Reconstruction (4Q-6%)

Part I: CLP
1

The five soft plate muscles arise from

a Hard palate
b Palatal bone
c Base of skull
d Palatopharyngeal arch

Cleft Lip C means

a Collumellar base flap

Millard C flap in correction of cleft lip is

a Rotation flap of lateral lip
b Rotation flap of medial lip
c A divided rotation to increase columella and nasal floor +++
d ?

4
5

Millard technigue for cleft lip C flap is for balance of collemela and nasal base
Millard indications , wide clefts , bilateral

Tenisson incision:
a Straight
b Triangular
c Parallel to philtrum
d Wave shaped

Advantages of millard rotational flap in clp

e repair lip and nose together
f
less muscle manipulation

The skin of the prolabium is used for

a Collumela lengthening
b Creation of vermillion
c Lining the labial mucosa

Pt with wide cleft lip and palate lip adhesion or nasoalveolar molding planned
a Few weeks after birth
b First to third month
c Third to sixth
d 69

10 The main concern of alveolar cleft repair:??

a The growth of the graft
b The development of the maxilla
11 The main complication in cleft palate repair is:
c Eruption delay
d Retardation of maxillary growth
12 In adolocent Philtrum is:
a Above commisure (shorter than commisure hight)
b Below commisure
c In the same line --Best bone graft in reconstruction of alveolus cleft is:

Part II: Flaps and Grafts

13 Best site for harvesting calvarial bone graft
a Parietal bone
b Occipatal bone
c Temporal bone
d Frontal bone
14 With age the cranium becomes
a Thick and dense
b Thin and light
c Thick and heavy
d ?
15 A 54 year old man has undergone an anterior en-bloc resection of the mandible for treating
as part of cancer therapy. The surgeon wishes to use the clavicle based on the SCM to
reconstruct the mandibular defect. Select the statement which is true.
a The graft cannot be segmented to fit the morphology
b The graft is good to place dental implants
c Gives good morphological substitution for defect
d It is the best of reconstructive options available
16 A 58 year old male presents with an ulcer that is 3x2 cm in size with no palpable lymph
nodes. Contrast enhanced CT is done and reveals no cortical perforation in the lesion and no
lymphatic involvement. A SND(i-iii) is planned for his treatment. The surgeon wishes to
reconstruct the defect. His best option is
a PMMC
b Temporalis myofascial flap
c Full thickness skin graft
d Split thickness skin graft
17 Cancer removal from Floor of Mouth best reconstructed by:
a pectoralis Major
b Temporalis
18 Posterior iliac graft nerve injured is
a Lateral cutaneous
b Lateral femoral
c Superior cuneal
19 iliac graft is:
a cancellous bone
b cortico-cancellous bone
20 Clavicle/mandible/palate bone growth by:
a intramembranous ossify
b endochondral ossify
c subperiosteal ossify
21 patient had resection for SCC and radiotherapy Reconstruction options:
a The best answer was free fibula flap
22 Disadvantage of buccal advancement flap:
b decrease the vestibular depth
23

(latissmus dorsi free vascularized flap) bluish graft congested(blue i.e venouse
congestion)after one day The best evaluating tools is:
a doppler velocitymeter
b laser Doppler flowmeter
c Laser flow meter

24 lesion with 80% of the upper lip, reconstruction is done by:

a
b
c
d

Bernard Flap
Releasing incision of naso-alar fold and advisement of cheek flaps bilaterally
local naso-labia flap
Radial forearm

25 Best graft is:

a Iliac
b Fibula
The four principles of pedicled flap is all except:
The base is wider than the top
The length is not longer than the width
Contains a blood vessel

Part III: Craniofacial Reconstruction

26 A patient has midface deformity with deficiency in the malar and zygomatic regions. How
would you correct her condition.
a High level lefort 1
b Quadrangular lefort 2
c Lefort 2
d Lefort 3
27 A 7 year old boy has come to your maxillofacial clinic with a history of congenital facial
deformity. His OMENS score is 8. What systemic examination will you send the boy to next.
a CNS, Skeletal, CVS
b CVS, Pulmonary , skeletal
c CVS, CNS, Skeletal
d CNS, CVS, Pulmonary
28 Syndrome question(Question incomplete)
a Crhon syndrome
b Carpenter Syndrom
c Crouson
d Angioneurmatic Edema
they ask about crouson syndrome or any other syndrome features so study them
29 Dysesthesia is
a Unpleasant sensation due to normal stimuli
b Increased pain sensation to normal stimuli
c Increased sensation to painful stimuli
d Anaesthesia for a prolonged period of time
30 Cleidocranial Dysostoses

Part IV: MicroNeuroSurgery

31 After surgical procedure on lower left first molar, the parasthesia continued in mandible, the
sensation will come back first to:
a Wisdom tooth area
b First molar area
c Anterior teeth area

APPENDIX Nerve Terminology Review* Petersons

2nd Ed. P.837
(Very Important, at least one Question will come)
allodynia: Pain due to a stimulus that does not normally provoke pain.
analgesia: Absence of pain in the presence of stimulation that would normally
be painful.
anesthesia: Absence of any sensation in the presence of stimulation that
would normally be painful or nonpainful.
anesthesia dolorosa: Pain in an area or region that is anesthetic.
atypical neuralgia: A pain syndrome that is not typical of classic
nontraumatic trigeminal neuralgia.
axonotmesis (Seddon) or second- sthrough fourth-degree injuries
(Sunderland): Nerve injury characterized by axonal injury with subsequent
degeneration and regeneration.
causalgia: Burning pain, allodynia, and hyperpathia after a partial injury of a
nerve.
central pain: Pain associated with a primary central nervous system lesion
(spinal cord or brain trauma, vascular lesions, tumors).
chemoreceptor: A peripheral nerve receptor that is responsive to chemicals,
including catecholamines.
deafferentation pain: Pain occurring in a region of partial or complete
traumatic nerve injury in which there is interruption of afferent impulses by
destruction of the afferent pathway or other mechanism.
dysesthesia: An abnormal sensation, either spontaneous or evoked, that is
unpleasant. All dysesthesias are a type of paresthesia but not all paresthesias
are dysesthesias.
endoneurium: A connective tissue sheath surrounding individual nerve fibers
and their Schwann cells.
epineurium: A loose connective tissue sheath that encases the entire nerve
trunk.
fascicle: A bundle of nerve fibers encased by the perineurium.
hyperalgesia: An increased response to a stimulus that is normally painful.
hyperesthesia: An increased sensitivity to stimulation, excluding the special
senses (ie, seeing, hearing, taste, and smell).
hyperpathia: A painful syndrome characterized by increased reaction to a
stimulus, especially a repetitive stimulus. The threshold is increased as well.
hypoalgesia: Diminished pain in response to a normally painful stimulus.
hypoesthesia: Decreased sensitivity to stimulation, excluding the special
senses (ie, seeing, hearing, taste, and smell).
mechanoreceptor: A peripheral nerve receptor preferentially activated by
physical deformation from pressure nd associated with large sensory axons.
mesoneurium: A connective tissue sheath, analogous to the mesentery of the
intestine, that suspends the nerve trunk within soft tissue.
monofascicular pattern: Characteristic cross-section of a nerve containing
one large fascicle.
neuralgia: Pain in the distribution of a nerve or nerves.
neurapraxia (Seddon) or first-degree injury (Sunderland): Nerve injury
characterized by a conduction block, ith rapid and virtually complete return of
sensation or function and no axonal degeneration.
neuritis: A special case of neuropathy now reserved for inflammatory
processes affecting nerves.
neurolysis: The surgical separation of adhesions from an injured peripheral
nerve.
neuroma: An anatomically disorganized mass of collagen and nerve fascicles,
and a functionally abnormal egion of a peripheral nerve resulting from a failed
regeneration following injury.

neuropathy: A disturbance of function or a pathologic change in a nerve.

neurotization: Axonal invasion of the distal nerve trunk.
neurotmesis (Seddon) or fifth-degree injury (Sunderland): Nerve injury
characterized by severe disruption of the connective tissue components of the
nerve trunk, with compromised sensory and functional recovery. Third-degree
injury: Characterized by axonal damage and a breach of the endoneurial
sheath, resulting in intrafascicular disorganization. The perineurium and
epineurium remain intact. The mechanism is typically traction or compression.
Fourth-degree injury: Characterized by disruption of the axon, endoneurium,
and perineurium, resulting in severe fascicular disorganization. The epineurium
remains intact. Possible mechanisms include traction, compression, injection
injury, and chemical injury. Fifth-degree injury: Characterized by complete
disruption of the nerve trunk with considerable tissue loss. Possible
mechanisms include laceration, avulsion, and chemical injury.
nociceptor: A receptor preferentially sensitive to a noxious stimulus or to a
stimulus that would become noxious if prolonged.
oligofascicular pattern: Characteristic cross-section of a nerve containing 2
to 10 rather large fascicles.
paresthesia: An abnormal sensation, either spontaneous or evoked, that is
not unpleasant. A global term used to encompass all types of nerve injuries.
perineurium: A thick connective tissue sheath surrounding fascicles.
polyfascicular pattern: Characteristic cross-section of a nerve containing >
10 fascicles of different sizes, with a prevalence of small fascicles.
protopathia: The inability to distinguish between two different modes of
sensation, such as a painful and nonpainful pinprick.
sympathetically mediated pain: A general term that refers to a family of
related disorders including causalgia, reflex sympathetic dystrophy, minor
causalgia, Sudecks atrophy, and postherpetic neuralgia, which may be
sympathetically maintained.
synesthesia: A sensation felt in one part of the body when another part is
stimulated.
wallerian degeneration: The distal degeneration of the ax