants. This requires static physical separation of the two cavities in the region of the hard palate and dynamic closure of the soft palate against the posteriorpharyngeal wall with a functioning levator veli palatini muscle. In
a cleft palate, the levator veli palatini muscle fbers are oriented abnormally along the cleft. Thus, all modern techniques of cleft palate repair involve repair of the nasal lining and oral mucosa and reorientation and repair of the levator veli palatini muscle.
The primary measure of outcome of cleft palate repair is normal speech.