Oral Cavity & Salivary glands MCQs

The premalignant lesions of oral cavity are leukoplakia, erythroplakia, oral submucous fibrosis, lichen planus, chronic hyperplastic candidiasis. Erythroplakia is a red patch or plaque on the oral mucosal surface. Aphthous ulcers are recurrent and superficial ulcers usually involving movable mucosa of oral cavity. Fordyce Spots - Aberrant sebaceous glands present under the buccal or labial mucosa and shine through it as yellowish or yellow-brown spots. They are considered normal. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 265, 257, 255.

Explanation: Multiple lymph node involvement is an indication for adjuvant radiotherapy, not single lymph node involvement. Indications of Adjuvant radiotherapy: Advanced stage T3 or T4. (Option D) Presence of lymphovascular invasion Presence of Perineural invasion Positive surgical margins (Option B) Multiple lymph node involvement Extra capsular nodal extension. (Option C)

Explanation: The incidence of a neck node with unknown primary origin in head and neck region is about 3%. Carcinoma of unknown primary is defined as histological confirmation for at least one of the cervical lymph nodes to be metastatic , in the absence of a primary tumour, which is confirmed by thorough physical, endoscopic and radiological examination. Theories of occurrence include the following: The squamous element of brachial remnants in lymph nodes turning malignant. (Option A) The subclinical primary with nodal metastasis, either due to the faster growth rate of the nodal metastasis or the sloughing of necrotic carcinoma. (Option B) The primary regressing due to immune hyperactivity. (Option C) The small hidden primary in tonsil/base of tongue crypts with aggressive nodal metastasis.

Ankyloglossia(Tongue Tie) Causes speech defects if tongue cannot be protruded beyond the lower incisors. A mobile tongue is important to maintain orodental hygiene-to clean the debris and prevent formation of dental plaques. Treatment of any significant tongue tie is transverse release and vertical closure. Thin mucosal folds can be simply incised. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Pg. no. 257

Pleomorphic adenoma is the most common benign salivary gland tumor, also known as a mixed tumor . It can occur in both major and minor salivary glands. Pleomorphic adenoma is composed of a mixture of different cell types, including epithelial and myoepithelial cells, and it is encapsulated. A. Adenocarcinoma: Adenocarcinoma is a malignant tumor derived from glandular epithelial tissue. It is less common than pleomorphic adenoma and represents a cancerous (malignant) tumor. C. Mucoepidermoid tumor: Mucoepidermoid tumor is a common malignant salivary gland tumor that includes both mucus-secreting and squamous cells. It is less common than pleomorphic adenoma. D. Basal cell carcinoma: Basal cell carcinoma is a type of skin cancer that arises from basal cells in the epidermis.

Explanation: The fibular flap is an example of a free flap, which means that in this type of flaps the donor site and recipient sites are distant from each other and the flap carries it's blood vessels along with it. Fibular flap is based on peroneal vessels. The fibular flap provides good bone stock and it's robust peroneal supply ensures that multiple osteotomies can be performed. The flexor hallucis longus muscle and skin can be harvested along with the flap to provide soft tissue reconstruction along with the bone. Up to 25 cm of bone can be harvested. Key takeaway: The fibular flap is an example of free flap which means that in this type of flaps the donor site and recipient sites are distant from each other and the flap carries it's blood vessels along with it. Fibular flap is based on peroneal vessels.

Answer- A. Staphylococcus Aureus MC organism is Staphylococcus Aureus >> streptococcus viridans >> pneumococcus. Acute bacterial parotitis: is most often caused by a bacterial infection of Staphylococcus aureus but may be caused by any commensal bacteria. Usually ascending infection Staphylococcus aureus Ref- Manipal Manual of Surgery 5th edition

Potential for malignant change The potential risk for malignant transformation includes: Severity/grade of dysplasia Increases with increasing age of the patient Increases with increasing size of the lesion May be higher in smokers (although contradictory evidence exists to suggest non-smokers are at higher risk) Increases with alcohol consumption Depends on the anatomical site of the premalignant lesion Is particularly high for premalignant lesions on the lateral/ventral surface of the tongue, particularly in younger women, even in the absence of associated risk factors. Reference: Love & Bailey short practice of surgery, chapter: 48, Edition: 27 th , Pg: 762