When, Why and Where in Oral and Maxillofacial Surgery

WHEN, WHY AND WHERE
IN ORAL AND
MAXILLOFACIAL SURGERY
WHEN, WHY AND WHERE
IN ORAL AND
MAXILLOFACIAL SURGERY
PREP MANUAL FOR

UNDERGRADUATES AND POSTGRADUATES
PART III
111 GOLD COINS

AND
1651 QUESTIONS WITH ANSWERS
KC Gupta MDS
Professor and Head
Department of Oral and Maxillofacial Surgery
Modern Dental College and Research Center
Indore, Madhya Pradesh, India
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When, Why and Where in Oral and Maxillofacial Surgery: Part III
First Edition: 2014
ISBN: 978-93-5090-998-0
Printed at
Dedicated to
My parents
Preface
A good teacher is the one who creates the interest in his subject.
Round the year, students read the textbooks very thoroughly. At
the time of examination, there is little time for revision and also it
is difficult to remember all the points.
In this book, I have tried to highlight the important points from
the examination point of view so that students can revise all the
topics in the short span of time.
Lastly, Gold Coins may help students from academic as well as
clinical points of view.
KC Gupta
Acknowledgments
I am deeply grateful to all my postgraduate students for their

untimely support and suggestions. I am also thankful to my family
membersmy wife Sadhana, my daughter Jeenal and my son
Kunal for their support and encouragement. I am also thankful to
Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing
Director), Mr Tarun Duneja (Director-Publishing), Mr KK Raman
(Production Manager), Mr Sunil Kumar Dogra (Production Executive),
Mr Neelambar Pant (Production Coordinator), Mr Akhilesh Kumar
Dubey, Mr Gyanendra Kumar (Proofreaders), Mrs Yashu Kapoor,
Mr Inder Jeet (Typesetters), and staff of M/s Jaypee Brothers Medical
Publishers (P) Ltd, New Delhi, India, for showing personal interest
and trying to the level best to bring the book in present form.
Contents
1. Gold Coins in the Form of Key Points 1
2. Basic Science 11
3. Basic Oral Surgery 36
4. Local Anesthesia 58
5. Exodontia 80
6. Impaction 96
7. Odontogenic Infection 111
8. Disease of Paranasal Sinuses 132
(Disease of Maxillary Sinus)
9. Salivary Gland Disorders 141
10. Nerve Disorders 154
11. Temporomandibular Joint Disorders 164
12. Cysts of the Jaws and Oral Cavity 178
13. Tumors 190
14. General Maxillofacial Trauma 202
15. Preprosthetic Surgery 248
16. Precancerous Lesion/Condition and Oral Cancer 254
17. Cleft Lip/Palate, Dental Implants and 265
Distraction Osteogenesis
18. Orthognathic Surgery 278
19. General Anesthesia 284
20. Miscellaneous 299
Gold Coins in the chapter
Form of Key Points 1

1. The LOGIC in reference of radiograph:
The radiograph should be read as follows:
LLocalization
OObservation
GGeneral consideration
IInterpretation
CClinical consideration.
2. Luxation is the best policy for extraction of tooth to avoid
fracture of tooth and to have atraumatic extraction.
3. Patient position for mandibular teethocclusal plane should
be parallel to the floor and for maxillary teeth, occlusal plane
should be 45 to the floor.
4. In case of routine extraction; if there is no pathology-related
and oral hygiene is moderate to fair or periodontium is healthy,
then no antibiotic therapy is required postoperatively.
5. After any tooth extraction, socket should be compressed with
finger pressure to recontour the expanded socket and to
control bleeding.
6. Three basic principles of elevator and three basic steps in tooth
extraction can be correlated in the following way:
a. Wedge principleto luxate the tooth
b. Lever and fulcrumto elevate the tooth
c. Wheel and Axle principleto deliver the tooth from socket.
7. Elevator should be applied on cemento-enamel junction (CEJ)
in predetermined direction with finger guard. Never use the
adjacent tooth as fulcrum.
2 When, Why and Where in Oral and Maxillofacial Surgery
8. Perfect suturing can increase 40% success rate and surgeon

skill. In 99% cases, interrupted suturing is indicated or advised
and is advantageous. Suturing avoids food lodgment, delay
healing and infection.
9. Collection of anything, e.g. pus, blood, saliva may cause
infection; therefore, dependent drainage should always be
provided.
10. There is no hard and fast rule that the impacted tooth should
be removed with dental elevator; sometimes tooth extraction
can be done with the help of extraction forceps also.
11. Irrigation of any wound or cavity as local careLast irrigation
with H2O2 should be avoided, otherwise it may cause periapical
emphysema due to release of nascent O2 which results of
increase in pressure in cavity and the patient may complain of
severe pain. Thus, last irrigation should be either with normal
saline or betadine.
12. In suppurative conditions, whenever possible, avoid suturing.
13. If the patient is diabetic and, in emergency, if fluid replacement
is required in case of hypoglycemic shock, then IV DNS is
advisable. Best treatment for hypoglycemic unconscious
patient is IV 50% Dextrose in water.
14. Radiation therapy should start after 2-3 weeks of tooth
extraction. And if the patient is on radiation therapy, extraction
should be avoided for at least 3 months.
15. In the management of dry socket, avoid unduly curettage or
antibiotic therapy.
16. If an abscess is present and is treated with antibiotic alone and
without I and D (where required), it may cause formation of
antibioma.
17. Basic principle: Before closure of any surgical wound, hemo
stasis should be achieved.
18. Any intraoral dressing should be changed maximum within 72
hours, otherwise it may act as a source of infection, delayed
healing or may act as foreign body.
19. Initially, antibiotic therapy should be prescribed for minimum
three days (unless the patient is allergic); frequent changes may
Gold Coins in the Form of Key Points 3
cause Antibioma. The strength of antibiotic therapy depends

upon severity and age of the patient. The dose should be
repeated after definite intervals.
20. The golden hour of the trauma refers to the period of time
which is exactly one hour after the trauma is sustained.
21. The most frequent cause of airway obstruction in an
unconscious patient is the Tongue.
22. The ABCD of basic life support (BLS) is:
A Airway
B Breathing
C Circulation
D Defibrillation/Drug therapy/Definite treatment.
23. A victim, whose heart and breathing have stopped, has the
best chance for survival if the emergency medical services
(EMS) are activated and CPR is given within 4 minutes.
24. The three major signs of cardiac arrest are:
a. No response
b. No adequate breathing
c. No signs of circulation.
25. In case of neck injury, airway can be established by three basic
maneuvers are:
a. Head tilt
b. Chin lift
c. Jaw thrust.
26. No surgical intervention should be done in acute conditions;
otherwise infection may spread to deep fascial spaces resulting
in life-threatening conditions, e.g. Ludwigs angina, cavernous
sinus thrombosis.
27. The cause of uncontrolled bleeding at the scalp region is
because of its rich blood supply and also the vessels are bound
firmly in the dense connective tissue, making it difficult to
control the vessel.
28. Avoid hot fomentation in acute conditions or infection;
otherwise it may cause spread of infection due to vasodilatation.
29. Hot and cold fomentation should be as follows:
Immediately after surgery or first dayCOLD fomentation
Second dayNo fomentation

Third dayHot fomentation (if no infection).
30. Symphysis fracture is best diagnosed in occlusal view;
sometimes unable to be diagnosed in OPG.
31. If a patient has a head injury, the most important thing to note
is patients ability to open his/her eyes.
32. More than 50% of mandible fractures are multiple. Associated
injuries are present in 43% of the patients. 11% of these
patients suffer from cervical spine injuries.
33. In case of maxillofacial injury, if the patient is unable to
voluntarily control the tongue, then at the emergency sight,
Towel Clipping of tongue avoids the tongue fall.
34. In gross comminuted fracture, if the patient is in shock, then
immediately start with Ringers Lactate as its high osmotic
value maintains the fluid in vascular compartment.
35. The safest initial approach to maintain patent airway in
emergency maxillofacial trauma is Head Tilt, Chin Lift
position.
36. Middle third fracture generally does not undergo any
displacement.
37. Root Canal Treatment is contraindicated in fascial space
infection (acute or odontogenic condition).
38. Injection Voveran should always be given IM (never IV).
39. In case of Maxillofacial trauma or jaw fracture, during primary
care, the goal should be to save the patients life instead of
achieving normal occlusion.
Temporary immobilization can be done:
a. To reduce the pain
b. To control bleeding from the fracture site
c. To prevent further displacement of the fractured fragment.
40. 90% cases of condylar or subcondylar fracture can be treated
by closed method (use of surgical elastic or ligature wiring).
41. In pregnant women, 2nd trimester is the safest for extraction;
reason being it can lead to abortion in 1st trimester and
premature delivery in 3rd trimester.
42. In hypertension, if the patient had taken antihypertensive and

BP is recorded normal, even then, during surgical procedure
the patients BP can shoot up high.
43. Dexamethasone (Dexona) is the safest life-saving drug;
only contraindication being severe hypertension (>200/
120 mm Hg).
44. Ibuprofen is absolutely contraindicated in asthmatic patients
as it causes bronchospasm.
45. Adrenaline (epinephrine) acts as vasoconstrictor when used
locally but, when given systemically, causes bronchodilation,
i.e. used for asthmatics.
46. In case of a patient allergic to penicillin, erythromycin is the
safest alternative antibiotic.
47. The most important step in the control of bleeding (during or
postoperative) is application of local pressure to the site.
48. In a cardiac patient, aspirin should be stopped minimum
3 days before any surgical intervention.
49. In a hemophilic patient, aspirin is contraindicated.
50. Atropine is contraindicated in glaucoma.
51. In LA, the loss of function will be in the following sequence
pain, temperature, touch, proprioception and skeletal muscle
tone. The return of sensation will be reverse.
52. All local anesthetics readily cross the BBB (blood-brain barrier).
They also readily cross the placenta and enter the circulatory
system of the developing fetus.
53. In syncope, pupils get dilated.
54. Bilateral mandibular nerve block is not contraindicated.
55. The adult on an average should take 1800 mL of fluid daily.
56. One unit of fresh blood raises the Hb concentration by 1 gm%.
57. 30-60% amount of bone should be destroyed to manifest itself
on radiographs.
58. If both the parents have cleft lip and cleft palate, the probability
of first child suffering from the same will be 60%.
59. The four clotting factors synthesize in the liver are factors II,
VII, IX and X.
60. The level of reduced hemoglobin at which a patient becomes

cyanotic is 05 gm/dl.
61. Tramadol is a unique analgesic with opioid-like activity for
both acute and chronic pain management; side-effects include
sedation and dizziness; seizure is rare. It is used with caution
in a patient with history of seizure.
62. Heparin increases the normal clotting time (4-6 minutes) to
6-30 mins. The duration of action is 3-4 hours.
63. For every one degree centigrade rise in body temperature,
there is corresponding 9-10 beats/minute increase in patients
heartbeat.
64. Some common cause of postoperative nausea and vomiting
are hypoxia, hypertension and narcotics. It is more common
in children than in adults and more in women than in men.
65. The average rate of an injured axons forward growth is
approximately 1-2 mm/day.
66. What are anesthetics artery and why
1. Facial artery
2. Superficial temporal artery
Because anesthetic can confirm pulsation during operation.
67. The calvaria or brain case is composed of 8 bones and facial
skeleton is composed of 14 bones.
68. What are triple antibiotics and dosesA shotgun approach
to potential life-threatening infection when the patient is
seriously ill (the therapy is):
a. Gram-positive coverage(e.g. Ampicillin) 1 gram 6 hourly
IV in adult. 40 mg/kg 6 hourly IV in children
b. Gram-negative coverage(e.g. Gentamicin) 7 mg/kg IV
every 24 hours. This single daily dose is less nephrotoxic
than 2 mg/kg every 8 hourly
c. Anerobic coverage(e.g. Metronidazole-Flagyl) 500 mg
IV every 6 hourly in adults; 7.5 mg/kg IV every 6 hourly in
children.
69. An inhaled foreign body most probably enters into right
bronchus.
70. Hyoid bone present in the neck is the only jointless bone in
the human body.
71. Nails and cornea are the only tissues in the human body which
do not take oxygen from the blood.
72. Autogenous cancellous bone graft has greater osteogenic
potential than other grafts.
73. Advantages of sharp dissection over blunt dissection are:
a. Less traumatic
b. Permits muscle splitting than muscle tearing.
74. The patient with maxillofacial injuries should be carried in
lateral position but in case of spinal and cervical injury, the
patient should be carried in supine position.
75. Eyebrows should not be shaved when facial lacerations are
repaired because these do not always grow back.
76. In general, for IV fluid, common site is dorsal vein at the back
of the hand.
77. In case of uncontrolled bleeding after tooth extraction (for
example, in case of hemangioma) replacing the tooth in the
socket should be the first step to control bleeding.
78. In the case of an unconscious patient with no pulse and dilated
pupils, the correct procedure is to start artificial ventilation at
once.
79. Universal distress signal characterizing the obstructed airway
in a conscious adult is victims hand at his throat.
80. Postoperative edema can be minimized by:
a. Gentle manipulation of soft and hard tissues.
b. Early application of cold fomentation (acts as a vasocons
trictor and analgesic effect).
c. Postoperative serratiopeptidase accordingly.
81. In case of cardiopulmonary resuscitation (CPR), if efforts are
effective, there will be constriction of pupilsone of positive
sign.
82. The complete physical examination of a patient includes:
a. Inspection
b. Palpation and percussion
c. Auscultation.
83. If a normal patient loses 1000 cc of blood due to surgery, it

should be replaced by 3000 cc of colloidal fluid.
84. Few drugs that may cause syncope are:
a. Antihypertensive drugs
b. Overdose of insulin
c. Diuretics
d. Procaine.
85. 5-As that may cause postextraction bleeding are:
a. Alcohol
b. Aspirin
c. Anticoagulant
d. Antimalignant
e. Antibiotic (Sulfonamide).
86. If a patient gives history of allergy to Sulfa drugs, the same
patient may be allergic to xylocaine (Lignocaine) because both
are having same benzene ring.
87. Adrenal crisis is characterized by Hypotension, Hypoglycemia
and Shock.
88. 4-As that are important in management of allergic reaction
are:
a. Aminophylline
b. Antihistamine
c. Adrenaline
d. Airway with oxygen administration.
89. In case of trigeminal neuralgic attack, pain never crosses the
midline of the face (either left or right) and never occurs during
sleep.
90. Digastric muscle having dual nerve supply, one from mandi
bular nerve (motor branch from trigeminal nerve) and another
from facial nerve (motor branch).
91. The patient with tongue-tie or ankyloglossia cannot pronounce
the words like P, Q, R, S and T.
92. The central nervous system does not have any lymphatic
drainage system.
93. Lateral pterygoid muscle is only one of the principal muscles of

mastication which are attached to the condyle and responsible
for depression of the lower jaw (to open the mouth).
94. Thickness of skin is 0.5-3 mm.
95. Each cardiac cycle takes 0.8 seconds and denotes series of
changes which the heart undergoes during each beat.
96. The pain is defined as an ill-defined, unpleasant sensation,
usually evoked by an external or internal stimulus.
97. Sleep is periodic resting stage for the body, especially the
cerebral cortex.
98. Syncope is one of the common complications in dental clinic. It
requires immediate attention, otherwise untreatable syncope
may turn into shock and may be fatal.
99. The brain works for three minutes after cardiac arrest till the
oxygenated blood circulates to the brain. Each cycle takes
three minutes.
100. In general, the following drugs should be avoided during
pregnancy:
a. Aspirin
b. Corticosteroid
c. Diazepam
d. Morphine
e. Nitrous oxide
f. Phenobarbital
g. Carbamazepine.
101. The tip of the tongue is responsible for sweet taste and the
lateral wall of the tongue is responsible for other tastes, like
bitter, salty, sour.
102. In temporomandibular joint, the articular cartilage and central
portion of the disc do not have any nerve supply and blood
supply.
103. Aneurysmal bone cyst (ABC) is considered as a giant cell lesion
because histopathological examination shows the presence
of giant cells.
104. In case of suspected head injury the patient is never given
morphine (as sedative and to reduce pain) because morphine
mask the head injury symptom and arrests the respiratory

center.
105. About 44.6 kg/m to 74.4 kg/m energy is required to fracture
the mandible, zygoma and frontal bone.
106. Above 40 years of age, 60-75% patients of facial space
infection suffer from diabetes and/or hypertension. Medical
history should be evaluated and treatment should be done
accordingly.
107. Mild to moderate oral submucous fibrosis is treated conser
vatively with antioxidant therapy. It is one of the key treatment
modalities.
108. Apart from other local hemostatics, hydrogen peroxide also
plays an important role in arresting the intraoral bleeding.
109. Crocodile tears (False tears) is a condition that results after the
injury to fibers of facial nerves, leading to crying when the
patient eats.
110. All the facial muscles receive their innervations along their deep
surface except Mentalis muscle, Levator angularis superioris
and Buccinator muscle. They receive their innervations along
their superficial surface.
111. Three actions must occur at the time of cardiac arrest:
a. Active Emergency Response System (AERS)
b. Perform CPR
c. Use Automated External Defibrillator (AED).
chapter
Basic Science 2
1. What is the difference between growth and development?
Ans. Growth: Craniofacial growth is a complex phenomenon.
Growth is quantitative; for example, it is a measurable aspect of the
biologic life. Growth is change or difference in quantity, Growth is
increase in size.
Development: In simple words, it means progression towards
maturity. Development can be considered as a continuum of
casually related events from the fertilization of ovum onwards.
Development is a physiological and behavioral phenomenon.
Development is progression towards maturity.
2. What are the sex difference in the skull?
Ans. No sex difference until puberty. Post-puberty the differences
are:
Features Male Female
i. Weight Heavier Lighter
ii. Size Large Small
iii. Walls Thicker Thinner
iv. Muscular ridge More marked Less marked
v. Forehead Sloping Vertical
vi. Mastoid process More marked Less marked
vii. Vault Rounded Flattened
viii. Contour of face Long or chin bigger Rounded
ix. Supraorbital margin Rounded Sharp
x. Facial bones More rough, massive Smooth, smaller
3. Define the following terms:

(i) Anatomy; (ii) Surface anatomy (Topographic anatomy);
(iii) Applied anatomy (clinical anatomy); (iv) Gross Anatomy;
(v) Surgical Anatomy.
Ans.
i. Anatomy: It is derived from a Greek word anatome meaning
cutting up. The term dissection is a Latin equivalent of the
Greek anatome.
ii. Surface anatomy (Topographic anatomy): This is the study of
deeper parts of the body in relation to the skin surface. It is
helpful for clinical practice and surgical operation.
iii. Applied anatomy (Clinical anatomy): It deals with the application
of the anatomical knowledge to the medical and surgical
practice.
iv. Gross anatomy: It includes number, location, size, shape, length,
width of structures.
v. Surgical anatomy: It includes exact location, contents,
boundaries, nerve, arterial, venous supply, lymphatic drainage
and muscle attachment of the structures.
4. What are the derivatives of Meckels Cartilage (First Arch
Cartilage)?
Ans. i. Ear ossicles
ii. Malleus, incus
iii. Anterior ligament of malleus
iv. Spine of sphenoid
v. Sphenomandibular ligament
vi. Musculature derived:
Muscles of mastication
Mylohyoid muscle
Anterior belly of digastric muscle
The tensor of tympani
The tensor veli palatini.
5. How does mandible get developed?
Ans. From 1st Brachial Arch or Mandibular Arch.
Basic Science 13
6. When does the development of mandible takes place?

Ans. At the 4th week.
7. When does the ossification of mandible start?
8. When does ossification of maxilla start?
9. When do TMJ rudiments take place?
10. How does the development of tongue occur?
Ans. It develops from 1st/3rd/4th Brachial Arch.
11. When does the tongue development take place?
Ans. In the 4th week in the utero.
12. When does the condyle formation occur?
Ans. In the 10th week.
13. Where after fertilization is the zygote formed?
Ans. In the fallopian tube.
14. What are the other names of Stomodeum?
Ans. Primitive Face/Primitive oral cavity.
15. What are the muscles developed from 1st pharyngeal or
visceral arch?
Ans. Muscles of mastication
Digastric muscle of anterior belly.
16. How does the development of anterior mid facial skeleton
occur?
Ans. It occurs from:
Frontonasal process
Lateral process
Maxillary process.
17. What are the anomalies (developmental) related to middle

3rd face development?
Ans. i. Oblique facial cleft
ii. Macrosomia
iii. Maxillary sinus hematosis (Enlarged Maxillary Sinus).
18. In which conditions the bilateral condylar hypoplasia is
seen?
Ans. i. Pierre-Robin syndrome
ii. Treacher-Collins syndrome
iii. Nagers syndrome
iv. Townes-Brocks syndrome
v. Branchio-otorenal syndrome
vi. Branchio-oculofacial syndrome
vii. Stickler syndrome.
19. In which conditions is hemimandibular hypoplasia seen?
Ans. i. Goldenhar-Gorlin syndrome
ii. 1st and 2nd Brachial Arch syndrome
iii. Craniofacial Microsomia
iv. Dyke-Davidoff-Masson syndrome
v. Femoral Facial syndrome
20. What is Hiltons law?
Ans. Each pharyngeal arch is characterized by its own muscular
components. The muscular components of each carry their own
nerve and whenever the muscular cell may migrate, they carry their
cranial nerve component and, in addition, each arch has its own
arterial component.
State that: Nerve which supplies a joint also innervate the muscle
that move it.
21. Which structures are attached to the lingula?
Ans. Sphenomandibular ligament, which is the remnant of Meckels
cartilage.
Basic Science 15
22. What are the two peculiarities of lateral pterygoid muscle,

which differs from other principle muscles of mastication?
Ans. i. Only muscle attached with condyle.
ii. Responsible for depression of the mouth (open the
mouth)
23. What are the cranial nerves present in the neck region?
Ans. i. Glossopharyngeal nerve (CN 9th)
ii. Vagus nerve (CN 10th)
iii. Accessory nerve (CN 11th)
iv. Hypoglossal nerve (CN 12th).
24. What are the five layers of the scalp?
Ans. Scalp is made up of the following five layers (outward to
inward):
i. Skin
ii. Dense connective tissue
iii. Gala apponeurotica
iv. Loose connective tissue
v. Periosteum or pericranial layer.
25. What are the five layers of the pharynx?
Ans. There are five layers (inward to outward).
i. Mucosa
ii. Submucosa
iii. Pharyngeal aponeurosis (Pharyngobasilar fascia)
iv. The muscular coat
v. The buccopharyngeal fascia.
26. What are different parts of the pharynx?
Ans. i. Nasal part (Nasopharynx)
ii. Oral part (Oropharynx)
iii. Laryngeal part (Laryngopharynx).
27. How many cartilages are present in larynx?
Ans. Total nine cartilages are present in larynx:
6 paired, which are: Arytenoid (two)
Corniculate (two)
Cuneiform (two)
3 unpaired, which are: Thyroid (one)

Cricoid (one)
Epiglottic (one)
28. What are the structures present in the floor of mouth?
Ans. Structures present in the floor of mouth are:
i. Whartons Duct (Submandibular gland duct)
ii. Lingual nerve
iii. Sublingual artery
iv. Sublingual gland
v. Hypoglossal nerve
vi. Submandibular gland.
29. What are the deep structures present in the neck?
Ans. i. Gland: Thyroid and parathyroid gland
ii. Thymus
iii. Arteries: Subclavian and carotid
iv. Veins: Subclavian, internal jugular and brachiocephalic
v. Nerves: Glossopharyngeal nerve (9th CN)
Vagus N (10th CN)
Accessory N (11th CN)
Sympathetic Chain
Cervical plexus
vi. Lymph nodes
vii. Thoracic duct
viii. Viscera: Trachea and oesophagus
ix. Muscles: Scalene muscle
x. Cervical pleura, suprapleural membrane
xi. Styloid apparatus.
30. Which artery is most commonly involved in extradural
hemorrhage?
Ans. Middle meningeal artery.
31. When attempting venipuncture in anticubital fossa, which
artery is most likely to be encountered?
Ans. Brachial artery may be encountered.
Basic Science 17
32. From where do the branches of trigeminal nerve pass

through?
Ans. i. Ophthalmic branches: Superior orbital fissure
ii. Maxillary branches: Foramen rotundum
iii. Mandibular branches: Foramen ovale.
33. What is the source of motor nerve innervations of larynx?
Ans. Vagus nerve (10th CN).
34. From which structure does the facial nerve exit from the
skull?
Ans. Stylomastoid.
35. Which foramen is associated with middle meningeal artery?
Ans. Foramen spinosum.
36. The blood vessels and nerves are absent in which structure
of TMJ?
Ans. Central portion of the disc.
37. How are Langers line usually placed in the face?
Ans. Parallel to the natural creases of the face.
38. Which all structures are supplied by hypoglossal nerve?
Ans. Hypoglossal nerve provides motor innervations to all intrinsic
and extrinsic muscles of the tongue.
39. How many nerves are responsible for the nerve supply of
the tongue?
Ans. Motor nerve supply: Accessory nerve (11th CN)
Hypoglossal nerve (12th CN)
Sensory nerve supply: Trigeminal nerve (5th CN)
Facial nerve (7th CN)
Glossopharyngeal nerve (9th CN)
Vagus nerve (10th CN)
40. Which nerve is involved in Bells palsy?
Ans. Facial nerve.
41. Lingual artery is the branch of which artery?

Ans. External carotid artery.
42. Which is the triangle of lingual artery?
Ans. Lessers triangle.
43. Hypoglossal nerve is purely sensory or motor?
Ans. It is purely motor nerve.
44. What are the components of posterior triangle of the neck?
Ans. Occipital triangle and subclavian triangle.
45. The trigeminal nerve is motor/sensory/mixed in nature?
Ans. Mixed in nature.
46. How many branches of the internal carotid artery are
present in the neck region?
Ans. None of the branches is present in the neck region.
47. What is the name of the cavity in which semilunar/gasserian
ganglion is present?
Ans. Meckels cavity.
48. Ansa hypoglossal is composed of which nerve?
Ans. Descending cervical and descending hypoglossal nerve.
49. At which level is CCA divided into ECA and ICA?
Ans. At the level of superior border of thyroid cartilage.
50. Which nerve supplies the sensory innervations for taste to
anterior 2/3rd of the tongue?
Ans. Chorda tympani.
51. Waldeyers ring contains what type of tissue?
Ans. Lymphoid tissue.
52. Where is the greater palatine foramina situated?
Ans. It is situated between the 2nd and 3rd maxillary molar.
53. Which artery is commonly involved in stroke?
Ans. Lenticulostriate artery.
Basic Science 19
54. Which tissue has less tendency to regenerate tendon or

bone?
Ans. Tendon has less tendency.
55. Sensory fibers of the lingual nerve supply which structures?
Ans. They supply:
i. Tongue
ii. Lingual surface of mandible
iii. Floor of mouth.
56. Which of the following bones does not contain air sinus:
Frontal/nasal/sphenoid/ethmoidal?
Ans. Nasal bone does not contain any air sinuses.
57. Which muscles are responsible for the make-up of pterygo
mandibular raphe?
Ans. Anteriorly by buccinator muscle and posteriorly by superior
constrictor muscle of pharynx.
58. What are Arnolds nerve and Jacobsons nerve?
Ans. Arnolds nerve: It is a branch of vagus nerve (10th CN and
supplies sensory innervations to the ear (concha and auditory canal).
Jacobsons nerve: It is a branch of glossopharyngeal nerve (9th CN
and supplies sensory innervations to the ears (concha, auditory
canal and middle ear).
59. What is the interval between open eyelids called?
Ans. The palpebral fissure (Rima palpebrarum).
60. Which bones form the orbital cavity?
Ans. Lacrimal, ethmoidal, palatine, frontal, sphenoid, zygomatic
and maxillary.
61. How many bones form the orbit?
Ans. Seven bones form the orbit:
i. Orbital roof: Orbital plate of the frontal bone
ii. Orbital floor: Orbital plate of the maxilla
iii. Lateral wall: Orbital surface of the zygomatic bone and
greater wing of the sphenoid bone
iv. Medial wall: Composed of 4 bonesethmoidal bone

(centrally)
v. Frontal bone (superioanteriorly)
vi. Sphenoid bone (posteriorly)
vii. Lacrimal bone (inferioanteriorly).
62. What is Whitnalls orbital tubercle?
Ans. It is a bony protuberance present at the lateral orbital wall,
approx. 5 mm behind the lateral orbital rim.
63. Which is the only bone that exists entirely within the orbital
confines?
Ans. The lacrimal bone.
64. Which bone is the keystone of the orbit?
Ans. The sphenoid bone. All neurovascular structures to the orbit
pass through this bone.
65. Where the superior orbital fissure located and which struc
tures pass through it?
Ans. The superior orbital fissure is a 22 mm cleft that runs outward,
forward and upward from the apex of the orbit.
Three motor nerving pass through the extraocular muscles
of the orbites:
i. Oculomotor nerve (CN 3rd)
ii. Trochlear nerve (CN 4th)
iii. Abducens nerve (CN 6th)
The ophthalmic division of trigeminal nerve also enters the
orbit through this fissure.
66. What are the structure pass throughing inferior orbital
fissure?
Ans. Inferior orbital fissure acts as passage for:
i. Maxillary division of trigeminal nerve (CN V2) and its
branches including the infraorbital nerve
ii. The infraorbital artery
iii. Branches of sphenopalatine ganglion
iv. Branches of inferior ophthalmic vein to the pterygoid
plexus.
Basic Science 21
67. What are the contents of the carotid sheath?

Ans. It contains:
i. Carotid artery
ii. Jugular vein
iii. Vagus nerve (CN 10th)
Within the carotid sheath, vagus nerve lies posterior to the
common carotid artery and internal jugular vein.
68. At what distance from the stylomastoid foramen does the
facial nerve bifurcate?
Ans. The average distance is 1.3 cm. The nerve bifurcates into two
main trunks, zygomaticofacial and mandibular cervical.
69. At what distance from the external auditory canal does the
facial nerve bifurcate?
Ans. The point of bifurcation is located 1.5 to 2 cm inferior to the
lowest concavity of the bony external auditory canal.
70. What is the Danger Zone for the frontal branch of the facial
nerve as it crosses the zygomatic arch?
Ans. Facial nerve crosses the superficial to the zygomatic arch in an
area that lies at 0.83.5 cm anterior concavity of the bony external
auditory canal (average 2 cm anterior to the canal).
The danger zone for injury of the frontal branch of the facial
nerve during surgical procedures is in the temporal and pre-auricular
regions.
71. What is the Danger Zone for the marginal mandibular
branch of the facial nerve?
Ans. The marginal mandibular branch of the facial nerve is located
in an area where incision to approach the mandible and mandibular
condyle is given.
The danger zone is located between the inferior border of
the mandible and a line in the retromandibular and submandibular
regions.
72. What are the surface anatomy landmarks for tracheostomy?

Ans. i. Thyroid notch
ii. Cricoid ring
iii. Sternal notch
iv. Innominate artery.
73. What are the layers encountered during the dissection of
trachea from the skin to the trachea?
Ans. i. Skin
ii. Subcutaneous connective tissue
iii. Platysma
iv. Investing fascia
v. Linea alba of infrahyoid muscle
vi. Thyroid isthmus
vii. Pretracheal fascia
viii. Tracheal rings.
74. What major vessels are encountered with during trach-
eostomy?
Ans. The anterior jugular vein and jugular venous arch are found
in suprasternal space.
The infrahyoid vein and artery as well as thyroid artery, all lie
in the space between the pretrachea and infrahyoid fascia.
75. What are the possible postoperative complications
associated with tracheostomy?
Ans. i. Atelectasis: Blood or foreign material is aspirated into the
tube
ii. Tracheoesophageal fistula
iii. Subglottic edema
iv. Tracheal stenosis
v. Pneumonia
vi. Difficult decannulation
vii. Persistent fistula.
76. Risus sardonicus is one of the signs of the tetanus. What
does it involve?
Ans. It involves spasm of the facial muscle causing a fixed smile.
Basic Science 23
77. What are the indications for prophylactic antibiotics?

Ans. i. To prevent local wound infection
ii. To prevent infection at surgical site
iii. To prevent metastatic infection.
78. When should the antibiotics be used?
Ans. i. Acute onset infection
ii. Diagnosed osteomyelitis of the jaw
iii. Infection with diffused swelling
iv. Involvement of the facial spaces
v. Severe pericoronitis
vi. Patients with compromised host defenses.
79. When are the prophylactic antibiotics for the prevention of
odontogenic infection not necessary?
Ans. Minimal or no benefits in the treatment of:
i. Chronic well-localized abscess
ii. Dry socket
iii. Minor vestibular abscess.
iv. Root canal sterilization.
80. What is the most common side effect of the oral admini-
stration of ampicillin?
Ans. Diarrhea.
81. Which antibiotic is primarily bactericidal?
Ans. Gentamycin.
82. What is the choice of the drug in the patient allergic to
penicillin?
Ans. Erythromycin (E-mycin) or althrocin.
83. Which antibiotic is mainly effective against the gram-
negative bacteria?
Ans. Kanamycin.
84. In what all conditions is morphine contraindicated?
Ans. i. Bronchial asthma
ii. Head injury
iii. Emphysema.
85. What is the common side effect of NSAIDs drug?

Ans. Gastric irritation.
86. What is overdose of salicylate in the children causes?
Ans. Reyes syndrome.
87. Why is salicylate contraindicated in pregnancy?
Ans. Because it readily crosses the placental barrier.
88. What are the side effects of tetracycline in children?
Ans. Discolored teeth.
89. In reference of paracetamol.
Ans. i. ContraindicatedIn chronic hepatitis
ii. Can be safely given:
to a pregnant lady
in the case of congestive cardiac failure.
90. In reference of aspirin.
Ans. i. ContraindicatedIn peptic ulcers
ii. Produces the following effects:
Frank gastric bleeding
Prolonged prothrombin time
Platelets dysfunction
Prolonged bleeding time.
iii. Causes hypoprothrombinemia
iv. Tendency to produce blood dyscrasias.
91. How will you manage a case of substantial convulsive
reaction to a local anesthesia?
Ans. Use diazepam and oxygen to reduce convulsive reaction.
92. What do the glucocorticoids reducethe pain threshold
or inflammation?
Ans. These decrease the inflammation.
93. Which drug is contraindicated in G6PD deficiencyaspirin
or paracetamol?
Ans. Aspirin is contraindicated.
Basic Science 25
94. Which is the broad spectrum antibioticpenicillin or

tetracycline?
Ans. Tetracycline is the broad spectrum antibiotic.
95. How will you manage a case of postoperative cutaneous
ecchymosis?
Ans. By the application of cold.
96. What is the characteristic clinical sign of hemophilia?
Ans. i. Bleeding time is normal.
ii. Clotting time/prothrombin time/partial thromboplastin
time is prolonged.
97. Which are the new blood clotting factors?
Ans. There are three new factors:
i. Factor 14: PrekallikreinFletcher factor
ii. Factor 15: High molecular weight kininogenFitzgerald
factor
iii. Factor 16: Calcium.
98. Which of the following muscles has a dual nerve supply
digastric or masseter muscle?
Ans. Digastric muscle has a dual nerve supply. It is supplied by
mandibular and facial nerves. It gets the motor nerve supply from
both nerves.
99. Which muscle insertion caps the coronoid process
temporalis or pterygoid muscle?
Ans. Temporalis muscle insertion caps the coronoid process.
100. Which nerve causes the following disorders?
(i) Ptosis; (ii) Trigeminal neuralgia; (iii) Facial paralysis and
Bells palsy; (iv) Freys syndrome; (v) Vagus glossopharyngeal
neuralgia; (vi) Glossopharyngeal neuralgia.
Ans. i. Occulomotor nerve (cranial nerve III lesion causes ptosis)
ii. Trigeminal nerve causes trigeminal neuralgia
iii. Facial nerve causes facial paralysis and Bells palsy
iv. Auriculotemporal nerve and facial nerve cause Freys
syndrome
v. Vagus (cranial nerve X), glossopharyngeal nerve (cranial

nerve IX) cause vagus glossopharyngeal neuralgia
vi. Glossopharyngeal nerve causes glossopharyngeal
neuralgia.
101. Differentiate between hemorrhage, hematoma and
ecchymosis.
Ans. Hemorrhage is the escape of blood from the vascular system.
Hematoma is the collection of blood in extravascular space.
Ecchymosis is the collection of blood below the skin and the
mucous membrane.
102. Differentiate between thrombosis and embolism.
Ans. Thrombosis is the intravascular coagulation of blood, which is
attached to the endothelial lining of the vessel known as thrombus.
Embolism occurs when the attached clotted blood gets
detached from lining and circulates in the blood and detached
blood clot is known as embolus.
103. Differentiate between bacteremia, septicemia, toxemia and
pyemia
Ans. Bacteremia is the presence of small number of bacteria in the
blood, which does not multiply significantly and is not detected
microscopically, e.g. E. coli, etc.
Septicemia is the presence of rapidly multiplying highly
pathogenic bacteria in the blood, e.g. pyogenic cocci and bacilli.
Toxemia is the condition resulting from the spread of the
bacterial product by the blood-stream or the condition resulting
from the metabolic disturbances.
Pyemia is the dissemination of small septic thrombi in the
blood which causes their effect at the site where they are lodged.
This can result in pyemic abscess or septic infarcts.
104. Differentiate between sinus and fistula.
Ans. Sinus is a blind tract which is open at one end and lined by
epithelium.
Fistula is a track open at both the ends and lined by epithelium.
Basic Science 27
105. In reference to the bleeding time and clotting time, what

is the basic difference between hemophilia and purpura?
Ans. Hemophilia: Clotting time is increased and bleeding time is
normal.
Purpura: Clotting time is normal and bleeding time is
increased.
106. Which are the important foramina of the base of the skull
and which structures pass through them?
Ans.
Foramina Structures passing through them
1. Incisive foramen a. Terminal part of greater palatine vessels
b. Nasopalatine vessels
2. Greater palatine a. Greater palatine vessels
foramen b. The anterior palatine nerve
3. Lesser palatine a. Middle and posterior palatine nerves
foramina
4. Jugular foramen a. Through anterior partinferior petrosal sinus
b. Through the middle part
IX. Glossopharyngeal nerve
X. Vagus nerve
XI. Accessory nerve.
Meningeal branch of ascending pharyngeal
artery
c. Through posterior partemissary vein
5. Hypoglossal canal a. Hypoglossal nerve (XII CN)
b. Meningeal branch of the ascending
pharyngeal artery
c. Emissary vein connects the sigmoid sinus
with the internal jugular vein
6. Foramen rotundum a. Maxillary division of trigeminal nerve (V2).
107. In which condition does the lymph node become rubbery

hard?
Ans. In the case of lymphoma.
108. In which system is the lymphatic drainage not present?

Ans. Central nervous system.
109. What is the basic difference in carcinoma metastasis and
sarcoma metastasis?
Ans. Carcinoma metastasis is through the lymphatic route.
Sarcoma metastasis is through the hematogenous route.
110. Which are the lymphoid organs?
Ans. 1. Thymus gland: i. Primary or central
ii. Secondary or peripheral
2. Lymph nodes
3. Spleen
4. Tonsils
111. How many lymph nodes are present in an adult body?
Ans. Total 400 to 450 lymph nodes are present in an adult body.
i. Head and neck = 60 to 70
ii. Arms/superficial thorax = 40
iii. Legs/superficial buttocks = 30
iv. Thorax = 100
v. Abdomen/pelvis = 230
112. What are the functions of the lymph nodes?
Ans. i. Defense: To remove microorganisms and other injurious
particles
Hematopoiesis: Site for the final stage maturation of
ii.
lymphocytes and monocytes.
113. What is the composition of lymph nodes?
Ans. i. Water96%
ii. Solids4%
Protein2 to 6%
Lipid5 to 15%
Carbohydratessugar (glucose)
Non-protein nitrogen substance, e.g. urea, amino acid,
creatine
ElectrolytesNa, Ca, K, Cl, bicarbonate
Cellular contentslymphocytes.
Basic Science 29
114. What is the rate of lymph flow?

Ans. i. Total rate of lymph flow: 120 ml/hr
ii. About 100 ml/hour through thoracic duct
iii. About 20 ml/hour through channels
iv. About 2 to 3 liters/day.
115. What are the functions of lymphatic system?
Ans. i. It collects the waste materials from the tissues
ii. It acts as drainage of metabolites
iii. It maintains the body fluids and blood volume
iv. It helps in the defence mechanism against the foreign
bodies and bacteria
v. It is the site of formation of lymphocytes
vi. It serves to arrest the spread of malignant cells, though
temporarily.
116. Define anesthesia and analgesia
Ans. Anesthesia: Loss of the touch sensitivity.
Analgesia: Loss of the pain sensibility.
117. Define symptoms and signs.
Ans. Symptoms are subjective complaints of the patient about his/
her disease.
Signs (physical signs) are objective findings of the doctor on
the patient.
118. Differentiate between typical trigeminal neuralgia (classic)
and atypical trigeminal neuralgia.
Ans.
Typical trigeminal neuralgia Atypical trigeminal neuralgia
1. Pain only during attack 1. Pain is of long duration and it is dull
boring pain
2. Never crosses midline during 2. Involves other areas of the face and
attack or at any time then crosses the midline
3. Attack never occurs during 3. Attack can be during sleep also.
sleep
119. Define (i) Lymph; (ii) Blood; (iii) Plasma; and (iv) Serum.
Ans.
i. Lymph: The tissue fluid which enters the lymphatic vessels is
called lymph. It is a clear fluid. It has the composition similar to
blood and plasma. It contains lymphocytes, large molecule of
protein and particulates matter absorbed from the tissue fluid.
ii. Blood: It can be defined as a specialized connective tissue in
which there is liquid cellular substance known as plasma and
formed elements, WBC, RBC and platelets suspended in the
plasma.
iii. Plasma: It is a light yellow transparent alkaline fluid. It is fluid
protein (approximately 55%) obtained from the blood without
clotting.
iv. Serum: It is plasma fluid procured after blood clotting.
(i) Sensory afferent nerve; and (ii) Motor efferent nerve
Ans. i. Sensory afferent nerve carries impulses from periphery
to the CNS
ii. Motor efferent nerve carries impulses from CNS to the
peripheral structure like muscles.
121. Which are the triangles of the neck and which muscle
demarks these triangles?
Ans. i. Anterior triangles of the neck
ii. Posterior triangles of the neck
These two triangles are divided by sternocleidomastoid
muscle.
a. Anterior triangles are divided into:
Digastric triangle
Submental triangle
Carotid triangle
Muscular triangle.
b. Posterior triangles are divided into:
Occipital posterior triangle. It is also known as upper
posterior triangle of the neck
Basic Science 31
Supraclavicular (subclavian) triangle. It is also known as

lower triangle of the neck.
Both the posterior triangles of the neck are divided or
demarcated by the inferior belly of the omohyoid.
(i) Tendon; (ii) Ligament; (iii) Belly; and (iv) Aponeurosis.
Ans. i. Tendon: The fibrous, non-contractile and cord-like part
of the muscle.
ii. Ligament: Ligaments are fibrous bands which connect the
adjacent bone forming the integral parts of the joints.
iii. Belly: The fleshy and contractile part of the muscle.
iv. Aponeurosis: The flattened tendon.
123. Define muscle and what are the type of muscles?
Ans. Muscle is a contractile tissue which brings about the
movement.
Type of muscles:
i. Skeletal muscle: Voluntary, striated or somatic muscle
ii. Smooth muscle: Involuntary, plain, non-striated and
visceral muscle
iii. Cardiac muscle: Striated, involuntary, automatic and
rhythmic contractions of the heart.
124. Why does blood not clot in the vessels?
Ans. i. Constant flow of blood in the vessels
ii. Smoothness of vessel walls provided by intact endothelial
lining
iii. Presence of natural inhibitors of coagulation, e.g. heparin
in blood with cofactors, anticephalin neutralizes excess
thromboplastin.
125. Define the following terms
(i) Eupnea; (ii) Dyspnea; (iii) Tachypnea; (iv) Bradypnea;
(v) Hypercapnia; (vi) Hypocapnia; (vii) Hypoxemia; (viii)
Hypoxia (anoxia); (ix) Cyanosis; and (x) Aphyxia.
Ans. i. Eupnea: It is normal respiration at normal rate and
amplitude
ii. Dyspnea: It is difficult or belaboured breathing

iii. Tachypnea: It is rapid breathing
iv. Bradypnea: It is slow breathing
v. Hypercapnia: It is excess of carbon dioxide (2 to 4%) in
body fluid
vi. Hypocapnia: It is decreased carbon dioxide in body fluid
vii. Hypoxemia: It is decreased oxygen carriage in blood
viii. Hypoxia (anoxia): It is the lack of supply and utilization of
oxygen
ix. Cyanosis: It is blue coloration of skin especially lips, ears,
hands, foot and nails
x. Asphyxia: It is due to presence of increased amount of
reduced Hb in blood. It signifies suffocation.
126. Define: (i) Cerebrospinal fluid (CSF); and (ii) Spinal cord.
Ans. i. Cerebrospinal fluid (CSF): CSF is a modified tissue fluid. It
is contained in the ventricular system of the brain and in
the sub-arachnoid space around the brain and the spinal
cord. CSF replaces the lymph in the CNS. It is protective,
nutritive and a pathway for the metabolites from the CNS.
ii. Spinal cord: Spinal cord is the lower part of the central
nervous system, responsible for establishing contacts
between the brain in the cranial cavity and the peripheral
end organ.
127. Which are the muscles responsible for the following facial
expressions?
(i) Smiling; (ii) Anger; (iii) Horror; (iv) Closing the mouth;
and (v) Whistling
Ans. Following are the muscles responsible for various facial
expressions:
i. Smiling: Zygomaticus major
ii. Anger: Dilator naris and depressor septi
iii. Horror: Platysma
iv. Closing the mouth: Orbicularis oris
v. Whistling: Buccinator and orbicularis oris.
Basic Science 33
128. Which are the principal muscles of mastication?

Ans. i. Temporalis muscle
ii. Masseter muscle
iii. Medial pterygoid muscle
iv. Lateral pterygoid muscle.
129. Which are the accessory muscles of mastication?
Ans. i. Suprahyoid muscle:
Digastric
Mylohyoid
Stylohyoid
Geniohyoid.
ii. Infrahyoid muscle:
Sternothyroid
Sternohyoid
Thyrohyoid
Omohyoid.
iii.Platysma.
130. Define: (i) Trachea; (ii) Esophagus; (iii) Pharynx; and (iv)
Larynx
Ans. i. Trachea: The trachea is a non-collapsible, wide tube
forming the beginning of the lower respiratory passages.
It is kept patent because of the presence of C-shaped
cartilaginous rings in its wall. The cartilages are deficient
in its posterior part, this part of the wall being made up
of muscle (trachealis) and fibrous tissue.
ii. Esophagus: The esophagus is a muscular food passage
lying between the trachea and the vertebral column. The
oesophagus is a downward continuation of the pharynx
and begins at the lower border of the cricoid cartilage.
iii. Pharynx: The pharynx is a wide muscular tube situated
behind the nose, the mouth and the larynx. Clinically, it
is a part of the upper respiratory passages. Upper part
of the pharynx transmits only air, lower part (below the
inlet of the larynx) only food but middle part is a common
passage for both air and food.
iv. Larynx: The larynx is the organ for the production of

voice or phonation. It is also an air passage and acts as a
sphincter at the inlet of the lower respiratory passages.
The larynx lies in the anterior midline of the neck
extending from the root of the tongue to the trachea
and, in adults it lies in front of the third to six cervical
vertebrae but, in females and children, it lies at a little
higher level.
131. Which are the layers of a neck?
Ans. i. Skin
ii. Superficial fascia
iii. Investing layers of deep fascia. It is also known as fascia
colli. These layers are:
Deep cervical fascia
Pretracheal fascia
Prevertebral fascia
Carotid fascia.
132. What is torticollis or wry neck?
Ans. It is a deformity in which the head is bent to one side and
the chin points to the other side. This is the result of spasm or
contracture of the muscles supplied by the spinal accessory nerve,
e.g. sternocleidomastoid muscle and trapezius.
133. Which are the extracranial sites for the branches of maxillary
nerve?
Ans. There are mainly three sites:
i. Branches within pterygopalatine fossa
ii. Branches within intracranial canal
iii. Branches on the face.
134. List five key points about the taste buds.
Ans. i. They are seen in the papillae, mucosa of soft palate and
pharynx
ii. They are barrel-shaped structures surrounded by
stratified squamous epithelium
Basic Science 35
iii. They consist of two types of cells:

The taste cells 4 to 20 taste cells per bud known as
gustatory or neuroepithelial cells
The supporting cells are called sustentacular cells.
135. Give the full forms of the following abbreviations:
(i) AIDS; (ii) HIV; (iii) LASER; (iv) ELISA; and (v) PGL syndrome
Ans. i. AIDS: Acquired Immunodeficiency Syndrome
ii. HIV: Human Immunodeficiency Virus
iii. LASER: Light Amplification of Stimulated Emission of
Radiation.
iv. ELISA: Enzyme Linked Immunosorbent Essay
v. PGL syndrome: Persistent Generalized Lymphadenopathy
Syndrome.
chapter
Basic Oral Surgery 3

1. What is the correct way to ask systemic history for the
patient assessment?
Ans. Specific points related to the systemic diseases are as follows:
i. Allergies
ii. Blood disorders
iii. Cardiac and respiratory conditions
iv. Diabetesdrug taken
v. Existence of low or high blood pressure
vi. Faints or epilepsy
vii. Gynecology problems and pregnancy
viii. Hepatic and kidney ailments.
2. Who introduced the first aseptic technique?
Ans. Joseph Lister introduced the first antiseptic technique.
3. What are the parts of a needle?
Ans. There are four parts of a needle:
i. Bevel
ii. Shaft
iii. Hub
iv. Adaptor.
4. Why is PNS view called Waters view?
Ans. This view was described by Water and Waldron (1915).
5. What is the main difference between syncope and shock?
Ans. Syncope: Refers to a sudden transient loss of consciousness,
usually secondary, to the cerebral ischemia (only one system is
involved due to cerebral ischemia).
Shock: It is an acute generalized inadequate perfusion of critical

organ that, if continued, will produce serious pathophysiological
consequences. Hemodynamic, endocrinal metabolic alteration
produce clinical signs of shock (chain of events of pathophysiological
consequences of multiple system involvement).
6. List the nerves which innervate the maxillofacial region?
Ans. There are four cranial nerves:
i. V cranial nerve: Trigeminal nerve
ii. VII cranial nerve: Facial nerve
iii. IX cranial nerve: Glossopharyngeal nerve. These are
sensory fibers to the posterior part of tongue and help
in swallowing
iv. XII cranial nerve: Hypoglossal nerve is a motor nerve which
innervates the tongue.
7. What is the difference between tetany and tetanus?
Ans. Tetany is characterized by extensive spasm of skeletal muscle
causing severe trismus. There is steady decrease in extracellular
calcium followed by parathyroidectomy, resulting in hypocalcemic
tetany.
Tetanus is a bacterial infection caused by gram-positive anaerobic
organism, the Clostridium tetany which causes widespread spasm
of the muscle.
8. What is hyperventilation syndrome?
Ans. Hyperventilation is simply an increase in alveolar ventilation
caused by abnormally rapid and deep breathing. It is most
commonly seen in dental clinics among the patients due to
anxiety. Hyperventilation syndrome is often caused by anxiety,
fear, excitement, nervousness, emotional stress and psychoneurotic
reaction. It is most often seen in women. Hyperventilation results in
hypocapnia, lowering of the PaCO2 . Hypocapnia causes a reduction
in the cerebral blood flow.
9. Which method is used to sterilize the prepacked materials?
Ans. Gamma radiation.
10. What is the difference between allergy and idiosyncrasy?

Ans. Allergy is the acquired systemic complication of local
anesthesia and idiosyncrasy is genetically determined by bizarre
reaction.
11. On which principle does autoclave work?
Ans. Pressure cooker principle/steam under pressure.
(i) Sterilization; (ii) Antiseptic; (iii) Disinfectant; (iv) Sepsis;
(v) Asepsis.
Ans. (i) Sterilization: It is a process by which all the microbial forms
are destroyed or it can be defined as the use of physical or chemical
procedure to destroy all forms of microorganisms, including
bacteria, spores, fungi and viruses.
(ii) Antiseptic: A chemical that is applied to a living tissue, such as
skin, mucus membrane, to reduce the number of microorganisms
present through inhibition of their activity or destruction.
(iii) Disinfectant: A chemical used on nonliving objects to kill the
surface vegetative pathogenic organisms but not necessarily spore
forms or viruses.
(iv) Sepsis: It is the breakdown of the living tissues by the action of
microorganisms usually accompanied by inflammation.
(v) Asepsis: Medical asepsis attempt to keep the patients, health
care staff and objects as free as possible of organisms that cause
infection. Surgical asepsis is used to prevent microbes from gaining
access to wounds.
13. What is the basic difference between normal cycle and flash
cycle in autoclaving?
Ans. Normal cycle:
i. Temperature: 121C
ii. Time: 15 minutes
iii. Pressure: 15 psi.
Flash cycle:
i. Temperature: 134C
ii. Time: 3 minutes
iii. Pressure: 30 psi.
14. At what percentage does alcohol show maximum antiseptic
activity?
Ans. At 70%, alcohol shows the maximum activity.
15. What is the mechanism by which the disinfectants and
antiseptic act on microorganism?
Ans. i. Coagulation of bacterial protein
ii. Alteration in the properties of bacterial wall
iii. Binding of sulfhydryl groups.
16. How does steam autoclaving kill the microorganism?
Ans. It kills the microorganism by RNA and DNA breakdown.
17. What is the basic action of dry heat sterilization?
Ans. Dehydration and oxidation.
18. What is the time and temperature cycle in dry heat
sterilization?
Ans. 170C for one hour.
19. Which materials are sterilized by glass bead sterilizer?
Ans. It is used mainly for endodontic files and burs.
20. Which method is used for the disinfection of operation
theaters?
Ans. Fumigation method is used.
21. What is the status of oral cavity at the time of birth?
Ans. At the time of birth, oral cavity is sterile.
22. How much time is required to kill the bacteria by boiling
water sterilization?
Ans. 100C for 10 minutes.
23. Which is the most commonly detected organism in the

mouth of a newborn baby?
Ans. Streptococcus salivarius.
24. Which material cannot be sterilized by a hot air oven?
Ans. Culture media cannot be sterilized by hot air oven.
25. Which material is used for cold sterilization?
Ans. Benzalkonium chloride.
26. At what temperature is ethylene oxide used for gas
sterilization?
Ans. At 108C.
27. What is the method of the sterilization of metal instruments?
Ans. Infrared radiation.
28. What is the method of the sterilization of catgut suture
material?
Ans. Ethylene oxide.
29. What is the method of the sterilization of heat and water-
sensitive instruments?
Ans. Gas sterilization.
30. What is the method of the sterilization of needle, suture
material, dressing material?
Ans. Ionizing radiation.
31. By which method is air purified in an operation theater?
Ans. Ultraviolet rays.
32. Which material is used for the preoperative skin preparation?
Ans. Povidone iodine.
33. What is the mode of action of alcohol?
Ans. Denaturation of protein.
34. What is the mode of action of phenols?
Ans. Precipitation of proteins.
35. What is the purpose of a hand scrub?

Ans. i. Remove superficial contaminants
ii. Loosen epithelium
iii. Reduce bacterial count.
36. What is the time duration for a hand scrub?
Ans. 10 minutes.
37. Which is the most commonly used disinfectant for dental
unit and handpieces?
Ans. Glutaraldehyde is most commonly used.
38. Which is the fastest, safest and the most effective way to
sterilize a metal impression tray?
Ans. Autoclaving is the best method even above 175C.
39. What is cidex?
Ans. Two percent glutaraldehyde is known as cidex.
40. How should be the edges of skin during the suturing on
the face?
Ans. Edges should be everted.
41. What is the primary aim of an extraoral dressing?
Ans. i. Keep the surgical field free from infection
ii. Pressure may help in controlling bleeding.
42. At what time interval should the dressing be changed?
Ans. After every 24 to 48 hours.
43. What is the difference between anesthesia and paresthesia?
Ans. Anesthesia: It is achieved after injecting a chemical known as
local anesthetic agent thereby producing temporary loss of painful
sensation.
Paresthesia: It is a complication in the form of numbness due to
nerve injury.
44. Which type of papilla does not contain taste buds?
Ans. Filliform papilla.
45. Which muscles are present on the floor of the mouth?

Ans. Genioglossus and mylohyoid muscles.
46. Which largest muscle is attached with the body of man-
dible?
Ans. Platysma muscle is attached to the body of mandible.
47. What is the difference between excisional biopsy and
incisional biopsy?
Ans. Excisional biopsy: It is indicated if the lesion is less than 2 cm
in diameter.
Incisional biopsy: It is indicated if lesion is more than 2 cm and
requires a normal tissue with a pathologic tissue.
48. What is the name of the fixer used for biopsy specimen?
Ans. 10% formalin is used.
49. What is incisional biopsy and when is it required?
Ans. It is one of the biopsy techniques. It is required for the removal
of living tissue (diseased and normal tissues), in case lesion is more
than 2 cm in diameter.
50. What is the characteristic feature of excisional biopsy?
Ans. Excisional biopsy includes normal tissues and all of the lesion.
It implies removal of the entire lesion. It should be employed with
smaller lesion less than 1 cm in diameter.
51. What are basic requirements of flap design?
Ans. i. Base of flap should be broad
ii. Provide adequate blood supply
iii. Flap should rest on the healthy bone.
52. List the types of absorbable sutures.
Ans. Plain and chromic catgut, polyglycolic, polyglactin.
53. List the types of nonabsorbable sutures.
Ans. Silk, nylon, stainless steel.
54. Which suture material elicits more tissue reaction among

catgut and silk?
Ans. Catgut elicits more tissue reaction.
55. What is the advantage of chromic catgut over plain catgut
suture material?
Ans. Greater strength, less corrosiveness.
56. Which numbers of blades are used for intraoral and
extraoral incision?
Ans. Intraoral incision: 15 no. blade
Extraoral incision: 10 no. blade.
57. Why are drains used?
Ans. i. To provide exit for pus
ii. To prevent formation of hematoma
iii. To prevent formation of seromas in hard and soft tissues.
58. Which type of needle is used intraorally?
Ans. Round body half circle needle is used.
59. What is the basic disadvantage of dry heat sterilization or
hot air oven?
Ans. Usually 160C for two hours or 120C for six hours is widely
employed for sterilization of the cutting instruments. This whole
process is time-consuming.
60. What is vicryl?
Ans. Polyglycolic acid (vicryl) is an absorbable synthetic suture
material.
61. What is proline?
Ans. Proline is one of the suture materials. Proline or polypropylene
is a synthetic, monofilament, non-absorbable suture material having
minimal transient acute inflammatory reaction.
62. Which is the most commonly used suture material in an oral
surgical procedure?
Ans. Black silk (non-absorbable synthetic suture material) is the
most commonly used suture material.
63. How is gut suture material absorbed?

Ans. Absorbable sutures are digested by the tissue enzymes
through hydrolysis.
64. In what packing is the catgut suture material supplied?
Ans. Surgical gut suture (plain and chromic) supplied with packing
fluid like 90% isopropyl alcohol or 0.5% sodium benzoate or 0.5%
diethyl ethanolamine.
65. What is the advantage of chromic catgut over plaingut?
Ans. Delayed resorption is the advantage over plain catgut. Plain
catgut resorbs in 70 days. Chromic catgut resorbs in 90 days.
66. What concentration of alcohol is effective against spores?
Ans. 70% ethyl alcohol is effective against spores.
67. A patient is on periodic renal dialysis. When and why should
minor oral surgical procedure be performed?
Ans. A patient requires elective oral surgery. Elective surgery is best
undertaken one day after dialysis has been performed because this
allows heparin used during dialysis to disappear and the patient
to be in the best physiologic status with respect to intravascular
volume and metabolic by-products.
68. Which blood product factor VIII cryoprecipitate or factor VIII
concentrate is preferred for preoperative administration
to achieve surgical hemostasis in a patient suffering from
hemophilia A?
Ans. The preferred blood product is factor VIII concentrate.
69. Which agent is used in the management of a hemophilic
patient?
Ans. Tranexamic acid is used in the management of a hemophilic
patient IV 10 mg/kg body weight, 4 to 6 hourly.
70. What percentage of blood loss in case of hemorrhagic shock
may cause hypotension?
Ans. If blood loss is about 30 to 40%, it may cause hypotension.
71. How does pupil look in the patients of syncope?

Ans. Dilated and fixed (dilatation of the pupil). Compression of the
3rd nerve and oculomotor nucleus in brain leads to fixed dilated
pupil nonreacted to light.
72. Which is the most common organism associated with an
attack of subacute bacterial endocarditis (SABE) of dental
origin?
Ans. Streptococcus viridans.
73. How will you treat Ecchymosis and hematoma?
Ans. Ecchymosis: It consists of immediate application of cold
followed by heat if there is no infection. In severe cases, antibiotics
are given along with proteolytic enzymes, which causes breakdown
of coagulated blood.
Hematoma: Ice may be applied to the region immediately on
recognition of a developing hematoma. It acts as a vasoconstrictor
and it aids in minimizing the size of hematoma. Heat may be applied
to the region at the beginning of the next day.
74. What are the early signs of the want of oxygen?
Ans. i. Cyanosis
ii. Increased pulse rate
iii. Tachycardia.
75. What are the important signs of obstruction of air in a
conscious patient?
Ans. i. Stertorous breathing
ii. Pronounced retraction of intercostals and supraclavicular
spaces
iii. Hands over throat (universal sign).
76. What is the primary hazard for an unconscious patient in a
supine position?
Ans. Tongue may fall back tongue obstruction.
77. Which common condition is seen in all types of shocks?
Ans. Inadequate tissue perfusion.
78. When does the hypovolemic shock develop?

Ans. After the loss of 40% of blood, hypovolemic shock develops.
79. What is the common type of shock in maxillofacial trauma?
Ans. Hypovolemic shock.
80. What is the earliest sign of hemorrhagic shock?
Ans. Tachycardia (increased heart rate) is the earliest sign.
81. What is the choice of drug in cardiogenic shock?
Ans. Cardiogenic shock occurs as a result of:
i. Inadequate cardiac output
ii. Impaired oxygen delivery
iii. Reduced tissue perfusion.
It is caused by the loss of effective contractile function of
myocardium. Dopamine IV is the vasopressor of choice.
82. What is the main cause and complication of septic shock?
Ans. It is caused mostly by gram-negative bacteria. Acute
respiratory failure is one of the complications.
83. What is the disadvantage of semilunar incision?
Ans. Limited accessibility is the disadvantage.
84. What are the characteristic features of malignant hyper
tension?
Ans. i. Acidosis
ii. Rigidity
iii. Fever
iv. Hypermetabolism
v. Myoglobinuria.
85. What is the percentage of total body water?
Ans. Total body water is 60% of the body weight in an average male.
86. What is fever?
Ans. Fever is a pathologic state reflecting a systemic inflammatory
process with a core temperature of more than 38C but rarely more
than 40C.
87. What is the most common cause of fever in the first 24 hours
after surgery?
Ans. Aspiration pneumonia.
88. What are the most common causes of fever in the first 24
to 72 hours?
Ans. i. Bacterial pneumonia
ii. Thrombophlebitis.
89. What is the most common cause of fever 72 hours after
surgery?
Ans. i. Pneumonia
ii. Wound infection
iii. Urinary tract infection
iv. Pulmonary emboli
v. IV catheter infection
90. What are the five Ws of postoperative fever?
Ans. Possible causes of any postoperative fever are (i) Wind;
(ii) Water; (iii) Wound; (iv) Walking and (v) Wonder drugs.
91. What are common signs and symptoms of phlebitis?
Ans. Pain, tenderness, edema, erythema and streaking of the limb.
92. How will you manage phlebitis?
Ans. Remove the IV catheter. Elevate the affected limbs. Apply
warm, moist packs to the infected site. Initiate IV antibiotics.
93. What are the most frequent respiratory complications
following oral and maxillofacial surgery?
Ans. Pulmonary atelectasis, aspiration pneumonia and pulmonary
embolus.
94. What are the common causes of postoperative bleeding?
Ans. i. Incompletely ligated
ii. Cauterized vessels
iii. Wound infection
iv. Coagulotherapy
v. Rebound effect of hypotension anesthesia.
95. What are the common causes of postoperative hypotension?

Ans. i. Intravascular hypovolemia
ii. Myocardial depression
iii. Hypothyroidism.
96. What are the most common causes of postoperative
hypertension?
Ans. i. Pain and anxiety
ii. Hypoxia
iii. Hypercapnia
iv. Overdistention of the bladder.
97. What are some possible treatment options for postoperative
hypotension?
Ans. i. Elevation of lower extremities
ii. Administration of vasopressors (ephedrine)
iii. Administration of carefully monitored fluid.
98. Why is postoperative myocardial infarction difficult to
diagnose?
Ans. More than one-third of postoperative myocardial infarction is
asymptomatic as a result of the residual anesthesia and analgesics
administered postoperatively.
(i) Syndrome; (ii) Malformation; (iii) Malformation complex;
(iv) Malformation syndrome.
Ans. i. Syndrome: It means running together. It means two or
more abnormalities in the same individual. The term
syndrome can apply equally as well to one of a kind
condition as to a many of a kind condition.
ii. Malformation: It is defined as a primary structural defect
resulting from localized error of morphogenesis, e.g. cleft
lip and palate.
iii. Malformation complex: It may be defined as a malfor
mation together with its subsequent derived structural
changes.
iv. Malformation syndrome: It may be defined as two or more

malformations or malformation complexes occurring in
the same patient. For example, Goldenhar syndrome,
in which hemifacial microsomia occurs together with
lipodermoid, vertebral defect, cardiovascular and renal
anomalies (unilateral renal agenesis).
100. What do you understand by the following terms:
(i) Paralysis; (ii) Paresis; (iii) Anesthesia; (iv) Ageusia;
(v) Analgesia; (vi) Hyperesthesia; (vii) Hyperalgesia/
hypoalgesia
Ans. i. Paralysis: Loss of motor function in a particular part in
the body
ii. Paresis: Incomplete paralysis denoting neuromuscular
deficit
iii. Anesthesia: Loss of all types of sensation
iv. Ageusia: Loss of taste
v. Analgesia: Loss of sensitivity to painful stimuli
vi. Hyperesthesia: Excessive sensitivity
vii. Hyperalgesia/hypoalgesia: More/less painful stimuli.
101. In which sites are releasing incisions are contraindicated?
Ans. i. Palate
ii. Canine eminence
iii. Lingual surface of mandible
iv. Through muscle attachments
v. In the region of mental foramen.
102. How do the absorbable gelatin sponge (gelfoam) and
oxidized regenerated cellulose (surgical) assist in hemo-
stasis?
Ans. They form a matrix or scaffold upon which a clot can form.
Gelatin sponge does not become as readily incorporated into the
clot as does the oxidized regenerated cellulose. Healing is delayed
more often with cellulose than with the gelatin sponge but oxidized
regenerated cellulose is the more efficient agent.
103. Why are chromic catgut sutures packed in isopropyl

alcohol?
Ans. To prevent enzymatic degradation.
104. In which condition is the typical rail track scar formed?
Ans. In case of delayed wound closure.
105. What are Langers lines and what is their importance?
Ans. Langers lines are usually parallel with skin creases and
perpendicular to the action of the underlying muscle.
They are important in minimizing the scar.
106. Which is the best method to counteract severe acidosis
following CPR?
Ans. Administration of sodium bicarbonate IV.
107. Which is the positive sign if efforts in CPR are effective?
Ans. Constriction of pupils.
108. Where is the entry point in tracheostomy?
Ans. At the cricothyroid ligament.
109. In which patients is preoperative vitamin K indicated?
Ans. In patients with liver disease.
110. In which patients is diazepam contraindicated?
Ans. Psychic depression.
111. What is the side effect of prolonged use of phenytoin
sodium?
Ans. Gingival hypertrophy.
112. Which artery is involved in stroke?
Ans. Lenticulostrate artery.
113. What is the characteristic sign of hemorrhagic shock?
Ans. Increased pulse rateTachycardia.
114. Hemorrhagic shock is characterized by:
Ans. i. Hypotension
ii. Low blood volume
iii. Increased pulse rate.
115. There is a case of patient with the history of chest pain

on exertion which is relieved by rest and nitroglycerine.
What should one suspectangina pectoris or myocardial
infarction?
Ans. Angina pectoris.
116. How does aromatic spirit of ammonia act when a patient
is made to inhale during syncope apart from the positive
action to stimulate respiration?
Ans. Aromatic spirit of ammonia is irritating to the sensory endings
of the olfactory nerve.
117. What complication may arise in a patient with chronic
alcoholism?
Ans. Prolonged bleeding secondary to liver dysfunction. Prior to
surgery, LFT (liver function test) is advised.
118. A pregnant woman in her third trimester becomes uncon
scious on the dental chair. What treatment should be given
to her immediately?
Ans. She should the first lowered in supine position and then
turned to her left side.
119. An odor of acetone in ones breath would give suspicion of
what disease?
Ans. Diabetes mellitus.
120 There is a case of a patient with the history of polydispia,
polyuria and polyp hagia. What is the most probable
diagnosis in this case?
Ans. Diabetes mellitus.
121. What is the primary airway hazard for an unconscious
patient in a supine position?
Ans. Tongue obstruction is the primary hazard. Head tilt and chin
lift positions occur in this case.
122. Preoperatively in hemophilic a patient, which blood product
should be administered?
Ans. Factor VIII concentrate should be administered.
123. Give five cardinal principles of antibiotic therapy.

Ans. i. An antibiotic should not be used blindly. Use should be
appropriate to the anticipated organism
ii. Bacterial resistance may result from inadequate antibiotic
therapy
iii. Bactericidal drugs are not always essential
iv. Apart from the right choice of drug, the appropriate
dosages, mode and frequency of administrations are
important
v. Two or more antibiotics should not be used simultaneously
and if the patient is allergic to drugs, an alternative drug
must be used.
124. What is dog ear suturing?
Ans. Dog ear may develop due to faulty suturing. The suturing
should be removed and reclosure done or the dog ear should be
lifted with tissue forceps and excised. We should avoid creating any
dog ear at the end of the wound.
125. Give five cardinal principles of suturing.
Ans. i. Generally, needle should be placed from labial or the
buccal to lingual and palatal side
ii. Generally, intraoral knot should not be placed on an
incision line. It should be placed the buccal or labial side
without tension
iii. The needle always passes from thinner tissue to thicker
tissue, from deeper tissue to superficial tissue, from
movable tissue to fixed tissue
iv. The needle should enter the tissue perpendicular to the
tissue surface and the needle should be passed through
the tissue along its curve.
v. Dog ear suturing should be avoided.
126. Give five cardinal principles of incision and drainage.
Ans. i. Incision should be placed at the site of maximum
fluctuance
ii. Place the incision in an aesthetically acceptable area and

place the incision in a dependent position to encourage
drainage
iii. Place the drain through and through in case of bilateral
space infection, e.g. bilateral mandibular space infection
iv. Do not leave the drain in place for an overlying extended
period
v. Incision should be in healthy skin and mucosa. Wound
margins should be cleaned daily.
127. Catgut suture material is sterilized by what?
Ans. Ethylene oxide.
128 What are the different positionings of the patient in a dental
chair?
Ans. i. Elevation
ii. Supine position
iii. Semisupine position
iv. Trendelenburg head-down position
v. Lateral position (tilt table position)
vi. Table top turn position
vii. Orthopedic position
viii. Kidney surgery position
ix. Neurosurgery position
x. Lithotomy position.
129. What is the difference between granuloma, cyst and
abscess?
Ans. i. Granuloma is literally a tumor made up of granulation
tissue. This term is used to designate the situation in the
periapical region in which an abscess or localized area of
osteolysis is replaced by granulation tissue.
ii. Cyst is a cavity occurring in hard or soft tissue with liquid,
semisolid or air content. It is surrounded by a definite
connective tissue wall or capsule and may or may not
be lined by epithelium.
iii. Abscess is a localized collection of pus in a cavity formed

by disintegration of tissues usually caused by Staphy
lococcus aureus.
130. After the use of a needle, what is the name of the technique
to cover it?
Ans. Scooping technique.
131. What is Browns test for confirmation of sterilization?
Ans. Ampules contain a chemical indicator which changes its color
from red through amber to green at a specific temperature.
132. What drugs are used in hemophilic patients for systemic
administration?
Ans. i. Desmopressin
ii. Amicar = EACA (Epsilon Amino Caproic Acid)
iii. Cyclokaprone = Tranexamic acid.
133. What are the different types of knots?
Ans. i. Square knot: Two ties are given. The second throw is
opposite the first throw
ii. Surgeons knot: Because of the double throw to the first
tie, this prevents slippage of the first tie while the second
tie is put in place
iii. Granny knot: This knot involves a tie in one direction
followed by a single tie in the same direction as the first
one. However, the third tie squared on the second tie
must be made to hold the knot permanently.
134. Give different suturing techniques.
Ans. i. Interrupted sutures
ii. Continuous sutures
iii. Continuous locking sutures
iv. Horizontal mattress sutures
v. Vertical mattress sutures
vi. Figure of 8 suture
vii. Subcuticular sutures.
135. What is WHO standardized grading scale to measure the

severity of bleeding?
Ans. Grade 0no bleeding
Grade 1petechial bleeding
Grade 2mild blood loss (clinically significant)
Grade 3gross blood loss (serious), needs transfusion
Grade 4debilitating blood loss, (retinal or cerebral) asso-
ciated with fatality.
136. What is the anatomic radiolucencies of lower jaw?
Ans. i. Mandibular foramen
ii. Mandibular canal
iii. Mental foramen
iv. Mental fossa
v. Midline symphysis
vi. Medial sigmoid depression
vii. Airway shadow
viii. Lingual foramen
ix. Submandibular fossa
x. Anterior Buccal mandibular depression
xi. Cortical plate mandibular defect.
137. What is the anatomic radiolucencies of maxilla?
Ans. i. Incisive foramen.
ii. Incisive canal.
iii. Nasal cavity.
iv. Naris.
v. Nasolacrimal duct.
vi. Maxillary sinus.
vii. Greater palatine foramen.
138. What are the common radiolucency involving both the
jaws?
Ans. i. Pulpal chamber and root canal.
ii. Periodontal ligament space.
139. What are the anatomic radiopacities of jaws?

Ans. Radiopacities common to both the jaws are as follows:
i. Teeth
ii. Bone
iii. Cancellous bone
iv. Cortical plates
v. Lamina dura
vi. Alveolar process.
140. What are the anatomic radiopacities of peculiar to maxilla?
Ans. i. Nasal septum and boundaries of the nasal fossa
ii. Anterior nasal spine.
iii. Canine eminence.
iv. Walls and floor of maxillary sinus.
v. Zygomatic process of maxilla and zygomatic bone.
vi. Maxillary tuberosity.
vii. Pterygoid plates and pterygoid hamulus.
viii. Coronoid process.
141. What are the anatomic radiopacities of peculiar to
mandible?
Ans. i. External and internal oblique ridge.
ii. Mylohyoid ridge.
iii. Mental ridge.
iv. Genial tubercles.
142. Which are the superimposed radiopacities on the radio
graphs?
Ans. i. Soft tissue shadows
ii. Mineralized tissue shadows.
143. Suture material should be removed after how many days?
Ans. From oral cavity5-7 days
Head and neck region5 days
Other sites5-10 days.
144. How will you differentiate between the bleedings from

artery, vein and capillary?
Ans.
Arterial Venous Capillary

hemorrhage hemorrhage hemorrhage
1. It will be bright 1. It will be dark red in 1. An intermediate color
red in colour color (bluish color) (between brisk red
(brisk red) and bluish color)
2. Pulsating 2. No pulsating quality 2. Capillary blood will be
character oozing
3. The flow will be 3. The flow will be less 3. It is nonpulsating in
vigorous rapid nature
It may be aggressive
in nature in oral and
maxillofacial region.
145. List the rule of 1 mm/2 mm/3 mm and 5 mm for suturing.

Ans. On an average the suturing should be done:
i. 1 mm distance from top of the incision line
ii. 2 mm distance from the margin of incision line
iii. 3 mm depth from the surface
iv. 3 to 5 mm distance between two suture.
chapter
Local Anesthesia 4
1. Which is the first local anesthesia to be used clinically?
Ans. Cocaine in 1860 by Albert Niemann. In 1884, William Halstead
used cocaine for dental nerve block.
2. Define local anesthetic agent, local anesthesia and general
anesthesia?
Ans. Local anesthetic agents: These are the drugs which when
applied directly to the peripheral nervous tissue, block nerve
conduction and abolish all the sensations in the part supplied by
the nerve. They are generally supplied by the somatic nerve and are
capable of acting on axon, cell body, dendrites and synapses.
Local anesthesia: It is the local state of loss of sensation without the
loss of consciousness in a circumscribed area of the body due to
an inhibition of the conduction process in the peripheral nerves.
General anesthesia: It is a state which brings about the loss of all
modalities of sensation, particularly pain along with a reversible
loss of consciousness.
3. What are the contents of the anesthetic agent Lignocaine?
Ans. i. HCl = 2% (20 mg/ml)
ii. Adrenaline hydrochloride-vasoconstrictor-1:80000
(0.012 mg)
iii. Sodium metabisulfite 0.5 mg (preservative/vasocons
trictor/reducing agent)
iv. Methyl paraben (preservative/bacteriostatic) or Capryl
hydrocupreinotoxin which is included in xylotox = 0.1%
(1 mg)
Local Anesthesia 59
v. Sodium chloride (isotonic solution) = 6 mg

vi. Sodium hydroxide = to adjust pH
vii. Thymol = fungicidal
viii. Ringers solution = as vehicle to minimize discomfort
during injection
ix. Distiled water for dilution.
4. What are the theories to explain the mode of action of
local anesthesia (LA) and which theories are the most
acceptable?
Ans. i. Surface charge theory (Electric potential theory)
ii. Membrane expansion theory
iii. Specific receptor theory
iv. Acetylcholine theory
v. Reversible coagulation theory
vi. Calcium displacement theory
vii. Interference with nerve metabolism.
The most accepted theory is Specific receptor theory.
5. What is the most accepted specific receptor theory?
Ans. It decreases the permeability of the nerve membrane to the
sodium ions.
6. Which local anesthetic is used in a hemophilic patient?
Ans. Periodontal ligament/Intraligamentous technique.
7. What are the ideal requisites of a local anesthetic agent?
Ans. i. It should not be irritating to the tissue.
ii. It should not cause any permanent damage to the nerve
structure.
iii. Its systemic toxicity should be low.
iv. The time of onset of anesthesia should be as short as
possible.
v. The duration of action must be long enough to permit
the completion of procedure.
vi. It should be stable in solution.
vii. It should be relatively free from producing allergic

reaction.
viii. It should readily undergo biotransformation in the body.
ix. It should be capable of being sterilized by heat without
deterioration.
x. Its action should be reversible.
8. Which content of local anesthesia (amide type) may cause
allergic reaction most likely?
Ans. Allergic reaction caused by methylparaben used as germicidal
or preservative.
9. Which is the alternative content in case a patient is allergic
to methylparaben?
Ans. Capryl hydrocupreinotoxin, which is included in xylotox.
10. Local anesthetic injection results in the loss of function in
which order?
Ans. Pain > Temperature > Touch > Proprioception > Motor
sensation.
11. What are the other names of the following:
(i) Nasopalatine nerve block; (ii) Greater palatine nerve
block; (iii) Posterosuperior alveolar nerve block; (iv) Inferior
alveolar nerve block; and (v) Long buccal nerve block.
Ans. i. Nasopalatine nerve block:
a. Posterior palatine nerve block
b. incisive canal injection
ii. Greater palatine nerve block: Anterior palatine nerve block
iii. Posterosuperior alveolar nerve block: Zygomatic block
iv. Inferior alveolar nerve block: Pterygomandibular block
v. Long buccal nerve block: Buccinator nerve block and
buccal nerve block.
12. What is the maximum dose of local anesthesia in ml?
Ans. i. Local anesthesia with adrenaline (1: 80000) = 20 ml
ii. Local anesthesia without adrenaline = 14 ml
Local Anesthesia 61
13. Which is the most effective local anesthetic agent as topical

anesthesia?
Ans. Benzocaine.
14. Which of the following is not available as topical anesthesia?
Ans. Procaine is not available as topical anesthesia.
15. Majority of local anesthetic agent without adrenaline have
pH?
Ans. pH = 5.5 acidic in nature (The normal tissue pH = 7.0 (approx).
16. Which local anesthetic agent is not affected by the
effectiveness of tissue pH?
Ans. Benzocaine.
17. Why is lignocaine preferred as the local anesthetic agent
in comparison of procaine?
Ans. Since it causes less allergic reaction.
18. Which local anesthetic agent causes vasoconstriction
without a vasoconstrictor?
Ans. Cocaine.
19. What is the average duration of nerve anesthesia with 2%
lignocaine with 1 : 200000 adrenaline?
Ans. More than 60 minutes.
20. Which is the longest acting LA?
Ans. Bupivacaine 0.5% (pharmacologically belongs to the amide
group) and tetracaine = 175 minutes is the duration.
21. What is the first choice of drug in anaphylaxis?
Ans. Adrenaline 0.5 mg in 1:1000 I/M.
22. What is the exact cause of death due to local anesthetic
toxicity?
Ans. It is due to medullary depression.
23. What is the rate of deposition of LA?
Ans. Local anesthetic should be deposited at the rate of 1 ml per
minute.
24. In severe liver disease, which local anesthetic drug can be

used safely?
Ans. Procaine.
25. In case of allergy to procaine, which LA is contraindicated?
Ans. Topical spray of tetracaine.
26. How much lidocaine is present in dental cartridge (2 cc)
containing 2% lidocaine (xylocaine)?
Ans. 1 ml contains 20 mg or 2 grams. So two cc cartridge contains
40 mg or 4 grams.
27. Pain sensation is conducted through which fibers?
Ans. A-delta fibers.
28. Where does the LA act and how?
Ans. LA acts on the nerve membrane, blocking the conduction of
sodium from exterior to interior.
29. In general, what are the standard anesthetic cartridges
available?
Ans. Cartridges with 1.8 ml and 2.0 ml of the required contents.
30. Where is the LA metabolized in our body?
Ans. Plasma, liver and lungs.
31. Which LA undergoes biotransformation in the kidney?
Ans. Prilocaine is biotransferred in the kidney.
32. Syncope, trismus, hematoma and facial paralysisout of
these which is the most common complication of the LA?
Ans. Syncope is the most common complication in dental clinic.
33. What complication can arise if LA is injected in LA hyper-
thyroid patient?
Ans. i. Increased sensitivity
ii. Toxic crisis
iii. Tachycardia
iv. Fainting
v. Chest pain.
Local Anesthesia 63
34. Threshold of pain tolerance depends upon.

Ans. i. Fear and anxiety
ii. Mental status of the patient
iii. Age of the patient
iv. Previous experience.
35. How can we prevent syncope during anesthetic injection?
Ans. i. By administration of premedication
ii. By placing the patient in the reclined position
iii. Aspiration of syringe before the deposition of solution
(negative aspiration).
36. In syncope, if the patients condition deteriorates, what first
step should be carried out?
Ans. Administration of 100% oxygen can improve the condition.
37. What is the role of inhalation of aromatic spirit of ammonia
in the management of the syncope?
Ans. It acts as a respiratory stimulant.
38. How will you manage hyperventilation due to LA drug?
Ans. The patient is made to rebreathe in and out of a bag, such a
waste-paper bag, until recovery occurs.
39. If hyperventilation is not treated, which complication may
arise?
Ans. Tetany the complication characterized by extensive spasm of
skeletal muscle causing Trismus.
40. In the cases of cardiac patients, how many cartridges can
be given?
Ans. Only two cartridges, approximately 4 ml can be given.
41. Which is safest LA in children and why?
Ans. 2-chloroprocaine, due to short duration and less toxicity.
42. Which is the most toxic local anesthetic agent?
Ans. Propoxycaine.
43. Why is anesthetic effect not obtained in the presence of

inflammation or pus formation?
Ans. Because pH is decreased due to inflammation or pus formation
meaning more acidic media. It results in the abundance of H+ ions
outside the nerve sheath and the equilibrium of reaction in the
formation of lipophilic molecule [RH] is shifted to the left. Therefore,
RH fails to enter the nerve and cannot block the conduction of
impulse.
44. How the local anesthetic effect be increased?
Ans. Local anesthetic effect can be increased by addition of
adrenaline. In small doses, it causes vasoconstriction.
45. What are the advantages of adrenaline in a local anesthetic
agent?
Ans. Five advantages are:
i. It decreases the blood flow to the site of injection because
of vasoconstriction.
ii. It decreases the rate of absorption of the local anesthetic
agent into the cardiovascular system
iii. It lowers the plasma level of the local anesthetic agent,
thereby decreasing the risk of the systematic toxicity of
the local anesthetic agent
iv. Higher volumes of the local anesthetic agent remains
around the nerve for a longer period, thereby increasing
the duration of action
v. It decreases bleeding at the site of injection because of
the decreased perfusion.
46. What does the systemic absorption of LA cause?
Ans. i. Tonic clonic convulsion
ii. Decreased cardiac output
iii. Respiratory depression.
47. Accidental intravenous injection of LA, which contains a
vasoconstrictor, may cause.
Ans. i. Palpitation
ii. ConvulsionMost significant adverse consequence.
Local Anesthesia 65
iii. Unconsciousness
iv. Depressed respiration
v. Increased respiration.
48. What is the excess level of lignocaine can cause CVS collapse
due to?
Ans. Myocardial depression.
49. What is the cause of syncope in the patients receiving LA
(lignocaine-adrenaline 1:80,000) within 30 seconds of
injecting it?
Ans. The most probable cause is cerebral hypoxia or due to
temporary cerebral ischemia.
50. Why is lignocaine used most commonly in dentistry?
Ans. Because of the lesser incidence of allergy.
51. In reference to local anesthetic agent (Lignocaine):
Ans. i. Pharmacologically belongs to which groupAmide
group
ii. NatureAcidic salts and weak base.
52. What is the time of the onset action of LA?
Ans. 3-5 minutes is the time of the onset of LA.
53. A patient following local anesthesia manifests pallor and
becomes unconscious. What is the reason?
Ans. Syncope is the probable reason, which is associated with
bradycardia.
54. A patient who fainted during the extraction position should
be given, what is the immediate treatment?
Ans. The patients position should be Trendelenburg or head-down
(10 to 15).
55. Which is most alarming respiratory condition in the dental
clinic?
Ans. Aponea or respiratory arrest is the most common cause of
death due to overdoses of LA in the dental clinic.
56. What is the maximum dose of adrenaline in a normal patient

and a patient with cardiac problem?
Ans. In a normal patient, 0.2 mg is the safe dose. In a cardiac patient,
0.04 mg is the safe dose.
57. What are the symptoms of overdose of epinephrine
following LA injection?
Ans. i. Restlessness
ii. Apprehension
iii. Palpitation.
58. A cartridge with LA should not be soaked in alcohol. Why?
Ans. Alcohol can diffuse through rubber cap and cause contami
nation, neurolysis and even may result in paresthesia.
59. What is the drug of choice to control status epilepticus due
to overdose of LA?
Ans. Diazepam is the drug of choice.
60. What are the clinical signs of toxic signs of LA?
Ans. i. Convulsion
ii. Asystole
iii. Methemoglobinemia.
61. Due to overdose of LA, a patient will observe what
hypotension or hypertension?
Ans. Hypotension due to the vasodilatation properties of LA
62. What is the role of sodium metabisulfite in local anesthetic
agent?
Ans. Its role is to act as a reducing agent in local anesthetic to
prevent the oxidation of vasoconstrictor (adrenaline). It competes
with vasoconstrictor for the available oxygen and is oxidized to
sodium bisulfate.
63. What are the common drugs used for anesthetic
emergencies?
Ans. i. Dexamethasone
ii. Epinephrine (Adrenaline)
Local Anesthesia 67
iii. Atropine
iv. Avil
v. Aminofilin.
64. What is EMLA?
Ans. EMLA consists of 5% cream containing 25 mg/gram lidocaine
+ 25 mg/gram prilocaine. It is used for skin anesthesia. It is
contraindicated in the age-group below six months because of the
possibility of prilocaine induced methemoglobinemia.
65. What are the gases present in LA cartridges and why?
Ans. The gases present in LA cartridges are:
i. Nitrogen
ii. Oxygen.
The purpose is to prevent the deterioration of vasoconstrictor.
66. Name the gas used in a LA cartridge?
Ans. Nitrogen gas is used in dental cartridges in the form of a
small bubble about 1-2 mm in diameter. Nitrogen may not always
be visible in the normal cartridge.
67. What is hyaluronidase?
Ans. Hyaluronidase is an enzyme that breaks down the intercellular
content. It is added to LA to speed-up both the onset of the
anesthesia and the area of anesthesia.
68. What do you understand by induction time?
Ans. Induction time is defined as the timeperiod from the
deposition of the anesthetic solution to the complete conduction
blockade.
69. Which type of nerve fibers require more concentration of
the local anesthetic agentmotor fibers or sensory fibers?
Ans. Motor fibers require more concentration of the local
anesthetic agent.
70. What is the role of LA on myocardium?
Ans. It produces the depressant effect.
71. What does a local anesthetic agent initially affectssmaller

nerve fibers or larger nerve fibers?
Ans. Anesthesia of smaller nerve fibers occurs prior to that of the
larger nerve fibers.
72. What is basic difference between lignocaine and cocaine?
Ans.
Lignocaine Cocaine
1. Action on vessel- 1. Action on vessel-
vasodilatation vasoconstriction
2. Synthetic local 2. Natural local
anesthetic agent anesthetic agent
3. Produces vasoconstriction 3. Produces vasoconstriction
with adrenaline without adrenaline
4. Amide 4. Ester of benzoic acid.

73. Sensitivity of LA is greater in which type of fibers?
Ans. Type C fibers.
74. What is the onset time-period of lignocaine, xylocaine or
lidocaine?
Ans. 3-5 minutes is the onset time-period.
75. Which route of sedation is reversed most rapidly?
Ans. Inhalation route is most rapidly reversed.
76. In which condition LA is not effectivelocal infection or
edema?
Ans. LA is not effective in the local infection.
77. While giving inferior nerve block, if the bone is not contac
ted, then there are chances of what ailment?
Ans. Transient facial paralysis because the needle may pierce
the parotid gland and main trunk of the facial nerve may get
anesthetized causing facial paralysis.
78. After inferior nerve block, a patient has the difficulty in
opening eyelid on the side of injection. What is the probable
cause?
Ans. Anesthesia of facial nerve within the parotid gland.
Local Anesthesia 69
79. What is the cause of trismus resulting after the inferior nerve
block?
Ans. Damage to the medial pterygoid muscle.
80. What are the structures passing through the inferior nerve
block?
Ans. Mucous membrane Buccinator muscle Alveolar tissue.
81. Injury to the inferior alveolar nerve may result in what?
Ans. Temporary paresthesia of the lower lip.
82. What are the alternative techniques for the IAN block apart
from the classical IAN block?
Ans. i. Gow-Gates intraoral open mouth technique
ii. Akinosi intraoral closed mouth technique.
83. Which is the site of deposition of LA in:
(i) Classical inferior alveolar nerve block; and (ii) Gow-Gates
technique.
Ans. i. Classical inferior alveolar nerve block: Pterygomandibular
space
ii. Gow Gates technique: At the anterior region of the
condyle.
84. Why at a time is bilateral lingual nerve block contraindicated?
Ans. It may cause the loss of tongue movement and the tongue
may fall back, causing airway obstruction. If necessary, tongue may
be held with traction suture or it may be gently held.
85. Which facial space causes primary infection in case it is
contaminated during inferior alveolar nerve block?
Ans. Pterygomandibular space is primarily involved because the
solution is deposited in that space.
86. Sometimes swelling appears immediately after injecting
inferior alveolar nerve block on the injecting side. Why?
Ans. It may be due to injury to blood vessel.
87. Which is the most difficult maxillary tooth anesthetized by

the local infiltration technique?
Ans. Maxillary first molar due to the thick zygomatic covering.
88. In the posterosuperior alveolar nerve block, what are the
direction and position of the needle?
Ans. The needle is advanced slowly in upward, inward and
backward directions
Upward: Superiorly at 45 angle to the occlusal plane
Inward: Medially towards the midline at 45 to the occlusal
plane.
Backward: Posteriorly at 45 angle to the long axis of the
second molar.
89. In which nerve block most subjective symptoms are absent?
Ans. i. Long buccal nerve block
ii. Posterior superior alveolar nerve block.
90. What is the precaution to be taken while giving posterior
superior alveolar nerve block?
Ans. Short needle25 mm should be used instead of long needle.
Otherwise it may cause damage to:
i. Pterygoid venous plexus
ii. Posterior superior alveolar artery.
91. In which condition is the inferior alveolar nerve block
absolutelycontraindicated in the hemophiliac or von
Willebrand disease?
Ans. In hemophiliac disease, it is absolutely contraindicated.
92. Allergy to local anesthesia is due to, what?
Ans. Antigen antibody reaction.
93. Which muscles are inserted on pterygomandibular raphe?
Ans. i. Buccinator muscle
ii. Superior pharyngeal constrictor muscle.
94. Which two structures form a V-shaped landmark for an
inferior alveolar nerve block?
Local Anesthesia 71
Ans. i. Deep tendon of the temporalis muscle

ii. The superior pharyngeal constrictor muscle.
95. Local anesthesia is the most effective in which medium?
Ans. Alkaline medium.
96. A patient with periapical abscess after local anesthesia still
complains of pain while removing the tooth. Why?
Ans. Inadequate anesthesia due to infection.
97. Which are the structures anesthetized by greater palatine
nerve block?
Ans. Posterior portion of the hard palate and overlying structure
up to the first premolar on the injected side.
98. To achieve palatal side anesthesia in the region of the molar
teeth, the needle should enter in which foramen?
Ans. The needle should enter the greater palatine foramen.
99. Which nerves are anesthetized in the infraorbital nerve
block?
Ans. i. Anterior superior alveolar nerve
ii. Middle superior alveolar nerve.
100. The patient can be protected best from the toxic effect of
LA?
Ans. Using an aspirating technique. Before the deposition of the LA,
it should be aspirated and if blood comes in the syringe, it should
be withdrawn and again inserted.
101. Accidentally intravascular injection of 2% lignocaine with
adrenaline 1 : 100,000 are the clinical signs?
Ans. Hypertension, tachycardia and headache.
102. A patient susceptible or untoward to epinephrine, even in
small amount may suffer from what ailments?
Ans. i. Marked increase in BP
ii. Increased heart rate arrhythmias.
103. A woman having late pregnancy should never be in the

supine position on a dental chair. Why?
Ans. i. It can produce caval compression
ii. The uterus may press on the inferior vena cava
iii. It can produce hypotension syndrome.
104. What type of LA can be used in the pregnant or lactating
patients?
Ans. Lignocaine, prilocaine, or etidocaine can cross the placentrex
barrier but these are generally safe unless in excessive amount.
105. After LA with vasoconstrictor, there is an absence of pulse
rate and respiration. What is the reason?
Ans. Due to the anaphylactic reaction.
106. Due to LA, allergic reaction is characterized by what?
Ans. i. Cardiovascular collapse
ii. Angioneurotic edema
iii. Bronchospasm
iv. Urticaria.
107. A patient is allergic to the PABA derivatives. Which LA should
be considered as an alternative in this case?
Ans. Lidocaine (amide group).
108. Out of the following, which groups of drugs eliminate all the
sensationsanesthetics/analgesics/narcotics/sedatives?
Ans. Only anesthetics eliminate all the sensations.
109. Which drug counteracts the CNS stimulation due to
accidental introduction into the vascular bundle?
Ans. Pentobarbital counteracts the CNS stimulation.
110. What is the important data related to the LA 2.3.4.5.6.7.8.?
Ans. i. Its molecular weight is 234.
ii. Protein binding is 56%.
iii. Its PH is just 7.8.
111. Where is the greater palatine foramen present?
Ans. Between the second and third maxillary molar.
Local Anesthesia 73
112. In greater palatine nerve block, what should be the position

of the needle?
Ans. The needle should be perpendicular to the mucosa.
113. For extraoral mandibular nerve block, the needle should
be inserted from which position?
Ans. Below the zygomatic arch.
114. For the extraoral maxillary nerve block, what is the target
area?
Ans. Anterior to the lateral pterygoid plate.
115. To control the tonic-clonic seizure following lignocaine
toxicity the drug of the choice, what would be?
Ans. Diazepam.
116. What is the basic difference between asthmatic attack and
laryngeal edema in case of respiratory reaction in systemic
complication?
Ans. Asthmatic attack: Lower respiration system is involved
Laryngeal edema: Upper respiratory system is involved which
may cause airway obstruction and may even cause death.
117. What is main difference with reference to LA post-injection
complication?
Ans. i. Herpes simplex:
Viral infection
Site of soft tissue of hard palate (fixed tissue).
ii. Recurrent aphthous stomatitis:
Bacterial infection
Site-free movable tissue (buccal vestibule).
118. Which group of patients are called walking bombs and
why?
Ans. Cocaine abuses because the risk of death is more in the
patients with the use of local anesthesia with adrenaline. Moreover,
cocaine has vasodilator action.
119. When is the appropriate time to administer an analgesic to

control the postoperative pain?
Ans. An analgesic should be administered before the anesthetic
effects wear off.
120. Which is the drug of choice in the management of acute
allergic reaction involving hypotension?
Ans. Adrenaline is the choice of drug.
121. Toxic effect the after administration of LA with epinephrine
are probably due to LA agent. What is the most significant
sign?
Ans. Drowsiness is the most significant sign.
122. What is the difference between nerve block and field block
techniques of local anesthesia?
Ans.
Nerve block Field block
1. Local anesthetic solution is 1. The solution is deposited in proximity
deposited within the close to the larger terminal branch to
proximity to the main nerve achieve regional anesthesia
trunk, which blocks the nerve In this method, anesthetic solution
impulses. is deposited at or above the apex of
2. Nerve block involves a large the tooth to be extracted
area, e.g. pterygomandibular 2. Field block is more circumscribed,
block. involving tissue in and around one
or more teeth.
123. What are the methods of local anesthesia or regional

anesthesia?
Ans. The methods are summarized as follows:
i. Nerve block
ii. Local infiltration
iii. Field block
iv. Surface anesthesia
v. Intraligamentary injection.
Local Anesthesia 75
124. What are the different local infiltration methods?

Ans. The different local infiltration methods are as follows:
i. Submucosal injection
ii. Supraperiosteal injection
iii. Subperiosteal injection
iv. Intrabony injection
v. Intraseptal injection
vi. Intraligamentary injection
vii. Palatal infiltration
viii. Intrapulpal injection.
125. What are the two peculiarities of the mental nerve block?
Ans. i. Mental nerve is not responsible for any tooth innervation.
So, mental nerve block is not indicated for any tooth
extraction.
ii. Mental nerve block is mainly to anesthetize the mucous
membrane of the lower lip and skin of the chin.
126. What is Kurt-Thoma technique for mandibular nerve block?
Ans. It is indicated in the patients with limited mouth opening
(trismus and ankylosis). The needle is inserted through the skin from
below the lower border of the angle of mandible close to the inner
surface or ramus, so that the needle finally comes from the medial
to the mandibular foramen. Aspiration is done and the solution is
deposited.
127. How will you classify a local anesthesia agent according to
the time-period of action?
Ans. According to the time-period of action, LA can be classified
as follows:
i. Ultra-short acting: Less than 30 minutes:
2% lignocaine without vasoconstrictor
Procaine without vasoconstrictor
ii. Short acting: 45 to 75 minutes:
2% lignocaine with 1:100,000 adrenaline
4% prilocaine when used for nerve block
iii. Medium acting: 90 to 150 minutes:

4% prilocaine with 1:200,000 adrenaline
2% lignocaine for pulpal anesthesia
iv. Long acting: 180 minutes or more:
0.5% bupivacaine with 1:200,000 adrenaline
0.5% etidocaine with 1:200,000 adrenaline.
128. What are the immediate and late complications of a local
anesthetic agent?
Ans. i. Immediate complications:
Pain during injection
Burning sensation during injection
Breakage of needles
Syncope
Hematoma
Toxic reaction
Allergic reaction
Anesthesia in the non-specific areas.
ii. Late complications:
Self-indicated trauma
Infection
Difficulty in mouth opening
Paresthesia.
129. What is the sequence of mechanism of action of a local
anesthetic agent?
Ans. The following sequence was proposed by Covino and Vassallo
1976:
i. Displacement of calcium ions from the sodium channel
receptor sites
ii. Binding of the local anesthetic molecule to this receptor
site
iii. Blockade of the sodium channel
iv. Decrease in the sodium permeability
v. Depression of the rate of the electric depolarization
vi. Failure to achieve threshold potential
Local Anesthesia 77
vii. Lack of the development of propagated action potential

viii. Conduction blockade.
130. What are the pain conduction (pain perception) theories?
Ans. i. Specific theory
ii. Pattern theory
iii. Gate control theory.
131. What are vasoconstrictors? What is the systemic action of
epinephrine (adrenaline)?
Ans. Vasoconstrictors are the chemical agents or adjuncts added
to the local anesthetic solutions to appose vasodilation caused by
these agents and to achieve hemostasis.
Systemic actions of epinephrine are:
i. It stimulates myocardium
ii. Greater incidence of dysrhythmias
iii. It produces dilation of coronary arteries
iv. Systolic blood pressure is increased, whereas diastolic
blood pressure is decreased in smaller doses and increase
in larger doses
v. OHCVS: Increased stroke volume, increased heart rate,
increased cardiac output, increased blood pressure
(diastolic and systolic), increased myocardial oxygen
consumption
vi. Respiratory system: Potent dilator for the smooth muscles
vii. CNS: In a normal dose, it does not stimulate CNS. In a high
dose, it may stimulate CNS.
132. What are the components of dental cartridge?
Ans. i. Cylindrical glass tube
ii. Stopper (plunger, bung)
iii. Aluminium cap
iv. Diaphragm.
133. What are the contraindications of the use of vasoconstrictors?
Ans. i. Patients with blood pressure more than 200 mm Hg/
115 mm Hg
ii. Patients with uncontrolled hyperthyroidism

iii. Patients with severe cardiovascular disease
Less than 6 months after myocardial infarction
Less than 6 months after cerebrovascular accident
Episodes of angina pectoris
Bypass surgery less than 6 months
iv. Patients on tricyclic antidepressants
v. General anesthesia with halogenated agents.
134. Should glass cartridges be autoclaved?
Ans. No, autoclaving of glass cartridges destroys their seals. The
heat of autoclaving also degrades the heat labile vasopressor.
135. Should the dental cartridges be stored in alcohol or a cold
sterilizing solution?
Ans. No, because it may get diffused into the cartridges and may
cause burning sensation, irritation or paresthesia.
136. What is the difference between the bicuspid and central
incisor techniques for infraorbital nerve block?
Ans.
Bicuspid approach Central incisor approach
1.The needle is inserted at a distance 1.The needle bisects the crown of the
of 5 mm from the labial plate in central incisor into the distoincisal
order to pass over the canine fossa. and mesial gingival halves at a
distance of 0.5 mm from the bone
into the mucobuccal fold.
137. What is the reason oozing or bleeding from the extraction

socket after the third molar surgery when sometime has
elapsed?
Ans. During posterior superior alveolar nerve block, if the needle
is inserted more deeply, it may cause damage to the following
structures:
i. Pterygoid plexus of veins
ii. Posterior superior alveolar artery.
Local Anesthesia 79
138. Why is nasopalatine (sphenopalatine or incisive canal

injection) more resistant and painful?
Ans. Nasopalatine injection is more resistant and painful because:
i. Of the presence of free nerve endings in abundance
ii. Thick palatal mucoperiosteal flap causes resistance.
iii. Presence of narrow incisive canal, rapid forceful injection
may cause pressure on nerve, resulting in painful
sensation.
139. List the landmarks to make an imaginary line for infraorbital
nerve block.
Ans. The pupils of the eye when the patient looks straight:
i. Supraorbital notch
ii. Infraorbital notch
iii. Infraorbital foramen
iv. Mental foramen.
140. Typical but True
Ans. i. In which nerve block is the syringe/needle position from
the opposite side?
Inferior alveolar nerve block
Greater palatine nerve block.
ii. In which nerve block
Mouth should be in the wide open position = Inferior
alveolar nerve block
Mouth should be-half open position (cheek should
be retracted the maximum) = Posterior superior
alveolar nerve block
Mouth can be close but upper lip retracted maximum
= Infraorbital nerve block.
chapter
Exodontia 5
1. Define exodontia/tooth extraction.
Ans. Exodontia: It is a branch of oral surgery which deals with the
extraction of teeth.
Tooth extraction: The ideal tooth extraction is the painless
removal of the whole tooth or the tooth root with minimal trauma
to the investing tissue so that the wound heals uneventfully and no
prosthetic problem is created.
2. Which media can be used to transport the avulsed tooth?
Ans. i. Saliva
ii. Fresh milk
iii. Balanced salt
iv. Hank balanced salt solution (HBSS): If the tooth is placed
in an appropriate medium within 15 to 20 minutesIn
saliva the periodontal cells can remain vital for 2 hours.
In fresh milk, a tooth can remain vital for 6 hours. In
balanced salt solution, a tooth can remain vital for 24
hours.
3. Why is water a harmful medium to transport the avulsed
tooth?
Ans. As the water is a hypotonic fluid, it may cause periodontal
ligament cell death when it enters the cells down the osmotic
gradient, causing cell lysis and death.
4. How long should the extruded or avulsed teeth be splinted?
Ans. 7 to 10 days.
Exodontia 81
5. What are the different positions of an operator for the

extraction of teeth from different quadrants?
Ans. i. Upper left and right quadrants: Front the right side of the
patient
ii. Lower left quadrant: Front the right side of the patient
iii. Lower right quadrant:
Anterior teethFront right side of the patient
First and second premolarSlightly right side of the
patient
First and second molarExactly right side of the
patient
Third molarBehind the right side of the patient
6. Which tooth is extracted standing behind the patient?
Ans. Ideally mandibular right side third molar should be extracted
standing just behind the patient and the right side first and second
molar can also be extracted standing behind the patient.
7. What is the height the chair during the maxillary and
mandibular teeth extraction?
Ans. i. For maxillary teeth: 8 cm (3 inches) below the shoulder
level of the operator
ii. For mandibular teeth: 16 cm (6 inches) below the elbow
level of the operator.
8. How should be the beaks of the tooth extraction forceps
on the tooth surface?
Ans. The beaks of the tooth extraction forceps should be parallel
to the long axis of the tooth surface.
9. What should be the position of the tips of the beak of tooth
extraction forceps on the tooth surface?
Ans. The tips of the beaks should be on the root as far apically as
possible, minimum at the CE junction.
10. Which structure of the tooth receives the maximum force as
per the design of the beak of the tooth extraction forceps?
Ans. Maximum force should be transmitted to the root of the tooth.
11. What should be position of the occlusal plane of the

mandibular teeth when they are to be extracted?
Ans. The occlusal plane of the mandibular teeth should be parallel
to the floor when the mouth of the patient is wide open.
12. What is the important principle during extraction?
Ans. Least trauma to bone and mucosa.
13. Give the different parts of a tooth extraction forcep and a
dental elevator.
Ans.
Tooth extraction forcep Dental elevator
Beak Blade
Hinge Shank (shaft)
Handle Handle
14. What should be the position of the patient when the

maxillary teeth are to be extracted from a patients mouth?
Ans. When maxillary teeth are to be extracted, the patient should
be positioned in a such a way that the occlusal plane of the maxillary
teeth should be at 45 to the floor when the mouth is wide open.
15. What is the sequence of extraction?
Ans. The sequence to be followed for extraction is 8, 7, 5, 6, 4, 2, 3,
and 1.
Maxillary teeth should be extracted before the mandibular
teeth.
16. What are the methods of extraction?
Ans. i. Close (forceps extraction method) or intra-alveolar
extraction
ii. Open method (surgical extraction) or transalveolar
extraction.
Exodontia 83
17. What is the difference between close and open methods of

tooth extraction?
Ans.
Close method Open method
1. It is also known as forceps extrac 1. It is also known as surgical extrac
tion or intra-alveolar extraction tion or transalveolar extraction
2. The tooth is extracted entirely 2. The operator gains direct access
from the tooth socket within to the alveolar bone and root after
the alveolar bone raising the overlying soft tissue
3. The technique consists of 3. The technique consists of raising
removing the tooth or root by the flap. Removal of the bone
the use of forceps or elevator followed by tooth removal.
or both
18. What are the five steps of tooth extraction?

Ans. The five steps of tooth extraction are:
i. Reflection of the mucoperiosteum flap with the help of
periosteum elevator
ii. Luxation of tooth with or without the use of dental
elevator up to grade 1 mobility (up to 1 mm mobility of
tooth)
iii. Further luxation of tooth with or without the use of dental
elevator up to grade 3 mobility (up to 3 mm mobility of
tooth)
iv. Deliver the tooth from the socket with the help of the
tooth extraction forcep.
v. Compression of the socket with finger pressure to check
the bleeding and recontouring of the alveolar ridge.
19. What are the mechanical principles of the tooth extraction?
Ans. Mainly there are three mechanical principles:
i. Expansion of bony socket: To permit the removal of the
tooth from the socket
ii. The use of a lever and fulcrum: To force a tooth or root out
of the socket along the path of least resistance
iii. The insertion of a wedge or wedges between the tooth

root and the bony socket wall, thus causing the tooth to
rise in its socket.
20. Explain the following terms:
(i) Stobies extraction; (ii) Wilkinsons extraction; (iii) Rubber
band extraction; and (iv) Postage stamp extraction.
Ans. i. Stobies extraction: Adjacent teeth round and single root
can be cross luxated to facilitate their extraction, e.g.
mandibular anterior six teeth, extraction of mandibular
premolar teeth
ii. Wilkinsons extraction: Orthodontic extraction of grossly
carious lower 1 molar to create space for further eruption
of third molar. This technique is not much popular
iii. Rubber band extraction: It is done in the patients suffering
from hemophilia (to avoid bleeding) where a rubber
band is placed at the cementoenamel of the tooth,
the apical movement of which induces coronal tooth
migration and eventual exfoliation of tooth due to
pressure necrosis of the periodontal ligament
iv. Postage stamp extraction: The alveolar bone is cut in the
shape of a postage stamp by first drilling multiple holes
with a bur and then connecting them. This facilitates
direct exposure and removal of tooth mass.
21. List the key points to be remembered while using the dental
elevators.
Ans. i. Dental elevators should be used on cementoenamel
junction of the tooth
ii. They are mainly used to luxate, elevate and to deliver the
tooth from the socket
iii. Tooth can be removed with or without the use of a dental
elevator
iv. Never use labial, buccal, lingual and palatal cortical plate
as fulcrum
Exodontia 85
v. Inter-radicular bone can be used as fulcrum. In case of

extraction of roots of the tooth, an elevator should be
used from the gingival margin
vi. Elevators should be used in a predetermined direction
and always used with fingerguards to minimize the
complication.
22. What is the open-window technique of tooth extraction?
Ans. Open-window technique is a modification of the open
technique. In this method, a bur is used to remove the bone
overlying the apex of the tooth, exposing the fragment. An
instrument is then inserted into the window and the tooth is
displaced out of the socket.
For example, when the buccal crestal bone must be left
intact; for instance, in case of the removal of maxillary premolars
for orthodontic purpose.
23. A patient on steroid therapy needs extraction of chronically
infected teeth. What premedication do such patients
require?
Ans. Such patients should be premedicated with the antibiotic
therapy.
24. After giving inferior alveolar nerve block, the needle acci
dentally pricks the dentists finger. The dentist subsequently
develops malaise, weakness and elevated SGOT and SGPT.
What does this suggest?
Ans. This suggests that the dentist has contacted a patient through
prick injury suffering from serum hepatitis.
25. A patient receiving systemic corticosteroid therapy requires
the surgical removal of tooth. What is the protocol of corti
costeroid therapy in such patients?
Ans. Corticosteroid therapy should be continued. Double the
dose preoperative day, operative day and postoperative day. Then
gradually reduce the dose; otherwise it may cause adrenal crisis.
26. The extraction of maxillary 1 molar has resulted in perfo

ration of maxillary antrum of about 5 mm in diameter. What
is the immediate treatment protocol?
Ans. Smoothening of the bony socket margin, airtight suturing
across it. Broad spectrum antibiotics along with analgesics, anti-
inflammatory properties and supplements.
27. What is the best time for extraction in pregnancy?
Ans. Second trimester is the safe time for extraction. The first
trimester is the stage of organogenesis of fetus and the fetus is
highly susceptible to the developmental malformation, if the mother
passes through stress and strain. In third trimester, large quantity
of steroids are released into the blood. The pituitary gland secretes
oxytocin, which stimulates uterus contraction and increases the
chances of premature delivery.
28. A pregnant lady in the 2nd trimester falls in syncope during
extraction. What should be the patients position on the
dental chair?
Ans. Left lateral position.
29. For the extraction of which tooth is the rotatory or screw-
like movement used?
Ans. For the extraction of maxillary canine, the rotator movement
is used because the neck or cervical area is more conical. So it is easy
to rotate or a mesiodistal or screw-like movement is appropriate.
30. If a tooth is inhaled during extraction, what is the site to
enter and what complications can arise?
Ans. The tooth enters into the right bronchus. If the tooth is not
located in the mouth, take a radiograph of socket and chest. If the
tooth is located in the bronchus, it should be immediately removed
by bronchoscope.
31. Postoperatively one day after total extraction, a patient
complains of blue black spot on the face and neck region.
What is the reason?
Ans. Postoperative ecchymosis is the cause of blue black spot.
Ecchymosis is the extravasation of blood in the subcutaneous tissue
Exodontia 87
with facial discoloration caused by the breakdown of hemoglobin.

Management consists of cold fomentation. Antibiotics are given
with proteolytic enzyme, which cause the breakdown of coagulated
blood.
32. What is the first direction and force to be applied for the
removal of a tooth with the help of the tooth extraction
forceps?
Ans. First force is the apical force in the apical direction. First
movement is always apical in direction.
33. In which condition is the rubber band extraction indicated?
Ans. In case of bleeding disorder like hemophilia and heman-
gioma.
34. A known HIV-positive child requires tooth extraction
because of the severe pain due to abscess. What should be
done initially?
Ans. As patient is known to be HIV-positive, firstly the patient
should be referred for ELISA test, which is used for diagnosis.
35. In which condition is the following extraction absolutely
contraindicated: central hemangioma or hypertension?
Ans. Central hemangioma.
36. A patient had myocardial infarction. When should the
elective dental extraction be performed?
Ans. The extraction should be postponed for atleast six months
have lapsed.
37. Why are the patients with renal disease (late stage) at higher
risk when undergoing extraction of teeth?
Ans. i. They have increased tendency to bleed
ii. They are susceptible to infection
iii. They are often on steroid therapy.
38. What is the classic triad of the following conditions:

(i) Dry socket; and (ii) Osteoradionecrosis.
Ans. i. Dry socket
Clot loss or necrosis
Pain
Fetor oris
ii. Osteoradionecrosis
Infection
Radiation
Trauma.
39. List the synonyms of dry socket.
Ans. Following are the synonyms of dry socket:
i. Postextraction syndrome
ii. Alveolitis sicca dolorosa
iii. Alveolar osteitis
iv. Focal osteomyelitis
v. Acute alveolar osteitis
vi. Alveolagia
vii. Postextraction osteomylitic syndrome
viii. Postexodontic alveolar osteitis
ix. Fibrinolytic alveolitis
x. Fibrinolytic osteomyelitis
xi. Necrotic alveolar socket
xii. Localized alveolar osteitis.
40. What are the hypotheses to explain pathogenesis of dry
socket?
Ans. There are two hypotheses:
i. Birns hypothesis
Birns fibrinolytic theory (1973)
Bacterial hypothesis
ii. Nitizens hypothesis (1983)
Possible anaerobic infection
Plasmin like fibrinolytic activity
Clot dissolution
Exodontia 89
41. What is the ideal and primary treatments of dry socket?

Ans. Debridement of socket (local care of socket) and sedative
dressing (to relieve from the pain).
42. On which day is severe pain experienced in dry socket?
Ans. Third day after extraction.
43. Which is the most common site of dry socket?
Ans. Lower molar area due to less blood supply.
44. What is the reason for dry socket after extraction?
Ans. It results from the loss of blood clot in the socket.
45. What is the cause of hypoglycemia during extraction even
after taking of insulin?
Ans. If extraction is done on empty stomach, hypoglycemia occurs.
46. A 65-year-old diabetic patient requires extraction even
after taking the morning insulin dose. Which preoperative
instruction is important in this case?
Ans. The patient should maintain normal diet. An empty stomach
may cause hypoglycemia.
47. What is the initial treatment when a patient returns after
six hours of extraction with persistent bleeding?
Ans. Remove the clot and examine the bleeding area to localize
the source of bleeding.
48. What is most serious complication after the extraction from
area previously irradiated?
Ans. Osteoradionecrosis.
49. During the extraction of the maxillary third molar, if
maxillary tuberosity is fractured but remains attached to
mucoperiosteum, what is the treatment in this case?
Ans. Reposition the fractured fragment and stabilize with suture.
50. The displacement of the root into the maxillary sinus is most
likely to happen during the extraction of which tooth?
Ans. Maxillary 1 molar because the roots are very close to the
inferior wall of the maxillary sinus.
51. Which root is most likely to be pushed into the maxillary

sinus during a dental extraction?
Ans. Palatal root of maxillary 1 molar.
52. Why is it contraindicated to curette a dry socket to stimulate
bleeding?
Ans. Curetting a dry socket can cause the condition to worsen
because healing will be further delayed. Any natural healing already
taking place will be disturbed and there is a risk of causing the
localized inflammatory process to be spread to the adjacent sound
bone.
53. Why is the bone removal with an aerator usually contra
indicated?
Ans. It is contraindicated as there is danger of developing
emphysema.
54. What is the principle action of aromatic spirit of ammonia?
Ans. Syncope is transient loss of consciousness due to cerebral
ischemia (anoxia). Predisposing factors like anxiety, fear induce
the release of increased amount of catecholamines. This results
in lowered peripheral resistance and fall in blood pressure. Spirit
of ammonia acts as a respiratory stimulant and it overcomes the
cerebral hypoxia.
55. What are the persistent causes of pyrexia after tooth
extraction?
Ans. Wound infection, cellulitis, dehydration and endocarditis.
56. Why is it contraindicated to curette residual pathologic
tissue after removing the maxillary anterior teeth?
Ans. The bony crypt should never be scraped after the removal of
any tooth. Veins in this region (maxillary anterior teeth region) do
not have valve manipulation of the infected material, and thrombi
in the extraction site force it into the cranial vault to the cavernous
sinus, resulting in a cavernous sinus thrombosis.
Exodontia 91
57. After the teeth are removed, when does the radiographic
evidence of the bone formation in the extraction site first
become evident?
Ans. Evidence of bone formation does not become prominent
until the sixth to eighth week. There are radiographic differences
between the newly formed bone and adjacent alveolar bone for
about 46 months.
58. Why should mucoperiosteum flap be repositioned accu
rately?
Ans. Since mucoperiosteum is inelastic in nature, manipulation is
not possible. So it should be repositioned accurately.
59. What are the causes of postoperative bleeding or hemor
rhage?
Ans. Following are the causes of postoperative bleeding:
i. Alcohol
ii. Aspirin
iii. Antimalignant
iv. Antibiotic (Broad spectrum long therapy or sulfonamide)
v. Anticoagulant
vi. Liver disease.
60. Which muscle is most frequently encountered within an
incorrect infraorbital nerve block?
Ans. Quadratus labii superiors.
61. What are the possible complications which can arise during
the extraction of isolated residual maxillary molar?
Ans. i. Fracture of tuberosity
ii. Fracture of floor of the antrum.
62. If a tooth is resistant to luxation with forceps, its removal
is best performed by which method?
Ans. Transalveolar method or open method or surgical extraction.
63. Following the zygomatic block or maxillary tuberosity

injection or posterior superior alveolar nerve block within
a few seconds, the patients face becomes extremely
distended and swollen on the injected side. What is the
reason and how will you manage this?
Ans. Due to angioedema or hematoma formation, there may be
injury to the artery or vein (posterior superior alveolar vessels).
It should be managed by cold packs and digital pressure on the
affected side.
64. What is the role of acriflavine solution?
Ans. Acriflavine solution is applied to the alveolar bone to locate
a buried root, which is not visible even after the reflection of muco
periosteum flap. The bone being porous, takes up the orange stain
while the non-staining root becomes more obvious against the
darker background. But the test is not applicable for the sclerotic
areas of the bone as it fails to take up the dye.
65. Explain following terms:
(i) Lingual split technique; and (ii) Lateral trephination
technique of Bowdler-Henry.
Ans. i. Lingual split technique: For removal of impacted mandi
bular molar by splinting the lingual cortex adjacent of
the III molar and facilitates elevator in a distoangular
direction.
ii. Lateral trephination technique of Bowdler-Henry: Removal
of mandibular 3 molars which are unlikely to erupt into
occlusion when their roots have only begun to form.
An opening is made on the tooth by cutting the buccal
cortical plate and the tooth is delivered out by an elevator
from the same.
66. Name of the drugs which are relative or absolute contra
indicated in tooth extraction?
Ans. i. Anticoagulant therapy
ii. Corticosteroid
Exodontia 93
iii. Immunosuppressive drugs

iv. Chemotherapeutic drugs.
67. What are the rules for the use of forceps in extraction?
Ans. i. The correct forcep should be selected
ii. While holding the forcep, the end of the handle should
be covered by the palm of the hand
iii. The forceps beak must be placed on the sound root
structure and not on the enamel of the crown
iv. The long axis of the beak of the forceps should be along
the long axis of the tooth
v. The root structure must be grasped firmly so that when
pressure is applied, the beak does not move over the
cementum, otherwise breakage may occur
vi. Forceps should not impinge the adjacent tooths soft
tissue, like gingival, lip, cheek, tongue, etc. during the
application of force.
68. Which forces are exerted during the teeth extraction?
Ans. There are mainly two types of forces exerted:
i. Primary forces: To luxate the tooth
Apical pressure: Pushed into the socket
Buccal force: Towards the buccal side
Lingual pressure: Towards the lingual side
Palatal pressure: Towards the palatal side
Labial side: Towards the labial side
Rotational force: Screw-like or rotatory force
ii. Secondary forces: At the terminal stage of tooth extraction
It is also known as traction force, which finally delivers the
tooth from the socket.
69. What are the different steps of healing of the extraction
wound or socket?
Ans. This process may be divided into five stages:
i. Hemorrhage and clot formation
ii. Organization of clot by granulation tissue
iii. Replacement of granulation tissue by connective and

epithelization of the wound
iv. Replacement of the connective tissue by coarse fibrillar
bone
v. Reconstructing the alveolar process and replacement of
the immature bone to the mature bone tissue.
70. What is odontotomy?
Ans. In some cases, extraction may be simplified by cutting a tooth
apart. This is especially desirable in the case of:
i. Multi-rooted tooth
ii. Severely divergent roots
iii. The crown is so decayed that only the shell remains.
71. What are the causes of tooth/root fracture?
Ans. i. Improper technique
ii. Ankylosed teeth
iii. Hypercementosis teeth
iv. Divergent root
v. Endodontically treated teeth
vi. Extensively carious teeth
vii. Teeth with gross filling
viii. Condensing osteities
ix. Improper application of instrument/force
x. Uncooperative patient.
72. How many teeth should be extracted in a single visit?
Ans. It depends upon the health and fitness of the patient. In
case of a planned uncomplicated case, one side upper and lower,
either right or left posterior teeth can be removed in one visit
(anterior teeth removed later with infiltration). Further surgery,
even extraction should be done not earlier than a week till the time
swelling and discomfort have disappeared and white cell count has
turned to normal.
Exodontia 95
73. What is the rule of 3 for the extraction of maxillary first

molar?
Ans. Rule of 3 for the extraction of maxillary first molar:
i. The maxillary first molar having 3 roots.
ii. 3 pricks are required.
iii. To anesthetize 3 nerves:
Mesiobuccal root = middle superior alveolar nerve
Distobuccal root = posterior superior alveolar nerve
Palatal root = greater palatine nerve
74. Which is the common organism found in dry socket?
Ans. Most commonly Treponema denticola is found in dry socket.
75. Which teeth are most likely to slip during the extraction
process and the patient may swallow it?
Ans. In maxillary arch = Maxillary canine
In mandibular arch = First premolar.
chapter
Impaction 6
1. The word impaction is derived from which word?
Ans. It is derived the word from IMPACTUS
2. What is the basic difference between following terms:
(i) Unerupted tooth; (ii) Malposed tooth; and (iii) Impacted
tooth.
Ans. i. Unerupted tooth: A tooth which is not an erupted or
perforated tooth
ii. Malposed tooth: A tooth erupted or unerupted, which is
in an abnormal position in the maxilla or mandible
iii. Impacted tooth: If a tooth cannot assume its normal
position in the oral cavity due to any mechanical obs
truction, it is known as impacted tooth.
3. What are the theories to explain impaction?
Ans. i. Physiologic theory
ii. Mendelian theory
iii. Endocrine theory
iv. Pathologic theory
v. Orthodontic theory.
4. What points are to be considered as preoperative
assessment on the basis of radiographic evaluation for the
removal of the impacted third molar?
Ans. The following points are to be considered:
i. Access
ii. Position and depth of impacted third molar tooth
iii. Root pattern of impacted mandibular third molar.
Impaction 97
iv. Shape of crown of impacted mandibular third molar

v. Texture of investing bone
vi. Position and root pattern of mandibular third molar
vii. Inferior dental canal relationship with mandibular third
molar.
5. What is the base of Pell and Gregory classification for
impacted third molar?
Ans. On the basis of:
i. Relationship of the impacted lower third molar to the
ramus of the mandible and second molar.
ii. Relative depth of the third molar in the bone.
6. What are the different classifications of the impacted
mandibular third molar?
Ans. 1. I classification: Pell and Gregory classification
A. On the basis of the relation of tooth to ramus of
mandible and second molar:
i. Class I
ii. Class II
iii. Class III
B. On the basis of the relative depth of the third molar in
the bone
i. Position A
ii. Position B
iii. Position C
2. II classification: Winters classificationOn the basis of
the position of the long axis of third impacted third
molar in relation to the long axis of the second molar, e.g.
mesioangular, distoangular, linguoversion, buccoversion,
torsoversion (inverted).
3. III classification: Combined classification of the American
Dental Association (ADA) and the Association of American
Oral and Maxillofacial Surgeons (AAOMS): On the basis of
coding system.
7. What do you understand by the term torsoversion?

Ans. It means inverted tooth. For example, impacted mandibular
third molar crown will be downward and the root upward (reverse
from the routine pattern).
8. What are George Winters imaginary lines?
Ans. Three imaginary lines are drawn on the IOPA radiograph to
assess the position and depth of the impacted tooth known as WAR
lines.
i. White line: It indicates the difference in occlusal level of
second and third molars. It is drawn touching the occlusal
surfaces of first and second molars and is extended
posteriorly over the third molar.
ii. Amber line: It indicates the amount of the alveolar bone
covering the impacted tooth. It is drawn posterior to
anterior, from third molar to first molar
iii. Red line: It indicates the depth of the tooth in the bone
and the difficulty encountered in removing the tooth.
Normal depth is 5 mm. 1 mm increase in depth increases
three times more difficulty in the removal of the tooth. 9
mm or more increase in depth requires removal of tooth
in nasal intubation.
9. What is Wharfs assessment of impacted third molars?
Ans. The six factors determining Wharfs assessment are:
i. Winters classification
ii. Height of the mandible
iii. Angulation of third molar
iv. Root shape and morphology
v. Follicle development
vi. Path of exit of the tooth during removal
10. What is the clinical importance of access as preoperative
assessment for the removal of the impacted mandibular
third molar?
Ans. Access may be determined by noting the inclination of the
radiopaque line cast by the external oblique-ridge. If this line is
vertical, access is poor and if this line is horizontal, access is excellent.
Impaction 99
11. What is the importance of the shape of a clinical crown as

preoperative assessment in the removal of the impacted
Ans. i. Large square crown and prominent cusps are more
difficult to remove
ii. Small crown and flat cusps are easy to remove
12. What is the general sequence to remove the bone and make
a gutter from the different surfaces of the impacted tooth?
Ans. The sequence is as follows:
i. Occlusal surface: If the tooth is not visible in the oral cavity
ii. Buccal side/surface
iii. Mesial side/surface
iv. Distal side/surface
Any surgical intervention should be avoided on the
lingual side
Gutter should be made up to the minimum cemento-
enamel junction because the point of elevation
should be below the cementoenamel junction.
13. What are the systemic causes of impaction?
Ans. According to Berger:
i. Prenatal: Hereditary/misconception
ii. Postnatal: Tuberculosis/ malnutrition/congenital syphilis/
rickets/anemia/endocrine dysfunction
iii. Rare conditions: Cleft palate/oxycephaly/achondroplasia/
cleidocranial dysostosis.
14. What is the general order of the frequency of impaction?
Ans. i. Mandibular third molar
ii. Maxillary third molar
iii. Maxillary cuspid
iv. Mandibular bicuspid
v. Mandibular cuspid
vi. Maxillary bicuspid
vii. Maxillary central incisor
viii. Maxillary lateral incisor.
15. What are the different classifications of the impacted

maxillary canine?
Ans. i. 1st classification: Field and Ackerman classification. On the
basis of the location of the impacted tooth and relation
with adjacent teeth.
ii. 2nd classification: On the basis of the angulation of the
impacted tooth.
16. What are the basic steps for the removal of the impacted
Ans. The steps are as follows:
i. Reflection of adequate flap (mucoperiosteal flap) for
accessibility (with the help of different incision, e.g.
Terrance Wards standard incision
Envelope flap incision
Coma incision.
ii. Removal of the overlying bone either with the help of
the surgical bur or chisel or both and making a point of
elevation
iii. Sectioning of the tooth if required
iv. Delivery of the tooth from the socket (elevation and
extraction of the tooth from the socket)
v. Debridement of the wound
vi. Achieve hemostasis
vii. Smoothen the bony margins
viii. Closure of the wound with suture.
17. Shift tube technique que or Clarks rule or buccal object
rule are used to determine the position of which tooth?
Ans. Impacted canine position can be determined by these
techniques.
18. What are different incisions for the removal of the impacted
Ans. Different incisions or approaches are:
i. Terrance Wards standard incision
ii. Modified Wards incision (1st modification)
Impaction 101
iii. Modified Wards incision (2nd modification)

iv. Envelope flap incision
v. Modified flap incision type 1
vi. Modified flap incision type 2
vii. Tree incision
viii. S-shaped incision
ix. Lewis incision
x. Coma incision
xi. Bayonet flap
19. Which incisions are employed for the removal of the
maxillary impacted third molar?
Ans. i. Buccal sulcular incision
ii. Sulcular incision with vestibular extension
iii. Palatal incision flap.
20. Which incisions are employed for the removal of the
impacted maxillary canine?
Ans. i. Semilunar incisiondesigned on the alveolar mucosa
ii. Angulated or trapezoid or crevicular incisiongiven in
the gingival crevice.
21. What are the complications of the removal of impacted
maxillary canine?
Ans. i. Chances of damaging the nasal mucosa
ii. Damaging the infraorbital nerve
iii. Displacement of the root/tooth into the nasal cavity or
into the maxillary antrum
iv. Palatal artery may get damaged
v. Chances of oroantral communication
vi. Numbness or paresthesia
vii. Non-vitality of the adjacent teeth.
22. What is the basic difference at the time of making the point
of elevation and the elevation of tooth with the elevator
during the removal of the different types of angulated
mandibular impacted teeth?
Ans. i. Mesioangular: To make a point of elevation on the mesial
surface of the impacted tooth. The elevator used is
Couplands elevator
ii. Distoangular: Ideally, the point of elevation should be

on the distal side but it may require more retraction and
more bone removal, resulting in more postoperative
pain and edema because of its path of delivery into the
ascending ramus. To avoid such postoperative problem,
make a point of elevation on the buccal surface of the
tooth. The elevator used is Couplands elevator. Delivery
should be towards the ascending ramus but the elevation
should be from the buccal side
iii. Horizontal impaction: The point of elevation is on the
cervical area of the tooth. The elevator used is Couplands
elevator or winter crossbar elevator may also be useful if
more force is required, but it should be used with caution.
Sometimes, it may cause angle fracture
iv. Vertical impaction: To make a point of elevation on the
buccal surface below the cementoenamel junction
above the bifurcation point. The elevator used is Cryers
elevator or the straight elevator at the mesial surface. If
the tooth is deeply embedded, it requires more force to
be removed. In this case, winter cross bar elevators may
be useful to deliver the tooth in the upward direction
towards the occlusal surface.
23. Which complication can arise at the time of the following
situations?
Ans. i. At the time of incision (e.g. standard Wards incision):
Damage to the retromolar artery
Damage to the facial vein and facial artery
Damage to the lingual nerve.
ii. At the time of the removal of the bone:
Laceration of the soft tissue
Damaging of the adjacent teeth
Fracture of the mandible and the alveolar process
Sequestra formation.
Impaction 103
iii. At the time of the sectioning of the tooth:

Laceration of the hard and soft tissues
Dislodgement of the adjacent tooth
iv. At the time of the delivery of tooth/elevation of tooth:
Chances of fracture of root, tooth, mandible or alveolar
fracture
Displacement of tooth or root into the lingual pouch
Dislodgment of the adjacent tooth.
24. What is the shift rule as applied to the impacted maxillary
cuspids?
Ans. This radiographic technique determines the position of the
impacted cuspid. A series of periapical radiographs are taken. The
film position is kept constant and the head of the X-ray unit is moved
either anteriorly or posteriorly after each exposure. If the impacted
tooth seems to move with the X-ray head, it is located on the palate.
If it moves opposite to the unit head, it will be located on the buccal.
This is also referred to as the SLOB rule. SameLingual (palatal),
oppositeBuccal.
25. Which is the most common impacted tooth after third
molar?
Ans. Maxillary canine is the next most common impacted tooth
after third molar.
26. Which is the most difficult impacted mandibular third
molar?
Ans. Distoangular is one of the most difficult impacted teeth.
27. Why distoangular impaction is most difficult?
Ans. i. Its pathway of delivery is into the ascending ramus
ii. Large amount of the distal bone is to be removed
iii. Access to the roots is difficult.
28. Which type of the impacted maxillary third molar is most
likely to get displaced into the infratemporal space if an
improper technique is used?
Ans. Distoangular impacted maxillary third molar.
29. Which among these two is the systemic cause of im-

pactionrickets or tuberculosis?
Ans. Rickets.
30. In which syndrome impacted supernumerary teeth is one
of the features?
Ans. Gardeners syndrome.
31. What is the orthodontic indication for the removal of an
impacted molar?
Ans. To facilitate distal movement of the second molar.
32. Where is the inferior alveolar nerve most often located in
relation to the root of a mandibular third molar?
Ans. Buccal to the root and slightly apical.
33. What are the significant radiographic predictions of a close
relationship between the inferior alveolar canal and the
impacted mandibular third molar?
Ans. Signs of close proximity of the mandibular third molar to the
inferior alveolar canal are:
i. Darkening and notching of the root
ii. Deflected roots at the region of the canal
iii. Narrowing of the root
iv. Interruption of the canal outline
v. Diversion of the canal from its normal course
vi. Narrowing of the canal outlines on the radiograph
vii. Grooved tunnel.
34. The most common contributing factor to pericoronitis of
an impacted mandibular third molar?
Ans. Trauma from the opposing maxillary third molar.
35. Facial edema following the surgical extraction of an
impacted tooth can be best reduced by which method?
Ans. Careful retraction and manipulation of the soft tissue flap
during surgery.
Impaction 105
36. The line of withdrawal of a tooth is mainly determined by

what?
Ans. The root pattern of the impacted tooth.
37. Who described originally the lingual split bone technique
for removing the impacted mandibular third molar?
Ans. It was described by Sir William Kelsey Fry. Later first
popularized by Terrance Ward.
38. What are the disadvantage of the lingual split technique?
Ans. i. Injury to the lingual nerve
ii. Chances of dislodging the tooth or the root in the
sublingual space
iii. Opening up of the fascial spaces on the lingual side and
the floor of the mouth.
39. What are the basic advantages of the lingual split technique
for the extraction of the mandibular impacted teeth?
Ans. i. Bone loss is minimal
ii. Easy and quick method
iii. Tissue trauma is minimal.
40. What is the indication of the lateral trephination technique
of Bowdler Henry?
Ans. Removal of the partially formed unerupted mandibular third
molar tooth.
41. What injury can be caused while releasing the incision
(vertical incision) for the flap for the mandibular third molar
impaction?
Ans. Facial artery and vein can get injured.
42. Which is the important suture while closing the Wards
incision during the impacted mandibular third molar
surgery and why?
Ans. Suture of the area immediately distal to the second molar
because it may cause pocket formation and hot or cold sensation
in second molar region.
43. In which type of the impacted mandibular third molar bulls

eye of appearance is seen in the intraoral periapical (IOPA)
radiograph?
Ans. In case of linguoversionlingually placed. The crown of the
tooth is towards the lingual side. Hence, the crown is very close to
the film. The crown looks like the bulls eye, large in comparison to
the root which is away from film.
44. In which type of the impacted mandibular third molar is
the lingual split technique contraindicated?
Ans. In case of Buccoversion.
45. What are the different methods of the removal of the
surrounding bone from the impacted tooth?
Ans. i. Sir William Kelsey FryThe split bone technique with the
use of a chisel
ii. Moore and Gillbes Collar technique with the help of a
surgical bur
iii. Removal of the tooth using tooth division.
46. A pregnant lady in the second trimester during extraction
falls into syncope. What should be the patients posture and
why?
Ans. The patients position should be on the left side to relieve the
pressure. It should not be kept in the supine or reclined position,
otherwise it may cause pressure on the inferior vena cava by the
fetus, which results in poor venous return.
47. When is the elective dental extraction to be performed for
a patient with myocardial infarction?
Ans. After six months, elective dental extraction can be performed.
48. What are the common causes of the secondary hemorrhage
after tooth extraction?
Ans. It may be due to the rise in the blood pressure and slipping
of the ligature.
Impaction 107
49. Which is the common site of displacement of the impacted

third molar during surgery?
Ans. Lingual pouch and pterygomandibular space.
50. A patient has developed facial edema after 24 hours
of extraction. Which aid is advantageous, if there is no
infection?
Ans. In case there is no infection, warm wet application can help
reduce the facial edema.
51. A patient is complaining about the radiation pain to the ear
after the surgical removal of mandibular third molar on the
third day. What is the most probable diagnosis?
Ans. Postextraction alveolitis.
52. What are the muscles responsible for these three postopera
tive complications after the third molar mandibular surgery:
(i) Trismus; (ii) Pain in the temporal region; and (iii) Difficulty
in swallowing
Ans. i. Trismus: Medial pterygoid muscle
ii. Pain in the temporal region: Temporalis muscle
iii. Difficulty in swallowing: Superior constrictor muscle of
the pharynx.
53. What is the best treatment for pericoronitis involving the
impacted mandibular/maxillary third molar?
Ans. Extraction of the involved third molar is the best treatment.
Pericoronitis is recurrent in nature and may cause the damage of
the bone around the second and third molars.
54. What is the direction of the bevel of the chisel during bone
cutting?
Ans. Chisel is monobevelled (osteotome is bibevelled) and used for
cutting bone and the bevel is kept facing the bone to be sacrificed.
55. What is the cause of postextraction bleeding in a leukemic
patient?
Ans. Postextraction bleeding is due to platelets disorder. It may be
necessary to perform surgery on a patient with platelet counts in the
range of 25,000 because of the difficulty in achieving the platelet

level due to the circulating platelet antibodies.
56. Which of the following may cause dry socketoral
hypoglycemias or oral contraceptives and how?
Ans. Oral contraceptives may increase the risk of dry socket. High
levels of estrogen can increase the risk of dry socket by dissolving
the blood clot. Women who take the oral contraceptives are at high
risk of developing dry socket due to increased estrogen levels.
57. Which is the common complication after third molar
removal?
Ans. Dry socket is one of the common complications due to less
blood supply.
58. What is the problem associated with the longer root of
tooth?
Ans. It is more difficult to remove the tooth.
59. What is the more common cause of paresthesia of the lower
lip?
Ans. Removal of the mandibular impacted third molar as a result
of the damage to the inferior alveolar nerve.
60. Why should the posterior incision for the removal of the
impacted third molar mandibular be placed more buccally?
Ans. i. To prevent damage to the lingual nerve.
ii. To prevent damage to the retromolar artery
iii. Incision should be on the sound bone
iv. Repositioning of the flap should be on the sound bone
v. More visibility.
61. If a patient is unable to close the mouth due to subluxation
of condyles after the extraction of third mandibular molar.
How wiil you manage such a case?
Ans. Initially, it should be managed by manually manipulating the
mandible.
Impaction 109
62. Why distill water is not used for irrigation?

Ans. Distill water is a hypotonic solution and will enter the cells
down the osmotic gradient causing cellulitis and rapid death of
bone cells.
63. While trying to remove the root tip of a mandibular third
molar, it disappears from view, where it might be dislodged?
Ans. i. Inferior alveolar canal
ii. Cancellous bone space
iii. Submandibular space.
64. While extracting the third molar, the distal root is missing.
Where it is most likely to be?
Ans. In the pterygomandibular space.
65. What is the serious complication after the maxillary canine
surgical removal?
Ans. Cavernous sinus thrombosis.
66. How will you differentiate distoangular impaction radio
graphically from the normal erupted tooth?
Ans. Interdental septum between the second and third molars
is much narrower in comparison to the first and second molars. In
case of normal erupting of the third molar, there is no difference
in distance between first, second and third molars, i.e. interseptal
space is similar between first, second and third molars.
67. What are the advantages of mallet and chisel over the drill
for bone cutting during the tooth removal?
Ans. In case of mallet and chisel:
i. There is no need for the coolant
ii. The operator can assess after every stroke and can avoid
complication like soft and hard tissues injury.
iii. The operator can change the chisel position accordingly.
iv. The bone can be removed from the poorly accessible
area and the less visible area.
68. When should the prophylactic removal of the unerupted

third molar in a teenager is carried out?
Ans. When the root formation is 2/3rd complete.
69. During removal of a impacted tooth if mandible is fractured.
What is the immediate line of treatment?
Ans. There is more chances of fracture of the mandible at the angle
region in case of position C.
i. Intermaxillary fixation with ligature wire
ii. Superior border transosseous wiring
iii. Bone plating
70. During the removal of a impacted tooth if lingual plate
damage, what is the criteria to manage such situation?
Ans. If fractured lingual plate is attached with flap (mucoperio-
steum flap) then it should be sutured otherwise it should be
removed.
Odontogenic chapter
Infection 7
ACUTE AND CHRONIC INFECTION OF JAW

1. What is the meaning of (i) Periostitis of jaw; (ii) Osteitis of
jaw; and (iii) Osteomyelitis?
Ans. i. Periostitis of jaw: It is the inflammation of the periosteum
ii. Osteitis of jaw: It is the localized bone infection
iii. Osteomyelitis: It is an extensive inflammation of the bone.
It involves cancellous portion of the bone marrow, cortex
and periosteum.
2. What is the cause of odontogenic infectionaerobic,
anaerobic or mixed bacteria?
Ans. Mainly it is due to the mixed bacteria.
3. How will you treat Garreys osteomyelitis?
Ans. Surgical reconstruction is done to recontour the cortical
expansion of the jaw.
4. What deals with Hiltons method?
Ans. Drainage of the abscess.
5. What is palatal abscess?
Ans. Infection of the maxillary lateral incisor.
6. What is cellulitis?
Ans. Cellulitis is a warm, diffused, erythematous, indurated, and
painful swelling of the tissue in an infected area.
7. How will you manage cellulitis?
Ans. Cellulitis can be easily treated by:
i. Antibiotic therapy
ii. Removal of cause
iii. Surgical incision and drainage is done if no improvement
is seen in 2-3 days or if there is evidence of purulent
collection.
8. What is abscess?
Ans. An abscess is a pocket of tissue containing the necrotic tissue,
bacterial colonies and dead white cells. The area of infection may
or may not be fluctuant. The patient is often febrile at this stage.
Cellulitis, which may be associated with abscess formation, is often
caused by anaerobic bacteria.
9. What is the difference between cellulitis and abscess?
Ans.
Category of Cellulitis Abscess
differentiation
i. Duration Acute Chronic
ii. Pain Severe, generalized Localized
iii. Localization Diffused borders Well circumscribed
iv. Size Large Small
v. Palpation Indurated Fluctuant
vi. Presence of pus No Yes
vii. Degree of dangerness Greater Less
viii. Bacteria Aerobic Anaerobic
10. What is erysipelas?

Ans. Erysipelas is a superficial cellulitis of the skin that is caused
by beta-hemolytic streptococci and by group B-streptococci. It
usually presents with warm, erythematous skin, spreads rapidly
from the release of hyaluronidase by bacteria. It is associated with
lymphadenopathy and fever and has an abrupt onset with acute
swelling. It may affect the skin of the face. It is managed by parental
penicillin.
Odontogenic Infection 113
11. If abscess is treated with an antibiotic without I and D, what

does it may cause?
Ans. There may be the chances of the formation of antibioma.
12. Which organism is commonly associated with subacute
bacterial endocarditis?
Ans. Streptococcus viridans.
13. Osteoradionecrosis occurs due to the damage of which
structure?
Ans. Blood vessels.
14. What is the cause of severe pain in the dry socket?
Ans. Release of kinin from the degenerative clot and thermal
irritation of the exposed nerve endings of the alveolar bone.
15. What is the best imaging modality for detecting sequestra
in osteomyelitis?
Ans. Computerized tomography: It gives a more definitive picture of
calcified tissue involvement, especially with regard to the disrupting
cortical plate.
16. What are the synonyms of Garres osteomyelitis?
Ans. i. Chronic nonsuppurative sclerosing OML
ii. Chronic OML with proliferative periostitis
iii. Periostitis ossificans
iv. Focal gross thickening of the periosteum.
17. What are the synonyms of Noma?
Ans. i. Cancrum oris
ii. Gangrenous stomatitis
iii. Running horse gangrene
18. Which microorganism is responsible for acute osteomyelitis
and what does the blood picture show?
Ans. Staphylococcus aureus is responsible for acute osteomyelitis.
The blood picture shows leukocytosis.
19. When should I and D be performed in case of acute

infection?
Ans. When localization has occurred, stab incision should be given.
20. What are the conditions susceptible to osteomyelitis?
Ans. i. Pegets disease
ii. Fibrous dysplasia
iii. Radiation.
21. What is the triad of osteoradionecrosis?
Ans. Radiation > Trauma > Infection.
22. Who explained HBO for osteoradionecrosis?
Ans. Marx.
23. What are three hypos which explain osteoradionecrosis?
Ans. i. Hypoxia
ii. Hypocellularity
iii. Hypovascularity
24. What is the main cause of osteoradionecrosis?
Ans. Endarteritis of blood vessels.
25. In which condition of the infection of the jaw, one
radioactive dye Tc-99 appears as hot spot?
Ans. Osteomyelitis of mandible: The radioactive Tc-99 diphenyl
monophosphate is injected. The involved side of the mandible
appears active or as hot spot.
26. What is difference between sequestrectomy and
saucerization?
Ans. i. Sequestrectomy: Removal of sequestrum
ii. Saucerization: Removal of bony cavity.
27. Define sequestrum.
Ans. Sequestrum is a piece of dead and detached bone which is
hard, rough, porous, light in weight and color.
28. What are involucrum and sequestra?
Ans. Involucrum is a new live bone. Sequestrum is a dead bone.
29. Lip paresthesia is one of the classical signs in which type of

osteomyelitis?
Ans. In acute osteomyelitis of mandible, lip paresthesia is seen.
30. A dead bone is seen in X-ray as radiopaque or radiolucent.
What is it called in case of osteomyelitis?
Ans. A dead bone seen in an X-ray as white radiopaque is called
as sequestrum, one of the radiographic findings of osteomyelitis.
31. Infection of maxillary first molar drains into?
Ans. Buccal space and causes buccal space infection.
32. What is the new concept of osteoradionecrosis (ORN)?
Ans. The new concept of osteoradionecrosis is based on a radiation
induced wound healing defect. According to this hypothesis, the
pathophysiology sequence is:
i. Irradiation
ii. Hypovascular, hypoxic and hypocellular tissue.
iii. Tissue breakdown
iv. A non-healing wound in which the tissue metabolic
demand exceeds supply.
33. What is Hyperbaric Oxygen (HBO)?
Ans. Hyperbaric oxygen is an administration of 100% oxygen via
head tent mask or endotracheal tube with a special chamber at 2.4
atmospheric absolute pressure (ATA) for 90 minutes each session.
The treatment should be once daily, five times a week.
34. A patient with swelling over the angle region is having a
rise in temperature and also has difficulty in opening the
mouth. What is the possible diagnosis?
Ans. All the three symptoms indicate coronal infection of the
mandibular third molar.
35. Why is osteomyelitis rare in maxilla?
Ans. It is rare due to:
i. Extensive blood supply and collateral blood flow in
midface
ii. Porous nature of membranous bone

iii. Thin cortical plates
iv. Abundant medullary spaces.
36. Why is mandibular osteomyelitis more common in old age?
Ans. i. Mandibular arteries are occluded, leading to ischemia
and infarction
ii. Impaired immunity in old age
iii. Other systemic diseases, if present.
37. What is osteoradionecrosis (ORN)?
Ans. After the completion of the radiation treatment, an area
of exposed, non-viable bone at the field of radiation that fails
to show any evidence of spontaneous healing is diagnosed as
osteoradionecrosis. The bone which is exposed because of mucosal
or cutaneous ulceration must be atleast 3 to 5 mm in size and must
be present in the field of irradiation for atleast 6 months (some
require only 3 months for diagnosis).
38. What is the difference in incidence between maxilla and
mandible osteoradionecrosis?
Ans. Osteoradionecrosis is more common in the mandible than in
maxilla because of the lesser blood supply to the mandible and the
compact bone structure of the mandibular bone. Mandible involved
in the field of irradiation more than the maxilla is mostly in case of
oral cancer.
39. What are the clinical features of osteoradionecrosis?
Ans. Clinical features of osteoradionecrosis are:
i. Exposed bone
ii. Loss of soft tissue and bone
iii. Pain
iv. Paresthesia/anesthesia
v. Soft tissue necrosis
vi. Trismus
vii. Pathologic fracture
viii. Orocutaneous fistula
40. What are the radiographic features of osteoradionecrosis?

Ans. i. Diffuse radiolucency
ii. Mottled osteoporosis and sclerotic area can be identified
after the bone sequestra are formed
iii. CT and scintigraphy can be used to evaluate the
extension of the lesion.
41. What are the different modalities for osteoradionecrosis?
Ans. i. Conservative treatment approach
Daily local irrigation with normal saline
Chlorhexidine 0.2%
Systemic antibiotics
Avoid irritants like tobacco, alcohol, etc.
Good oral hygiene should be maintained
Removal of sequestrum.
ii. HBO surgical approach
42. What are the indications for HBO therapy in oral and
maxillofacial surgery?
Ans. i. Treatment of osteoradionecrosis (ORN)
ii. It is done before bony and soft tissue reconstruction
and before the placement of the dental implant in an
irradiated bone
iii. Treatment of necrotizing fasciitis
iv. Treatment of gas gangrene
v. Chronic refractory osteomyelitis.
43. What are the possible complications of the HBO treatment?
Ans. Complications of the HBO treatment are as follows:
i. Barotrauma
ii. TMJ rupture
iii. Oxygen toxicity
iv. Ear and sinus trauma
v. CNS reaction
vi. Pulmonary reaction
vii. Myopia
viii. Transient visual problem
ix. Pneumothorax
x. Air embolism.
44. What are the contraindications for the use of HBO therapy?
Ans. Absolute contraindications are:
i. Optic neuritis
ii. Untreated pneumothorax
iii. Congenital spherocytosis
iv. Fulminant viral infection.
Relative contraindications are:
i. Seizure disorder
ii. Pregnancy
iii. Emphysema
iv. Claustrophobia.
45. What are the peculiar features of Garres osteomyelitis?
Ans. i. Age group: Small children from 6 to 10 years
ii. Common site: Mandibular molar region
iii. Radiographic appearance: Onion peel appearance.
46. What is marble bone disease?
Ans. Osteoporosity characterized by a generalized extreme density
of bone.
47. What are the characteristic features of osteomyelitis?
Ans. The characteristic features of osteomyelitis are as follows:
i. There is a moth-eaten appearance because of the
enlargement of medullary spaces and widening of
Volkmanns canals
ii. Bone destruction of varied extent in which there are Islands
that is sequestra with a trabecular pattern and narrow
spaces. A sheath of new bone involucrum is often found,
separated from the sequestra by a zone of radiolucency
iii. Stippled or granular densification of bone. It is seen as a
fine linear opacity. Subperiosteal new bone (involucrum)
is superimposed upon that jaw, a delicate fingerprint or
orange peel appearance is there.
48. What are the goals and basic fundamental principles for
the treatment of osteomyelitis?
Ans. Goals of treatment are:
i. To remove pathological organism
ii. Promote healing
iii. Re-establishment of vascular permeability.
Basic fundamental principles of management are:
i. Early diagnosis
ii. Bacterial culture and sensitivity test
iii. Antibiotic therapy
iv. Analgesic for pain control
v. Proper surgical intervention
vi. Reconstruction, if indicated.
49. Enumerate the various periapical pathology treatments:
Ans. i. Periapical granuloma
ii. Periapical cyst
iii. Periapical abscess.
50. How will you differentiate radiographically a cyst, granu
loma and abscess?
Ans. i. Dental granuloma: Homogenous radiolucency (radio
lucent cavity) with smooth definite radiolucent outline
ii. Dental cyst: Homogeneous radiolucent cavity with
definitive sclerotic radiopaque margin
iii. Dental abscess: Radiolucent and radiopaque cavity
(mixed) with irregular margin (mixed radiolucent and
radiopaque).
51. Classify endodontic surgery.
Ans. Endodontic surgery is classified as follows:
i. Surgical drainage:
Incision and drainage
Fistulative surgery
ii. Periradicular surgery:
Curettage
Biopsy
Root end resection

Root end preparation and filling
iii. Replantation
iv. Implant surgery, e.g. endodontic implant.
52. List the synonyms of apicoectomy.
Ans. i. Apical surgery
ii. Endodontic surgery
iii. Root resection
iv. Root amputation.
53. Define apicoectomy?
Ans. The term apicoectomy is used for surgery involving the root
apex to treat the apical infection. It is cutting off of the apical portion
of the root and curettage of periapical necrotic, granulomatous,
inflammatory or cystic lesion.
54. What are the contraindications of apicoectomy?
Ans. i. Local contraindications:
Inaccessible areas like palatal root of the maxillary
molar
Poor bony support
Proximity of roots to the anatomic structures like
maxillary sinus, inferior alveolar canal
Short resorbed roots.
ii. Systemic contraindications
First trimester of pregnancy
Diabetes/nephritis/cardiac disease/liver disease
Anemia, leukemia, hemophilia.
55. List the complications of the endodontic surgery.
Ans. i. Intraoperative:
Bleeding
Damaging the neighboring root
Entering into sinus (upper)
Entering into inferior alveolar canal (lower).
ii. Postoperative:
Abscess formation
Fenestration
Sinus tract formation
Increased mobility of the tooth.
FACIAL SPACES/INFECTION/COMPLICATIONS
1. What are the primary facial spaces?
Ans. There are six facial spaces:
i. Buccal
ii. Canine
iii. Vestibular
iv. Submandibular
v. Sublingual
vi. Submental.
2. What are the secondary facial spaces?
Ans. There are eight secondary facial spaces:
i. Pterygomandibular
ii. Masticator
iii. Infratemporal
iv. Superficial and deep temporal
v. Masseteric
vi. Lateral pharyngeal
vii. Retropharyngeal
viii. Prevertebral.
3. What are the masticatory spaces?
Ans. i. Pterygomandibular space
ii. Submassetric
iii. Superficial temporal and deep temporal space.
4. What are the seven spaces of Grodinsky and Holyoke in the
head and neck region?
Ans. Space 1: Between platysma and investing fascia
Space 2: Between investing and infrahyoid fascia
Space 2 a: Space among infrahyoid muscles

Space 3: The pretracheal and retrovisceral spaces
Space 4: Between alar fascia and prevertebral fasciadanger
space
Space 4 a: Between prevertebral and investing fascia above
clavicle
Space 5: Spaces between the prevertebral fascia.
5. What are the different methods of the drainage of
odontogenic infection?
Ans. i. Extraction of the offending tooth
ii. Endodontic treatment
iii. Incision and drainage of the soft tissue collection.
6. What are the surgical principles of incision and drainage?
Ans. i. Before incision, obtain the fluid for culture through the
aspiration of pus
ii. Incise the abscess in the healthy skin or mucosa, using
blunt dissection
iii. Through the exploration of the involved space
iv. Use oneway drainage in intraoral and through and
through drainage in extraoral cases
v. Remove the drain gradually from the deep sites.
7. Which is the greatest barrier to infection?
Ans. Fascia is the greatest barrier.
8. What is the facial space is filled by?
Ans. Loose connective tissue.
9. Which fascial space is situated between the two muscles?
Ans. Buccal space is situated between the buccinator and masseter
muscle.
10. What are the classical signs of the following terms: (i)
Canine space; (ii) Buccal space; (iii) Masticatory space; (iv)
Infratemporal space; (v) Parotid space; (vi) Submandibular
space; (vii) Submental space; (viii) Sublingual space
Ans. i. Canine space: Infraorbital swelling, cellulitis of eyelid,
swelling lateral to the nose
ii. Buccal space: Cheek swelling up to four times more than

normal size
iii. Masticatory space: Trismus, e.g.
Pterygomandibular space
Submasseteric space
Temporal space.
iv. Infratemporal space: Dome-shaped swelling
v. Parotid space: Earlobe seems to be everted or lifted up
vi. Submandibular space: Plum-shaped swelling but no
trismus
vii. Submental space: Bulging of the chin
viii. Sublingual space: Elevation of tongue by indurated
sublingual tissue.
11. What is the distinctive difference in case of swelling of
masticator space and lateral pharyngeal space?
Ans. Masticator space swelling is not pushed towards the midline
but in case of lateral pharyngeal space, swelling is pushed towards
the midline.
12. Why does the infection of masticator space not enter into
the neck?
Ans. The fascia is firmly adhered to the periosteum of the lower
border of the mandible.
13. What is the peculiarity of the submasseteric space?
Ans. Abscess never points either intraorally or extraorally.
14. Submandibular space lies between which two bellies?
Ans. Between the anterior and posterior bellies of diagastric
muscle.
15. Which muscle separates the sublingual space from the
submental space?
Ans. Mylohyoid musclewhich forms a complete diaphragm
within the floor of the mouth.
16. What is the distinguishing feature of the masticatory

spaces?
Ans. Trismus is the common and typical feature because the spaces
are bounded by the muscles of mastication.
17. Generally in case of a mandibular third molar with
pericoronitis, where may the infection spread to?
Ans. The infection may spread posteriorly to the pterygoman-
dibular space.
18. Which is the most dangerous type of the spread of the
infection from the apical abscess and why?
Ans. Parapharyngeal space infection (including lateral pharyngeal
and retropharyngeal space) is dangerous because the lateral
pharyngeal space is intimately related with the carotid sheath the
and infection from these spaces spreads directly into the neck and
mediastinum.
19. Who did first describe Ludwigs angina?
Ans. It was first described by Wilhelm Von Ludwig.
20. What are the 3 Fs related to Ludwigs Angina?
Ans. 1st FIt should be Feared
2nd FIt rarely becomes Fluctuant
3rd FIt is often Fatal.
21. What are the synonyms of Ludwigs angina?
Ans. i. Angina maligna
ii. Carbulus gangrenous
iii. Cynanche
iv. Morbus strangulatoriusIt is so-called because of the
chocking effect, which is a victims experience
v. GarrotilloIt is the Spanish version for Hangmans Noose.
22. What is Ludwigs angina?
Ans. Ludwigs angina is a bilateral, brawny board like induration
of the submandibular, sublingual and submental spaces due to
infection of these spaces.
23. What is the bacteriology of Ludwigs angina?

Ans. In Ludwigs angina, there is the presence of staphylococci,
streptococci, gram-negative enteric microorganisms, such as E. coli
and Pseudomonas, anaerobes, including bacteriodes (B. oralis and
B. corrodens), Peptostreptococcus and fusospirochetosis.
24. What are the facial spaces involved in Ludwigs angina?
Ans. It involves: Submandibular space (bilaterally)
Sublingual space (bilaterally)
Submental space
25. What is the reason for death in Ludwigs angina?
Ans. Respiratory obstruction. In case of Ludwigs angina, there is
dyspnea, i.e. difficulty in breathing due to the backward spread of
infection. If it is not treated, it results in edema of glottis and causes
complete respiratory obstruction.
26. Which is the most classical intraoral sign of Ludwigs angina?
Ans. Raised tongue against the palate, resulting in airway obstruc
tion.
27. What are the clinical complications of the classic Ludwigs
angina?
Ans. i. Bilateral swelling of the submandibular, sublingual, fascial
space and swelling of submental space.
ii. Raised tongue
iii. Dysphagia
iv. Toxemia
v. Dehydration
vi. Pyrexia.
28. What is the reason that the spread of infection from
mandible premolars and first molar may cause sublingual
space?
Ans. It is because the root apices of these teeth lie above the
mylohyoid line.
29. How will you manage Ludwigs angina?

Ans. i. Early diagnosis
ii. Prompt surgical intervention
iii. Definitive airway management
iv. Surgical drainage of individual space
v. Appropriate antibiotic therapy
30. What is the reason that the spread of infection from
the second and third mandibular molars may cause
submandibular space?
Ans. It is because the root apices of these teeth lie below the
mylohyoid line.
31. What is the cavernous sinus thrombosis?
Ans. It is an uncommon but potentially lethal extension of
odontogenic infection. Valveless veins in the head and neck allow
retrograde flow of infection from the face (maxillary anterior or
premaxillary region) to the cavernous sinus. The pterygoid plexus
of veins and angular and ophthalmic veins may contribute to the
retrograde flow.
Initial clinical sign: Vascular congestion in periorbital, scleral and
retinal veins
Other clinical signs: Periorbital edema, proptosis, thrombosis of
the retinal vein, ptosis, dilated pupils, absent corneal reflex and
supraorbital sensory deficits.
32. In cavernous sinus thrombosis (CST), the infection is spread
from anterior maxillary teeth through which veins?
Ans. i. Ophthalmic vein
ii. Anterior facial vein
iii. Angular vein (all are valveless veins)
33. After the extraction of the maxillary central incisor, a patient
develops ophthalmoplegia, meningitis and lateral rectus
paralysis. What is the diagnosis in this case?
Ans. On the basis of Eagletons criteria diagnosis is cavernous sinus
thrombosis.
34. What is the bacteriology of cavernous sinus thrombosis?

Ans. The most common microorganisms are Staphylococcus
aureus, Staphylococcus albus and streptococci sp. Others include
Proteus Pseudomonas, Pneumococcus and Haemophilus along with
anaerobic organisms.
35. What are the six Eagleton diagnostic features of cavernous
sinus thrombosis?
Ans. i. A known site of infection
ii. Evidence of bloodstream infection
iii. Early diagnosis of venous obstruction in the retina,
conjunctiva or eyelid
iv. Paresthesia of the third occlumotor, fourth trochlear and
sixth abducent, resulting from the inflammatory edema
v. Abscess formation in the neighboring tissue
vi. Evidence of meningeal irritation.
36. Cavernous sinus thrombosis can occur due to the spread
of odontogenic infection through which route?
Ans. Hematogenous route.
37. What is the most serious complication can arise after
surgery in the maxillary incisors?
Ans. Cavernous sinus thrombosis, because of the rapid spread of
infection from these into the anterior facial vein, which drains into
and infects the cavernous sinus.
38. What is the peculiarity of the propagation of infection in
cavernous sinus thrombosis?
Ans. Infection from the face can spread in the retrograde direction
and can cause cavernous sinus thrombosis. Retrograde infection
spreads due to the presence of the valveless vein. For example,
facial vein, ophthalmic vein, deep facial vein, superior ophthalmic
vein, pterygoid venous plexus. Facial infection may spread to the
cavernous sinus by the following two routes or pathways.
i. Anterior route by ophthalmic, facial, angular, infraorbital
vein
ii. Posterior route by pterygoid venous plexus.
39. What is the name of the physical test conducted to confirm

the cavernous sinus thrombosis?
Ans. The name of the test is Tobey-Ayer test. This is performed by
compressing the interjugular vein with the fingers. On the side of
thrombosis, there will be no rise in the CSF pressure measured by
lumbar puncture. There will be a rise in pressure when the jugular
is compressed on the normal side.
40. Masticator space infection usually results from.
Ans. i. Infection of the last 2 lower molars
ii. Nonaseptic technique in LA
iii. External or internal trauma to the mandibular angle
region.
41. What is the first choice of antibiotic in the management of
the cavernous sinus thrombosis and why is penicillin contra
indicated in the treatment of cavernous sinus thrombosis?
Ans. The choice of antibiotic is:
Injection chloramphenicol IV, 1 gram 6 hourly.
It is contraindicated because it cannot cross the blood brain
barrier (BBB).
42. Dumb-bell-shaped swelling is the characteristic of which
type of odontogenic space infection?
Ans. In deep temporal space because of the zygomatic arch.
Swelling is seen superior and inferior to the zygomatic arch, resulting
in dumb-bell-shaped swelling.
43. What are the roles of the following drugs in the management
of the cavernous sinus thrombosis?
Ans. i. Heparin: To prevent extension of thrombosis
ii. Manitol: To reduce edema
iii. Anticoagulant: To prevent venous thrombosis, but its role
is controversial.
44. Which is the most serious complication of the canine space
infection?
Ans. Cavernous sinus thrombosis.
45. What is the standard airway procedure in case of Ludwig

angina?
Ans. Layrngotomy or cricothyroidectomy (tracheotomy) are always
preferred over tracheostomy.
46. What are the fascial spaces directly connected with the
lateral pharyngeal space?
Ans. i. Retropharyngeal space
ii. Submandibular space
iii. Sublingual space
47. Muffled or hot-potato voice is characteristic feature of:
Ans. i. Peritonsillar abscess quinsy
ii. Lateral and retropharyngeal space infection.
48. What is Lincolns Highway or visceral vascular space,
which was coined by Mosher?
Ans. It is the carotid sheath from jugular foramen and carotid canal
at the base of the skull to the pericardium or middle mediastinum.
Infections in this space are usually associated with internal jugular
vein thrombophlebitis or carotid artery erosion.
In case of the spread of infection in head and neck region,
infections are easily disseminated either upwards through various
foramina at the base of the skull producing brain abscess, meningitis
or sinus thrombosis, or are easily disseminated downwards into the
carotid sheath towards the mediastinum.
Mosher called this pathway as the Lincolns Highway of the
neck.
49. How can an abscessed maxillary canine cause swelling
beneath the eyes?
Ans. Because the apex of the canine lies above the attachment of
the caninus and levator labi superioris muscles.
50. What is danger space and what is its other name?
Ans. Space four of Grid in sky and Holyoke It is the potential space
between alar fascia and prevertebral fascia. Its superior limit is the
skull base and it extends inferiorly into the posterior mediastinum.
51. Why are the infections of the lateral pharyngeal space life-
threatening?
Ans. There may be dangers of:
i. Thrombosis of IJV
ii. Erosion of ICA
iii. Edema of Larynx.
52. When does the masticatory space become very painful?
Ans. When the masticatory space travels to the parotid space, it
becomes very painful because the capsule of the parotid does not
give way to the developing infection to spread.
53. I and D form abscess of pterygomandibular space from the
intraoral approach. Which muscle is most likely to be incised?
Ans. Medial pterygoid muscle is most likely to be incised.
54. What do you mean by teeth in line of fire?
Ans. It means teeth in the area of the planned therapeutic radiation.
55. Odontogenic infection mainly caused by which bacteria
aerobic/anaerobic/mixed bacteria?
Ans. Mainly caused due to the mixed bacteria.
56. What is the life-threatening or severe complication of the
parapharyngeal fascial space infection and how will you
manage in this case?
Ans. It may cause respiratory difficulty and it may require
tracheostomy.
57. What is the difference between canine space infection and
buccal space infection?
Ans. i. Swelling in case of buccal space infection is four times
more in the cheek region
ii. Infraorbital swelling is present in the canine space
infection
iii. The main region in case of canine space infection is the
canine region, whereas in case of buccal space infection,
it is mainly the maxillary I molar region.
58. What are the parts of deep cervical fascia.

Ans. Deep cervical fascia consists of the following parts:
i. A superficial or investing layer
ii. The carotid sheath
iii. The pretracheal layers
iv. The prevertebral layer.
59. What is quinsy?
Ans. It is also known as the peritonsillar abscess. It is a deep neck
infection. It is usually seen as a complication of acute tonsillitis. It can
spread to involve the lateral pharyngeal space. It is characterized by
the swelling of the tonsils, uvular displacement, trismus and muffled
voicehot potato in mouth.
60. What are the complications of the orofacial infection?
Ans. It is classified as follows:
i. Those related to the lower jaw:
Ludwigs angina
Mediastinitis descending deep cellulitis of the neck
Carotid sheath invasion.
ii. Those related to the upper jaw:
Intracranial complications
a. Cavernous sinus thrombosis
b. Brain abscess
c. Dural meninges
d. Osteomyelitis of the skull.
Retrobulbar cellulitis:
a.Blindness.
Disease of Paranasal
Sinuses (Disease of chapter
Maxillary Sinus) 8
1. What are the paranasal sinus? What are the common pecu
liarities of these paranasal sinuses?
Ans. Paranasal sinuses are four, paired, air-filled, mucosa-lined
cavities, which develop in the facial and cranial bones.
There are four paired paranasal sinuses:
i. Frontal sinus
ii. Maxillary sinus
iii. Sphenoidal sinus
iv. Ethmoid sinus.
All of these open into the nasal cavity through the lateral wall.
Common peculiarities: These sinuses communicate with the nasal
cavity. This is the reason why a patient suffering from cold complains
of headache because the nasal cavity communicates with the
frontal sinus.
2. In which radiograph, maxillary sinus is best demonstrated?
Ans. By 15C occipitomental radiograph described by Waters and
Waldron in 1915. It is also known as Waters view or PNS.
3. McGregor and Campbells line is seen in which projection?
What are these lines?
Ans. McGregor and Campbells line is seen in paranasal sinus view
or paranasal sinus (PNS) view or occipitomental view. These are the
five lines, which are as follows:
First line: Path from the zygomaticofrontal suture to the superior
orbital margin across the glabella region to the superior orbital
margin and zygomaticofrontal suture of the other side.
Disease of Paranasal Sinuses (Disease of Maxillary Sinus) 133
Second line: From the zygomaticotubercle to the continuous line

of zygomatic arch till it blends into the zygomatic bone and the
line continues along the inferior orbital margins across the frontal
process of the maxillae and the lateral wall of the nose through the
septum and then the same course on the opposite side.
Third line: From the condyle across the mandibular notch, coronoid
process of the mandible to the lateral wall of the antrum and
continues through the medial wall of the antrum or the lateral
wall of the nose at the nasal floor level and the same course on the
opposite side.
Fourth line: Occlusal curve of the unilateral arches.
Fifth line: Lower border of the mandible from one angle to the
other side angle.
4. What is an another name of the membrane of the maxillary
sinus?
Ans. It is also known as Schneiderian membrane.
5. What are the peculiarities of the maxillary sinus lining?
Ans. i. Name: Mucous membrane of the respiratory type.
Pseudostratified columnar ciliated epithelium (PSCCE)
ii. Cilia movement =1,000 beats/minute
iii. Cilia can move secretion, e.g. mucus = 6 mm/minute.
6. Which root of the tooth is very close to the maxillary sinus?
Ans. Maxillary second premolar.
7. What is the radiopaque feature of the maxillary sinusitis?
Ans. i. Odontogenic sinusitis: Either totally opaque sinus or with
the presence of fluid level
ii. Acute maxillary sinusitis: It shows uniform opacity.
iii. Chronic maxillary sinusitis: It shows the presence of fluid
level.
8. What are the symptoms of maxillary sinusitis?
Ans. i. Tenderness over the involved area
ii. Postnasal drip
iii. Change in phonation.
9. How will you manage a case of 0.5 mm perforation created

in the maxillary sinus during the extraction of the maxillary
molar?
Ans. Actually no treatment is required. If the opening is small,
a good clot is formed and normally healing occurs without any
complication. If the opening is large, immediate closure should be
done to reduce the chances of contamination and the formation
of oroantral fistula.
10. What are the 5 Es as the symptoms of OAF?
Ans. In case of fresh oroantral fistula (OAF):
i. Escape of fluid: From the mouth to the nose on the side
of the extraction during rinsing and gargling
ii. Epistaxis (unilateral): Due to blood in sinus escaping
through the osteum to the nostrils with or without
frothing
iii. Escape of air: From the mouth into the nose on sucking
or inhaling or drawing of cigarette or puffing cheeks
(inability to blow cheeks)
iv. Enhanced column of air: It causes alteration in vocal
resonance and subsequently a change in the voice.
v. Excruciating pain: In and around the region of the affected
sinus after LA stops acting.
11. What are the 5 Ps as the symptoms of OAF in case of the
late stage of OAF?
Ans. i. Pain
ii. Persistent, purulent or mucopurulent, foul unilateral nasal
discharge
iii. Postnasal drip
iv. Possible sequel of general systemic toxemic condition
v. Popping out of an antral polyp.
12. Nasal antrostomy usually done from through.
Ans. Inferior meatus: It will result in complete drainage from the
sinus to occur into the nose.
13. Where does the maxillary sinus drain?

Ans. Middle meatus.
14. During extraction, if there is an oroantral communication,
then how will you manage?
Ans. It must immediately be closed surgically.
15. Oroantral fistula most commonly occurs during the
extraction of which tooth?
Ans. Maxillary first molar, because the palatal root is very close to
the maxillary sinus.
16. Caldwell procedure is made through the?
Ans. Canine fossa, a semilunar incision is made in the canine fossa
from the canine to the second molar area, well above the apices.
17. During the extraction of the maxillary molar, a root tip is
left in the maxillary sinus. What is the choice of treatment?
Ans. Caldwell procedure is performed.
18. What is the head shaking test?
Ans. This test is done to diagnose the position of the root in
relation to the maxillary antrum or the foreign bodies in the sinus.
The presence of a foreign body such as root fragments or any other
things changes its position with the movement of the head. This
change in position can be confirmed by serial radiographs. In case
the foreign body does not move in consecutive radiograph, then
it is either (a) trapped into the polyp thick mucosa, (b) or present
between the antral lining membrane and the bony wall.
19. Confirmation of the presence of the OA communication is
made by which test?
Ans. Nose blowing test.
20. Where is the osteum situated?
Ans. Middle meatus.
21. What is pan sinusitis?
Ans. Inflammation of most or all of the paranasal sinuses simul-
taneously is called as pan sinusitis.
22. Bones contain air sinuses except which bonefrontal, nasal

or ethmoidal?
Ans. Nasal bone is without air sinus.
23. What is the role of the decongestant in sinusitis?
Ans. It reduces the vascularity of the lateral wall of the nose.
24. What does the chronic sinusitis transillumination show?
Ans. i. Thickened lining membrane
ii. Opaque air spaces
iii. Antral pathogens.
25. When OAF should be never closed?
Ans. If the signs of infection are present.
26. What is the role of nasal decongestant in the management
of OAF?
Ans. To shrink the antral lining.
27. What is Potts puffy tumor?
Ans. It is one of the serious complications of the frontal sinusitis,
if the periosteal abscess and osteomyelitis of the frontal bone are
present.
28. Berger flap procedure is used for which condition?
Ans. Modified von R Hermanns buccal advancement flap is also
known as Bergers flap. It is used as a method of closing the oroantral
fistula.
29. What are the functions of the paranasal sinuses?
Ans. The functions of the paranasal sinuses are as follows:
i. The sinuses give resonance to the voice
ii. They help in warming the inspired air
iii. They help in reducing the weight of the skull
iv. They serve as an insulator to prevent incoming of the
cold air
v. They act as shock absorbers for the face or skull
vi. They provide mechanical rigidity.
30. What is the Caldwell-Luc operation?

Ans. The direct visual examination of the maxillary antrum is best
made by cutting a window in the anterolateral wall of the maxillary
antrum and this approach is called the Caldwell-Luc operation.
31. What are the indications of the Caldwell-Luc operation?
Ans. The indications of the Caldwell-Luc operation are as follows:
i. Removal of tooth or root from the antrum
ii. Removal of foreign bodies from the sinus
iii. In case of chronic maxillary sinusitis, where the removal
of the lining of the antrum is desired
iv. For the removal of cysts from the antrum
v. For the removal of any benign growth of the maxillary
sinus
vi. For the control of any active hemorrhage following the
trauma of the maxillary sinus
vii. For lifting the floor of the orbit in case of blowout fracture
viii. For the removal of any impacted maxillary canine or third
molar
ix. For the closure of oroantral fistula by the buccal sliding
flap operation.
32. Define oroantral communication and oroantral fistula.
Ans. i. Oroantral communication: It is defined as an oroantral
perforation, which is unnatural communication between
the oral cavity and maxillary sinus
ii. Oroantral fistula: It is defined as an epithelialized
pathological unnatural communication between these
two cavities.
33. What is the purpose of the management of oroantral fistula?
Ans. i. To protect the sinus from the oral microbial flora
ii. To prevent the escape of the fluids and other contents
across the communication
iii. To eliminate the existing antral pathology.
iv. To establish drainage through the inferior meatus.
34. Which different types of flaps are used to close the oroantral
fistula?
Ans. If the defect is more than 5 mm in the diameter, it requires
surgical closure with different flaps, which are as follows:
A. Local flaps
i. Buccal flaps:
a. von R Hermanns buccal advancement flap
b. Sliding flap
c. Non-rotating flap
d. Transversal flap
e. Rotated flap
f. Labial vestibule bipedicled flap
g. Proctor flap
ii. Palatal flap:
a. Rotation-advancement flap or Ashley flap.
b. Straight advancement flap
c. Hinged flap
d. Island flap
e. Bipedicle advancement flap.
B. Distant flap:
i. Tongue flap
a. Anterior-based partial thickness dorsal tongue
flap
b. Posteriorly based full thickness lateral tongue flap.
C. Graft procedure:
a. Bone
b. Alloplastic material.
35. What is functional endoscopic sinus surgery (FESS)?
Ans. The purpose is to restore the normal paranasal air sinuses
mucociliary function, for example:
i. Recurrent sinusitis with stenosis
ii. Chronic hyperplastic sinusitis with obstructive nasal
polyps
iii. Chronic sinusitis with mucocele formation
iv. Fungal sinusitis
v. Neoplasm
vi. Orbital cellulitis/abscess.
36. List ten key points about the maxillary sinus.
Ans. i. Maxillary sinus is one of the largest, pyramidal shaped
paired (left and right)
ii. It is also known as antrum of high more and maxillary
antrum
iii. It is present in the body of the maxilla
iv. It is lined by pseudostratified columnar ciliated epithe-
lium, which is also known as Schneiderian membrane
v. Capacity of sinus is 30 ml, situated opposite to the
maxillary first molar, with a depth of 3.2 cm and breadth
of 2.5 cm
vi. Major arterial supply is by the internal maxillary artery,
small artery drived from the facial, maxillary, infraorbital
and greater palatine artery
vii. Venous drainage through the anterior facial vein and the
angular vein
viii. Lymphatic drainage towards the submandibular lymph
nodes
ix. Nerve supply through the infraorbital nerve
x. During the extraction of the posterior maxillary teeth
(second premolar and first molar particularly), it may
cause perforation of maxillary sinus resulting in the
formation of the oroantral communication. If the tract
is epithelialized, it is called oroantral fistula.
37. What are the methods to confirm the presence of the
oroantral communication or fistula?
Ans. The presence of the oroantral communication or fistula is
confirmed by the following methods:
i. A silver probe can be used to detect and confirm the
presence of the communication or fistula
ii. A suction nozzle, when placed over the fistula, will
produce a sound like an empty bottle
iii. During rinsing of the mouth, fluid can be seen escaping

through the nares
iv. Nose blowing test: A cotton bud is kept near the fistulous
opening and the patient is asked to blow the nose with
closed nostril and open mouth. If communication is
present, then there will be displacement of the cotton
bud.
38. What are the complications of the untreated maxillary
sinusitis?
Ans. Following are the complications of the untreated maxillary
sinusitis:
i. Cellulitis
ii. Abscess
iii. Meningitis
iv. Cavernous sinus thrombosis
v. Osteomyelitis
vi. Oroantral fistula
vii. Direct extension to the orbital wall.
39. Which tooth overfilling may cause force to the maxillary
sinus?
Ans. Overfilling of maxillary first molar.
40. What is the role of the blood clot in the formation of the
oroantral fistula?
Ans. Fate of the clotif the clot dislodges or gets infected, it may
cause the formation of oroantral fistula.
Salivary Gland chapter
Disorders 9
1. Give the examples of the salivary glands which secrete
serous, mucous and mixed secretions.
Ans. i. Serous secretion = Parotid gland
ii. Mucous secretion = Minor salivary gland of the cheek
iii. Mixed.
Seromucous = Submandibular gland (serous predomi
nantly)
Mucoserous = Sublingual gland (mucous predomi-
nantly).
2. What is the name of ducts of the salivary glands?
Ans. i. Parotid gland: Stensens duct (opens opposite to the
second maxillary molar)
ii. Submandibular gland: Whartons duct (thin-walled, 5 cm
long, opens at the floor of the mouth. Sublingual papilla
at the side of the frenum of the tongue
iii. Sublingual gland: Bartholins duct.
(i) Sialadenitis; (ii) Bacterial sialadenitis; (iii) Mumps/viral
parotitis/viral sialadenitis; (iv) Sialadenosis; (v) Sialorrhea/
Ptyalism; (vi) Xerostomia; (vii) Sialolithiasis; (viii) Sialectasis;
(ix) Sialodochitis; (x) Sialography; (xi) Sialoceles; (xii)
Sarcoidosis; and (xiii) Sialosis
Ans. i. Sialadenitis: Inflammation of the salivary gland
ii. Bacterial sialadenitis: Inflammation of the salivary gland
due to bacterial infection
iii. Mumps/viral parotitis/viral sialadenitis: Inflammation of
the salivary gland due to viral infection
iv. Sialadenosis: Enlargement of the salivary gland

v. Sialorrhea/ptyalism: Excessive salivation
vi. Xerostomia: Reduction in salivation
vii. Sialolithiasis: Formation of salivary calculi or salivary stone
in the salivary duct or gland
viii. Sialectasis: Swelling of the salivary gland
ix. Sialodochitis: Inflammation of the salivary duct
x. Sialography: Roentgenographic evaluation of the salivary
gland and the ductal system
xi. Sialoceles: It is the subcutaneous collection of saliva
xii. Sarcoidosis: It is a systemic granulomatous disease of
the undetermined etiology. It may involve any body site.
Salivary gland is involved in 3 to 10% cases
xiii. Sialosis: Non-inflammatory, non-neoplastic enlargement
of the salivary gland.
4. How many minor salivary glands are present in the oral
cavity?
Ans. Approximately 500 minor salivary glands are present.
5. What is the difference between exocrine and endocrine
glands?
Ans. In the exocrine glands, ducts are present, for example, salivary
glands, whereas the endocrine glands are ductless, like the pituitary
gland.
6. What is the difference between aplasia and atresia?
Ans. Aplasia is the absence of the gland whereas atresia is the
absence of the duct or congenital occlusion of the duct.
7. What is the shape of the major salivary gland?
Ans. Parotid gland: Pyramidal gland
Submandibular gland: Walnut shape
Sublingual gland: Almond shape.
8. What is the exact situation of the submandibular gland?
Ans. In the anterior part of the digastric triangle.
Salivary Gland Disorders 143
9. What are the structures present in parotid gland?

Ans. Arteries: External carotid artery, maxillary artery, posterior
auricular artery, superficial temporal artery
Veins: Retromandibular vein from the superficial temporal
vein, maxillary vein
Nerves: Facial nerves.
10. In reference to the parotid gland, explain the following
terms:
(i) Glenoid process; (ii) Facial process; (iii) Accessory part of
the gland; (iv) Pterygoid process.
Ans. i. Glenoid process: The superior margin of the gland extends
upwards behind the TMJ into the posterior part of the
mandibular fossa. This part of gland is called the Glenoid
process of the parotid gland
ii. Facial process: Anterior margin of the gland extends
forward, superficial to the masseter muscle to form the
facial process
iii. Accessory part of the gland: A small part from the facial
process, which may be separate from main parotid gland,
is called the accessory part of the gland
iv. Pterygoid process: The deep part of the gland extends
forward between the medial pterygoid muscle and the
ramus of the mandible to form pterygoid process.
11. Which structure separates the parotid gland from the
submandibular gland?
Ans. Stylomandibular ligament separates both the glands.
12. What are the causes of ptyalism?
Ans. Ptyalism means excessive salivation.
The causes of ptyalism are:
i. Aphthous ulcer
ii. Rabies
iii. Heavy metal poisoning
iv. Medicines like lithium
v. Cholinergic agonists.
13. What are the drugs that cause xerostomia?

Ans. Xerostomia means the reduction of saliva or dry mouth. The
drugs that cause xerostomia are as follows:
i. Anticholinergics (atropine)
ii. Anticonvulsants
iii. Antipyretics
iv. Antihypertensives
v. Diuretics
vi. Expectorants
vii. Sedatives.
14. Why is sialography not advisable in a sublingual gland?
Ans. Its ductal system has tortuous course. Because of its multi
ductal anatomy, the sublingual gland does not lend itself well to
this examination.
15. Why is sialolithiasis or salivary calculus more common in a
Ans. The following are the reasons:
i. The secretion of the submandibular gland is more viscous
ii. The presence of an anatomical weakness
iii. Secretion with higher concentration of calcium and
phosphate
iv. The flow of saliva is in an unfavorable direction against
the gravity.
16. Which salivary gland lesion is usually associated with the
sicca syndrome?
Ans. Benign lymphoepithelial lesion.
17. Which is the most common malignant salivary gland tumor
in the children?
Ans. Mucoepidermoid carcinoma.
18. Which is the most common salivary gland tumor affecting
the palatal salivary glands?
Ans. Adenoid cystic carcinoma.
19. Which is the most significant finding clinically in a patient

with parotid mass?
Ans. Parotid mass may be accompanied by facial paralysis.
20. What is Mikulicz disease?
Ans. It is an autoimmune disease. It is a well-known disorder
characterized by enlarged lacrimal and parotid glands caused by
infiltration with lymphocytes.
21. What are the conditions/lesions for which the bimanual
palpation technique is carried out?
Ans. For the submandibular, sublingual swelling and ranula.
22. A patient complains of the swelling in the floor of the mouth
which increases during the meal. What is the provisional
diagnosis?
Ans. Siolim of Whartons duct
23. There is a cystic lesion below the tongue or floor of the
mouth, which occurs due to an obstruction of the salivary
gland. What is the name of the lesion?
Ans. It is called as ranula (one of the retention cysts).
24. What is the most common reason for mucocele?
Ans. Rupture of the salivary gland.
25. What is the most common complication of mumps?
Ans. Orchitis is one of the serious complications.
26. What is the other name of adenoid cystic carcinoma?
Ans. Cylindroma.
27. If fatty changes occur in the parotid gland then what does
it signify?
Ans. It is a sign of alcoholism.
28. What are the signs and symptoms of salivary gland
malignancy?
Ans. i. Rapid tumor growth
ii. Pain
iii. Peripheral facial nerve paralysis.
29. Are sialoliths always visible on radiographs?

Ans. No, sialoliths in the early stage of development are quite small
and not adequately mineralized to be visible radiographically.
30. Is there any association between salivary disease and AIDS?
Ans. Yes, the condition affecting the salivary glands in the
AIDS patients includes parotid lymphoepithelial lesions, cyst,
lymphadenopathy, Kaposis sarcoma, Sjgrens syndrome like, the
condition with xerostomia.
31. What types of lesions can result from the mucous escape?
Ans. Mucocele and ranula.
32. What are the structures encountered while removing the
Ans. i. Facial artery
ii. Facial vein
iii. Cervical branch of the facial vein
iv. Lingual nerve.
33. How can the submandibular calculus be removed by?
Ans. Through the incision of duct and the removal of calculus.
34. What is meant by milking the gland?
Ans. A small stone in the distal portion of the duct can be removed
by manipulation called as milking the gland.
35. What are the characteristic triad features of the sicca
syndrome?
Ans. i. Xerostomia
ii. Enlargement of the salivary gland
iii. Enlargement of the lacrimal gland
36. What are the characteristic features of Freys syndrome?
Ans. It is caused by damage to the auriculotemporal nerve. Its
characteristic features are as follows:
i. Flushing and sweating of the involved side of face
ii. Chiefly in temporal area during eating
iii. Gustatory sweating when eating spicy food.
37. Caf-au-lait spot is seen in which conditions?

Ans. i. Sjgrens syndrome
ii. Tuberculous sclerosis
iii. Albright syndrome
38. In which condition of the mouth is an increase in the caries
activity seen?
Ans. Xerostomia (decrease in salivation) may cause an increase in
the caries activity.
39. Which is the most common benign tumor of the salivary
gland?
Ans. The most common benign tumor of the minor or major
salivary gland is pleomorphic adenoma.
40. List the synonyms of pleomorphic adenoma.
Ans. The synonyms of pleomorphic adenoma are as follows:
i. Bizarre tumor
ii. Iceberg tumor
iii. Mixed tumor of the salivary gland
iv. Endothelioma
v. Branchioma
vi. Dumbbell tumor of the salivary gland.
41. Why is the pleomorphic adenoma of the parotid gland also
known as bizarre tumor?
Ans. It is also known as bizarre tumor because the tumor constitutes
a heterogeneous group of lesion of the great morphologic variation.
Its morphologic complexity is the result of the differentiation of the
tumor cells. It is characterized by an unusual histologic pattern and
is derived from more than one primary tissues.
42. What type of cells are responsible for the origin of
pleomorphic adenoma?
Ans. Myoepithelial cells.
43. What is the treatment for pleomorphic adenoma of the
parotid gland?
Ans. Superficial parotidectomy.
44. Which salivary gland tumor is radiosensitive?

Ans. Pleomorphic adenoma of the parotid gland.
45. What is the difference between primary and secondary
Sjgrens syndrome?
Ans.
Primary Sjgrens syndrome Secondary Sjgrens syndrome
1. Dry eyes 1. Dry eyes
2. Dry mouth 2. Dry mouth
3. Rheumatoid arthritis
4. Systemic lupus erythematosus
5. Polyarteritis nodosa.
46. What are the diagnostic tests for Sjgrens syndrome?

Ans. The following are the diagnostic tests for Sjgrens syndrome:
i. The patient may show polyclonal hyperglobulinemia and
develop cryoglobulins
ii. Positive latex test for salivary duct antibody
iii. The Schirmer test: It consists of placing a strip of filter
paper in the lower conjunctival sac. In a normal patient,
the paper will wet up to 15 mm in 5 minutes and in a
patient with Sjgrens syndrome, the paper will wet up
to less than 5 mm in 5 minutes
iv. The rose Bengal dye test is used to detect the damaged
and denuded area of the cornea. The breakup time is
(BUT) performed using the slit lamp and noting the
interval between a complete blink and the appearance
of the dry spot in the cornea
v. Sialography demonstrates the cavitary defects which are
filled with radiopaque contrast media producing a fruit-
laden branchless tree or cherry blossom appearance.
47. What is the triad of Sjgrens syndrome?
Ans. This is a condition originally described as a triad of dry eyes,
xerostomia, and rheumatoid arthritis.
48. What is gustatory sweating?

Ans. It is also known as Freys syndrome. It is one of the
complications of the parotid gland surgery. To a varying degree,
there is flushing and sweating of the skin of the upper cheek,
temporal region and forehead, coincident with eating. It has
been suggested that following damage to the auriculotemporal
nerve or to the communicating branches to the facial nerve, the
secretomotor parasympathetic fibers from the otic ganglion and
also the sympathetic fibers to the sweat gland travelling in the
same nerve are divided following regeneration, fibers from the otic
ganglion come to supply the sweat glands. The only effective cure
is to divide the parasympathetic fibers from the glossopharyngeal
nerve.
49. In which syndrome is the flushing of face during eating
seen?
Ans. Freys syndrome. It is also known as gustatory sweating or
auriculotemporal syndrome.
50. What is the difference between viral and bacterial
sialadenitis?
Ans.
Viral sialadenitis Bacterial sialadenitis
1.It is also known as mumps or viral 1.It is also known as cat scratch
parotitis disease
2. Viral infection 2. Bacterial infection
3. It is caused by paramyxovirus 3.It is caused by organisms, such as
4. Elevation of the ear lobe Staphylococcus aureus, Staphy
5.Both the glands enlarge simulta lococcus pyogenes, Strepto
neously or within 24 to 48 hours coccus viridans, Pneumococcus,
6.No pus formation or pus discharge Actinomycetes, etc.
from the ductal opening 4.Elevation of the ear lobe is not
seen.
5.It is unilateral. It is seen on the
affected side.
6.Pus discharge on pressing the
duct from the ductal opening.
51. In which major salivary gland is:

(i) Pleomorphic adenoma more common; (ii) Sialolithiasis
more common; (iii) Sialography contraindicated?
Ans. i. Pleomorphic adenoma is more common in the parotid
gland
ii. Sialolithiasis is more common in the submandibular
gland
iii. Sialography is contraindicated for the sublingual gland.
52. In which condition is the acute nonsuppurative sialadenitis
seen?
Ans. Mumps.
53. What is sialography?
Ans. Sialography is a valuable aid in the diagnosis and management
of the salivary gland and ductal abnormalities.
Sialography can be defined as the radiographic visualization
of the two paired major salivary glands and their ductal system
(parotid and submandibular glands).
54. What are the indications of sialography?
Ans. Indications of sialography are as follows:
i. Detection of calculus/foreign body/fistulae/residual
stone
ii. Determination of residual tumor and retention cyst
iii. Determination of the extent of destruction of the gland
iv. Selection of the site for biopsy
v. Demonstration of a tumor and its location, size and origin.
55. What are the contrast media used for sialography?
Ans. Two types of contrast media are used:
i. Water-soluble contrast media
Hypaque 50% diatrizoate sodium
Renografin (diatrizoate meglumine)
Silograph
Isopaque
Dionosil
Triosil
ii. Fat-soluble or oil-based contrast media
Iodized oilEthiodol
Water-insoluble organic compoundPantopaque.
56. What is the amount of contrast media injected?
Ans. Submandibular gland: 0.75 to 1 ml
Parotid gland: 1 to 1.5 ml.
57. What are the contraindications of sialography?
Ans. The contraindications of sialography are as follows:
i. The patient with known sensitivity to iodine compound
ii. During the period of acute inflammation of the salivary
system
iii. If thyroid function test is required, it should be done prior
to sialography.
58. What are the steps of the sialography procedure and what
is the difference between the parenchymal phase and the
evacuation phase of sialography?
Ans. The three main steps of the sialography procedure are as
follows:
i. Primary plain film evacuation
ii. The injection or filling phase
iii. The parenchymal phase (in case water-soluble contrast
media is used) or evacuation phase (in case fat-soluble
contrast media is used).
59. What are the complications of the salivary gland surgery?
Ans. i. Freys syndromegustatory sweating
ii. Facial paralysis
iii. Salivary fistula
iv. Infection
v. Hematoma
60. Which tumor does not occur in the minor salivary gland?
Ans. Warthins tumor.
61. What are the different sialographic pictures for the follow
ing conditions?
1. Sjgrens syndrome; 2. Sialadenosis; 3. Sialodochitis;
4. Parotid gland; 5. Submandibular gland; 6. Salivary gland
tumor and benign tumor; 7. Sialectasia; 8. Chronic bacterial
sialadenitis; 9. Pleomorphic adenoma; 10. Sialadenitis;
11. Malignant growth; 12. Blockage of buds
Ans.
Condition Sialographic picture
1. Sjgrens syndrome Snow storm or branchless fruit-laden
tree or cherry blossom appearance
2. Sialadenosis Leafless tree
3. Sialodochitis String of sausage
4. Parotid gland Tree in winter/leafless tree
5. Submandibular gland Bush in winter
6. Salivary gland tumor and Ball in hands
benign tumor
7. Sialectasia Bunch of grapes
8. Chronic bacterial sialadenitis Pruned tree
9. Pleomorphic adenoma Grasping fingers appearance
10. Sialadenitis Apple tree in blossom
11. Malignant growth Spillage defect/scattered dye
12. Blockage of buds Offshoot appearance
62. What are the complications of sialography?

Ans. The complications are as follows:
i. Overdistention of gland may cause temporary swelling
and discomfort for a few hours to days
ii. Extravasation of the contrast media may result in foreign
body reaction
iii. Occasionally a chronic inflammatory process may be
aggravated and can be subsided by antibiotic therapy.
63. What is the water and solid ratio in saliva?

Ans. Water: 99.5%
Solid: 0.5%.
64. What are the functions of saliva?
Ans. Saliva is a complex fluid which has several proteins and
digestive functions:
i. Helps in the formation of bolus by moistening solid food
ii. Moistens epithelium and teeth and helps protect them
iii. Flushes and cleanses oral cavity
iv. Helps in speech by moistening the epithelial surface
v. Helps in digestion
vi. Helps in perception of taste
vii. Excretes the body metabolites
viii. Has bacteriolytic action
ix. Decreases the blood clotting time.
65. Which are the cysts of the salivary glands?
Ans. The cysts of the salivary glands are known as mucoceles.
Types of mucoceles:
i. Mucocele: This is a swelling due to the accumulation
of saliva as a result of the obstruction or trauma to the
salivary gland duct. The common sites are lower lip and
tongue.
ii. Ranula: It is a special type of mucocele. The common site
is floor of the mouth. The lesion appears like the belly of
the frog. That is why, it is called ranula (rana frog). Ranula
is formed because of the trauma to submandibular or
sublingual gland duct.
chapter
Nerve Disorders 10
1. What is neuropraxia?
Ans. Temporary sensation loss, no axonal degeneration, mild
temporary injury due to compression. Spontaneous recovery within
four weeks.
2. What is axonotmesis?
Ans. Loss of the continuity of some axons. Recovery is often less
and appears after 1 to 3 months. The nerve remains intact.
3. What is neurotmesis?
Ans. Complete severance of all the layers of the nerve. No recovery
is expected. There is permanent conduction block of all the impulses.
4. What are the common neuralgias in the dental region?
Ans. i. Trigeminal neuralgia
ii. Glossopharyngeal neuralgia
iii. Geniculate neuralgia
iv. Symptomatic neuralgia.
5. What are the synonyms of trigeminal neuralgia?
Ans. i. Fothergills disease
ii. Tic dolorosa
iii. Tic douloureux
iv. Classic trigeminal neuralgia
v. Idiopathic trigeminal neuralgia.
6. What are the clinical methods of examining trigeminal
neuralgia?
Ans. i. Pin-prick method
ii. Brush direction discrenation
Nerve Disorders 155
iii. Two-point discrenation

iv. Static touch.
7. Crocodile tears are related with which nerve disorder?
Ans. Bells palsyone of the facial nerve disorders.
8. Which division of the trigeminal nerve contain motor fibers?
Ans. Mandibular nerve V3 (third branch).
9. Maxillary nerve does not innervateupper eyelid or upper
lip.
Ans. It does not innervate the upper eyelid.
10. Maxillary nerve does not give any branchcranium or ear.
Ans. In ear, it does not give any branch.
11. From where is the mandibular nerve derived?
Ans. First branchial arch.
12. What are the trigger zones?
Ans. These are the zones which precipitate an attack when
touched. The trigger zones of trigeminal neuralgia are as follows:
i. Vermillion border of lips
ii. Ala of the nose
iii. Cheek
iv. Around the nose.
13. Which division of trigeminal neuralgia (TN) is most
commonly affected in neuralgia?
Ans. Mandibular nerve V3 third branch is affected most commonly.
14. In extreme cases of trigeminal neuralgia how does a
patients face look like?
Ans. Frozen face or masked face.
15. What is the drug of choice in trigeminal neuralgia?
Ans. Tablet Carbamazepine (Tegretol) 200 mg/day to 1200 mg/
day.
16. In case of contraindication of Carbamazepine, which is the

drug of choice?
Ans. Clonazepam1.5 mg/day.
17. Tinels sign is the indication of.
Ans. Nerve regeneration.
18. Which nerve is affected in Saturday night palsyulnar or
radial nerve?
Ans. Radial nerve is affected.
19. Ptosis may be caused by the lesion of which nerve
oculomotor nerve or trigeminal nerve?
Ans. It is caused by the lesion of oculomotor nerve.
20. What is the initial stage of paralysis of the facial nerve?
Ans. The tongue deviates to the same side on protrusion.
21. What does Bells palsy represent?
Ans. An inability to close the affected eye.
22. There is sudden onset of idiopathic paresthesia of facial
nerve without being related to any other disease. What is
this condition?
Ans. Bells palsy.
23. What is the six inch syndrome?
Ans. During the trigeminal neuralgia attack, patient stops all the
activities and tries to keep everything away from him/her. The
syndrome is characterized by:
i. Cleansing of the teeth
ii. Screwing of the eyes
iii. Sucking of the saliva
iv. Rubbing of the skin
24. How will you classify the cranial nerve?
Ans. i. Sensory cranial nerve contains only the afferent sensory
fibers (sensation towards the brain from the periphery)
Olfactory nervecranial nerve I
Optic nervecranial nerve II
Auditory (vestibulocochlear) nervecranial nerve VIII
Nerve Disorders 157
ii. Motor cranial nerve contains only efferent motor fibers

(sensation towards the periphery from the brain):
Oculomotor nervecranial nerve III
Trochlear nervecranial nerve IV
Abducent nervecranial nerve VI
Accessory nervecranial nerve XI
Hypoglossal nervecranial nerve XII
iii. Mixed nerves contain both sensory and motor fibers:
Trigeminal nervecranial nerve V
Facial nervecranial nerve VII
Glossopharyngeal nervecranial nerve IX
Vagus nervecranial nerve X.
25. What is Webers syndrome?
Ans. Midbrain lesion causing contralateral hemiplegia and
ipsilateral paralysis.
26. Explain the following tests:
(i) Rinnes test; and (ii) Webers test
Ans. i. Rinnes test: Vibrating tuning fork held opposite the ear and
then on the mastoid process. Ask the patient to compare
relative loudness of the fork in two instances.
ii. Webers test: Vibrating tuning fork placed on the center of
the forehead. Vibration is heard better on the side of the
middle ear disease.
27. What is the clinical test for the hypoglossal nerve (cranial
nerve XII)?
Ans. Ask the patient to protrude the tongue, if the nerve is
paralyzed. It deviates from the paralyzed side.
28. Enumerate various specific pain syndromes.
Ans. i. Idiopathic trigeminal neuralgia (Tic douloureux)
ii. Auriculotemporal nerve neuralgia
iii. Glossopharyngeal neuralgia
iv. Sphenopalatine neuralgia (Sluders syndrome)
v. Geniculate neuralgia.
29. Enumerate the various symptomatic neuralgias.

Ans. Few conditions labeled as symptomatic neuralgias are as
follows:
i. Costens syndrome
ii. Plummer-Vinson syndrome
iii. Trotters syndrome
iv. Styloid process syndrome
v. Neuromas
vi. Sjgrens syndrome
vii. TMJ dysfunction syndrome.
30. Define the following terms: (i) Pain; (ii) Neuralgia; and (iii)
Trigeminal neuralgia.
Ans. i. Pain: Pain is an ill-defined, unpleasant sensation, usually
evoked by an external or internal noxious stimulus. The
components of pain are perception, effect or emotion
and reaction
ii. Neuralgia: It may be defined as paroxysmal (intense,
intermittent) pain that is usually confined to specific
nerve branch of the head and neck region
iii. Trigeminal neuralgia: It is defined as paroxysmal (intense
intermittent) pain in the distribution of the trigeminal
nerve without any major weakness or demonstrable
sensory loss.
31. What are White and Sweets five diagnostic features of the
trigeminal neuralgia?
Ans. The five diagnostic features are as follows:
i. Pain is paroxysmal in nature (intense intermittent pain)
ii. Majority of the patients will have one or more of trigger
points
iii. The pain is confined to the area of the cutaneous inner
vation of the trigeminal nerve
iv. The pain affects only one side of the face at a time
v. The neuralgic examination between the attack is normal.
Nerve Disorders 159
32. What is anesthesia dolorosa?

Ans. Following the injury to the trigeminal nerve, a painful area of
numbness may develop. This is diagnosed as anesthesia dolorosa.
This pain is severe and constant and described as burning, gnawing
or stinging. Medications often do not relieve pain. There is limited
success in relieving pain with deep brain stimulation and premotor
cortex stimulation.
33. What is the differential diagnosis of trigeminal neuralgia?
Ans. i. Atypical trigeminal neuralgia
ii. Eagle syndrome
iii. Freys syndrome
iv. Paratrigeminal syndrome of Raeder
v. Post-therapeutic neuralgia
vi. Vagoglossopharyngeal neuralgia
vii. Ramsay Hunt syndrome
viii. Aneurysm of the ICA
ix. Fifthseven cranial nerve syndrome
x. Traumatic neuroma
xi. Torture syndrome
xii. Migraine
34. Differentiate between typical (classic) and atypical tri-
geminal neuralgia.
Ans.
Typical (classic) trigeminal Atypical trigeminal neuralgia
neuralgia
1. Intense intermittent paroxysmal 1. Dull boring pain for long time
pain
2. Pain occurs in the distribution of 2. Pain occurs on one side or on
particular nerve division the face
3. Attack never occurs at night 3. Pain occurs at night also
4. It never crosses the midline 4. It may also cross the midline.
35. List the outline to manage the case of trigeminal neuralgia.

Ans. i. Medical care:
Palliative treatment
Drug therapy.
ii. If the patient is not responding to the above-mentioned
treatment, then surgical treatment is opted:
Peripheral procedure:
a. Cryotherapy
b. Alcohol block
c. Laser
d. Neurectomy
Ganglion procedure:
a. Thermocoagulation
b. Glycerol injection
c. Balloon compression
Open operation:
a. Microvascular decompression
b. Trigeminal root section
Central procedure:
a. Tractomy
b. Dorsal root entry zone lesions.
36. What are the techniques of inferior alveolar neurectomy?
Ans. i. The extraoral approach is through Risdons incision. A
window is made in the outer cortex
ii. Intraoral approach via Dr Ginwallas incision. Incision is
made along the anterior border of the ascending ramus
extending lingually and buccally and ending in a fork-like
inverted Y-shape.
37. What are the techniques of infraorbital neurectomy?
Ans. i. The conventional intraoral approach: U-shaped Caldwell-
Luc incision is made in the upper buccal vestibule in the
canine fossa region
ii. Brauns transantral approach: Intraoral incision is made
from the maxillary tuberosity to the midline in the
maxillary vestibule.
Nerve Disorders 161
38. What is the role of balloon compression in management of

trigeminal neuralgia?
Ans. It is done under general anesthesia. It is a mechanical
technique to destroy the root fiber partially by advancing 4FG
Fogarty catheter 1 to 2 cm within Meckels cave and inflating the
balloon at the ventral aspect of the ganglion root.
39. What is the role of the anticonvulsant or antiepileptic
therapy as a medical management in trigeminal neuralgia?
Ans. Mainly two groups are there:
i. Classic anticonvulsant drug:
Carbamazepine (choice of drug is Tegretol): 100 mg to
1,600 mg per day
Phenytoin (dilantin): 200 mg per day to 800 mg per day
Baclofen: 50 to 60 mg/day alone. 30 to 40 mg/day
combined with others.
ii. Other groups of drugs:
Benzodiazepine: 10 to 15 mg/day
Clonazepam: 1 to 3 mg /day
Alprazolam: 1 to 3 mg/day.
40. What is the disadvantage of long therapy of carbamazepine
(tegretol)?
Ans. Apart from its toxicity (ataxia, diplopia, blurred vision) main
disadvantage in the use of carbamazepine is to induce its own
metabolism. Therefore, in the patients receiving carbamazepine, a
complete blood count with platelets count and liver functionality
test must be done before the treatment and after the first week.
41. What is the difference between facial paralysis and Bells
palsy?
Ans.
Facial paralysis Bells palsy
It is defined as the paralysis of facial It is an isolated facial paralysis
musculature, resulting in functional and of sudden onset caused by
cosmetic deformity on the affected side, neuritis of the 7th cranial nerve
particularly those supplied by 7th cranial within the facial canal.
nerve due to injury, infection, tumor, etc.
42. Which are the various syndromes that can be considered

as the etiology for facial palsy?
Ans. Various syndromes considered as etiologic factor for facial
palsy are as follows:
i. Ramsay Hunt syndrome: Herpes zoster oticus is the
common cause of facial paralysis. The patient suffers
with pain in the ears, loss of tears, loss of ipsilateral taste,
deafness, tinnitus and vertigo
ii. Melkersson-Rosenthal syndrome: It consists of triad of
recurrent orofacial edema, recurrent facial palsy and
lingual plicata (fissural tongue)
iii. Marcus Gunn or jaw-winking syndrome: It is a rare
condition. It may be congenital or following trauma or
surgery in the facial area. The patient complains of ptosis
or paradoxical oculopalpebral movements, provoked
chewing and mandibular movements.
43. What are the goals in the treatment of facial paralysis?
Ans. The goals of the treatment are as follows:
i. To achieve normal appearance at rest
ii. Symmetry with voluntary motion
iii. Control of ocular, oral and nasal sphincters
iv. Symmetry with involuntary emotion and controlled
balance when expressing an emotion
v. No significant functional deficit secondary to the
reconstrucutive surgery.
44. What are the different treatment modalities for the
management of facial paralysis?
Ans. Various modalities are:
i. Medicinal therapy: Steroids (tablet Betnesol multivitamins)
ii. Physiotherapy
iii. Surgical treatment:
Nerve decompression
Nerve anastomosis
Nerve grafting
Repair of facial drooping
Nerve Disorders 163
Reanimation procedures
Repair of facial paralysis by buccal sulcus support
Facial cramp.
45. What is facial cramp?
Ans. The spasmodic attacks of the motor nerves of the face
leads to twitching. It may be seen as a hemifacial spasm coming
intermittently on the face.
It is considered to be due to the constriction of the facial
nerve in the fallopian canal. Many of the facial tics do not have any
organic lesion and are considered as habit spasm. These are seen as
tonic contractions involving the orbicularis oculi muscle and cramps
producing a constant blinking. Normally, no treatment is required
and, at times, a voluntary control helps to control the tics.
Temporomandibular chapter
Joint Disorders 11
1. Define temporomandibular joint (TMJ).
Ans. It is referred to as an articulation between mandible and
cranium.
It may also be defined as the diarthrodial freely movable
articulation between condyle of the mandible and the squamous
part of the temporal bone.
2. List the synonyms of TMJ.
Ans. The synonyms of TMJ are as follows:
i. Craniomandibular syndrome
ii. Craniomandibular joint
iii. Mandibular joint
iv. Jaw joint
v. Craniomandibular articulation.
3. Which type of joint is the temporomandibular joint?
Ans. It is the ginglymodiarthrodial type of joint. It is capable of
hinge and gliding movements.
4. What is the volume of the upper joint space?
Ans. 1.2 ml is the volume of the upper joint space.
5. Which structure divides the joint into the superior and
inferior compartments?
Ans. Articular disc (meniscus).
6. How will you outline the surgical anatomy of the temporo
mandibular joint?
Ans. A. Arterial supply:
Temporomandibular Joint Disorders 165
Through the internal maxillary artery (branch of

external carotid artery) peripherally via its deep
auricular artery:
i. Anterior aspect:
Deep posterior temporal artery
Deep posterior masseteric artery
ii. Posterior medial aspect:
Deep auricular artery
Anterior tympanic artery
Middle meningeal artery
iii. Posterior lateral aspect:
Superficial temporal artery
B. Venous drainageIt drains into the:
i. Superficial temporal vein
ii. Maxillary vein
iii. Pterygoid venous plexus
C. Lymphatic drainage:
i. From the lateral and anterior surface, it drains into the
preauricular and parotid nodes
ii. From the medial and posterior surface, it drains into
the submandibular nodes.
D. Nerve supply:
i. Anteromedial portion of the capsule: Masseteric nerve
ii. Anterolateral portion of the capsule: Posterior deep
temporal nerve
iii. Medial, lateral, posterior and lateral half of the anterior
wall of the capsule: Auriculotemporal nerve.
7. Which are the accessory ligaments of temporomandibular
joint?
Ans. Stylomandibular ligament and sphenomandibular ligament.
8. What is Pinto ligament?
Ans. Mandibulomalleolar ligament of the temporomandibular
joint.
9. What is arthroscopy?
Ans. Arthroscopy is a technique by which the inside of a joint can
be seen and operated from outside without any open surgery.
10. What is synovium?
Ans. Synovium is the thin epithelioid tissue lining the non-articular
surfaces of the diarthrodial joints. In the healthy TMJ, the anterior
and posterior recesses of both the superior and the inferior joint
spaces are lined with synovium. The synovium contains the
specialized cell type A and type B.
11. What is synovitis?
Ans. Synovitis is an inflammatory disorder of the synovial
membrane which is characterized by hyperemia, edema and
capillary proliferation in the synovial membrane.
12. What is the most common form of pain and discomfort
associated with the TMJ disorders?
Ans. Masticatory myalgia or myofacial pain.
13. What is the common cause of TMJ ankylosis?
Ans. Trauma is one of the common causes. Trauma results in
extravasation of blood into the joint space (hemarthrosis). This
predisposes to calcification and finally results in ankylosis.
14. What are the diagnostic features of unilateral TMJ ankylosis?
Ans. The following are the features of TMJ ankylosis:
i. Facial asymmetry
ii. Trismus (partial/complete)
iii. Fullness on the normal side of mandible
iv. Chin deviated towards the affected side
v. Prominent antegonial notch on the affected side.
15. What are the surgical procedures of TMJ ankylosis?
Ans. i. Condylectomy
ii. Gap arthroplasty
iii. Interpositional gap arthroplasty, e.g. tentalium, steel,
acrylic, etc.
16. How can the temporomandibular ankylosis in an 8-year-old

child be treated?
Ans. Gap arthroplasty with costochondral graft.
17. Is the early movement after surgery in case of TMJ ankylosis
harmful or desirable?
Ans. Early movement is desirable in this case. According to the
internationally accepted protocols for the management of the TMJ
ankylosis put forward by Kaban, Perrot and Fisher in 1990, early
mobilization and aggressive physiotherapy is required for the period
of atleast 6 months postoperatively.
18. What are the causes of the TMJ ankylosis recurrence?
Ans. i. Inadequate gap created
ii. Fracture of costochondral graft
iii. Inadequate coverage of glenoid surface.
19. In case of unilateral TMJ ankylosis, the mandible and chin
are deviated to which side?
Ans. Mandible and chin are deviated towards the affected side.
20. Which vessels encounter excessive bleeding during the
surgical management of the TMJ ankylosis?
Ans. i. Inferior alveolar artery
ii. Internal maxillary artery
iii. Pterygoid plexus of vein.
21. In case of bilateral TMJ ankylosis, the chin is deviated to
which side?
Ans. Actually there is no deviation of the chin.
22. What is the frequent cause of TMJ dislocation?
Ans. Spasm of the muscles of mastication.
23. In which type of treatment eminectomy is done?
Ans. TMJ dislocation: Eminectomy involves the excision of the
articular eminence and thus allows the condyle head to move
anteroposteriorly free of obstruction.
24. How will you relocate the TMJ in case of the dislocation of
TMJ?
Ans. The following are the steps for the management of the
dislocation of TMJ:
i. Stand in front of the patient
ii. Thumb is placed on the mandibular molar
iii. Fingers are placed on the chin
iv. Apply downward pressure on the molar and the back-
ward
v. Finally upward pressure on the chin.
25. The most common dislocation of TMJ is in which direction
anterior or posterior?
Ans. The most common is the anterior dislocation.
26. What is articular disc (meniscus)?
Ans. Articular disc is a biconcave, fibrous structure which is thinner
at the periphery than the central portion.
27. What is genu vasculosa?
Ans. The posterosuperior aspect of condyle and anterior to
bilaminar zone is called genu vasculosa.
28. What is Jokeys cap?
Ans. Rees described the shape of the meniscus as Jockeys cap.
29. What is capsulorrhaphy?
Ans. The capsule tightening procedure is known as capsulorrhaphy.
30. Which is the basic/ideal approach to TMJ surgery?
Ans. The preauricular approach.
31. What is the reason for the interposition of the temporal
muscle and the fascia in the treatment of TMJ ankylosis?
Ans. To prevent reankylosis of TMJ.
32. What are the clinical features or symptomatology of MPDS?
Ans. There are four classical features of MPDS given by Laskin, one
or more of which are always present:
i. Pain (unilateral)
ii. Joint sound (clicking sound)
iii. Limitation of jaw movement and deviation of mandible
on opening
iv. Tenderness of the muscles of mastication.
33. MPDS can be precipitated by which factors?
Ans. i. High filling
ii. Malocclusion
iii. Bruxism
iv. Psychogenic factors.
34. In TMJ osteoarthritis, which medicament is injected in TMJ?
Ans. Hydrocortisone is injected.
35. Why is hydrocortisone acetate injected in a painful TMJ
arthritis?
Ans. To decrease the inflammation.
36. The Alkayat Bramley approach to the TMJ is the modification
of which approach?
Ans. It is the modification of preauricular incision where the
upper part of incision is extended in a question-mark fashion. This
approach exposes the joint without damaging the temporal branch
of the facial nerve.
37. Which nerve may get damaged in submandibular incision?
Ans. Marginal mandibular nerve (branch of facial nerve) may get
damaged.
38. Hinds approach to TMJ is through which area?
Ans. Through the postramal approach to expose the TMJ.
39. Explain brisement force.
Ans. It is one of the treatment modalities to treat TMJ ankylosis.
The forced opening of the jaw using mouth gag under general
anesthesia, e.g. Fergusson mouth gag, Doyans mouth gag and
Heister mouth gag. It is useful in fibrous ankylosis of TMJ.
40. List different incisions for the TMJ surgery.

Ans. Following are the incisions (approaches) for the TMJ surgery:
i. Preauricular incisionRowe (1972)
ii. Preauricular with modificationIrby
iii. Postauricular approachAlexander (1975)
iv. Postramal approach (Hinds approach)
v. Retromandibular (intraoral) approach
vi. Risdons (submandibular) approach
vii. Endural (aural or facial) approach
viii. Lemperts endaural approach (1938)
ix. Alkayat and Bramley approach (1978)
x. Inverted hockey stick (temporal) incision
xi. Bicoronal flap or transcoronal frontal flap approach
xii. Blairs incision (1928) (modified preauricular)
xiii. Dingman and Moormans approach (modification of
Lemperts incision)
xiv. Wakeley incision T-shaped incision
xv. Ron Gaddis incision (1954)
xvi. Martin Dunns incision (modified preauricular)
xvii. Modified endural incision
xviii. Fred Hennys approach (modified preauricular)
xix. Popowich and Crane (1982) (modified Alkayat Bramley
incision)
xx. Thomas incision (modified preauricular incision), 1958.
41. Enumerate the various TMJ surgeries.
Ans. Various TMJ surgeries are as follows:
i. Condylectomy
ii. High condylectomy
iii. Condylotomy
iv. Eminectomy
v. Meniscectomy
vi. Arthroplasty
vii. Meniscoplasty
viii. Zygomectomy
ix. Repositioning of the head of the condyle

x. Disectomy
xi. Lateral pterygoid myotomy
xii. Lateral pterygoid myotomy with disectomy
xiii. Discoplasty
xiv. Condyloplasty
xv. Arthroscopy
xvi. Capsulorrhaphy
xvii. Condylectomy with meniscectomy
xviii. Anchors procedure
xix. Reconstruction of the TMJ articulation structure.
42. What is TMJ arthrocentesis?
Ans. Arthrocentesis is the lavage or irrigation of the upper joint
cavity in case of limited mouth opening, accompanied by severe
pain. 10 cc syringe filled with ringer lactate solution is pushed into
the joint cavity (up to 200 ml). On termination of the procedure,
1 ml of hydrocortisone is injected into the joint space.
43. Differentiate between fibrous and bony TMJ ankylosis.
Ans.
Fibrous/False/Pseudo/Extra- Bony/True/Intracapsular TMJ
articular TMJ ankylosis ankylosis
It is a chronic condition in which It is defined as immobilization by bony
the temporomandibular joint is or fibro-osseous union (consolidation)
fixed, immobilized by a flexible between the condyle and glenoid fossa
soft tissue that may include the of the TMJ. Frequently fusion may be
joint capsule, ligament, tendons, present between the coronoid process of
muscles, oral mucosa and conti the mandible and the zygoma, mandible
guous tissue and maxillary tuberosity.
44. What is TMJ arthroscopy?

Ans. TMJ arthroscopy consists of the insertion of a specially
designed fiberoptic endoscope into the joint compartment for
observation (diagnostic) and therapeutic purpose (1.7 mm diameter
needle-type arthroscope).
45. What are the different types of TMJ ankylosis?

Ans. Different types of TMJ ankylosis are as follows:
i. Partial
Complete
ii. Fibrous
Bony
iii. Intracapsular
Extracapsular
iv. Unilateral
Bilateral.
46. What are the synonyms of the following TMJ disorders?
Ans. i. TMJ hypomobilityTMJ ankylosis
ii. TMJ hypermobilityTMJ subluxation
iii. TMJ dislocationTMJ luxation.
47. What are the different surgical procedures for fibrous and
bony TMJ ankylosis?
Ans. i. False TMJ ankylosis:
Coronoidectomy
ii. Bony TMJ ankylosis
Condylectomy
Arthroplasty
a. Gap arthroplasty
b. Interpositional arthroplasty
Meniscectomy
Costochondral grafting in children with temporalis
muscle flap and ear cartilage.
48. What are the different treatment modalities for myofacial
pain dysfunction syndrome (MPDS)?
Ans. i. Non-surgical procedure:
Counseling
Occlusal splint
Physical therapy
Therapeutic exercise
Corticosteroid injection therapy

Denervation procedure (injection sclerosant, 3%
sodium tetradecyl sulfate)
M edication NSAIDs: Ibuprofen, muscle relaxant,
narcotic analgesics (morphine) antidepressant
ii. Surgical procedure:
High condylectomy
Condylotomy
Lateral pterygoid muscle myotomy.
49. Which muscles are involved in different mandibular move
ments?
Ans. i. Jaw opening (depression):
Lateral pterygoid muscle
Sternohyoid muscle
Digastric muscle
Geniohyoid muscle
ii. Jaw closure (elevation):
Masseter
Medial pterygoid
Temporalis
iii. Jaw protrusion:
Lateral pterygoid
Medial pterygoid
iv. Jaw retrusion:
Temporalis muscle
Masseter muscle
Digastric muscle
Geniohyoid muscle.
50. What do 7 Rs stand for in the context of occlusal rehabi-
litation in case of management of MPDS?
Ans. i. Remove: Extract
ii. Reshape: Grind
iii. Reposition: Orthodontics/orthognathic surgery
iv. Restore: Conservative dentistry
v. Replace: Prosthesis
vi. Reconstruct: TMJ surgery
vii. Regulate: Control habit and symptoms.
51. Classify the TMJ hypermobility and TMJ subluxation and
luxation.
Ans. The classification is as follows:
i. Hypermobility of TMJ with pain
ii. Hypermobility of TMJ without pain
iii. Habitual dislocation
iv. Fixed dislocation
v. Acute dislocation
vi. Chronic or recurrent dislocation
vii. Permanent or prolonged dislocation.
52. What are the types of hypermobility?
Ans. i. Hypermobility syndrome
ii. Acquired hypermobility
iii. Systemic hypermobility
iv. Hypermobility due to occlusal factors
53. What are the different types of condyle of TMJ?
Ans. Mainly there are four types of the condyles of TMJ:
i. Slightly convex
ii. Flat condyle
iii. Pointed condyle
iv. Bulbous condyle.
54. Which are the articulating and ligamentous structures of
TMJ?
Ans. i. Articulating surfaces:
Articulating surfaces of glenoid fossa
Articulating eminence
Condyle
ii. Ligamentous structures:
Articular disc
Articular capsule (capsular ligament)
Synovial membrane
Temporomandibular or lateral ligament
Sphenomandibular ligament (internal ligament)
Stylomandibular ligament
Mandibulomalleolar ligament C Pinto ligament.
55. List the ten key points about TMJ.
Ans. i. It is a true synovial joint
ii. Both the articulating surfaces carry teeth
iii. It is a bilateral articulation with the cranium. So the
right and left temporomandibular articulation muscles
function together.
iv. It performs a variety of movements like:
Opening and closing the mouth (hinge and gingly
moid)
Lateral side-to-side movement (condyloid)
Translatory chewing movement (gliding)
v. The joint is divided into two compartments supero-
inferiorly:
Upper compartment, which provides hinge motion
Lower compartment, which sliding or translator
motion
vi. The lateral pterygoid, masseter and temporalis muscle
are closely related to TMJ
vii. The TMJ is a complex joint. Each joint has an articular
disc (meniscus) situated between the condyle and the
temporal bone
viii. There is no hyaline cartilage
ix. In a newborn baby, the articulating surface of both the
bones and disc (meniscus) are covered with synovial
membrane but with the use of the jaws, this soon
disappears and the membrane is then restricted to a
narrow lining of the capsule
x. The articular cartilage and the central portion of the disc
do not have any nerve supply and blood supply.
56. What are the different radiographic projections for TMJ?

Ans. There are mainly three projections:
i. Transorbital view
ii. Transcranial view
iii. Transpharyngeal view.
57. Differenciate between TMJ pain dysfunction and man-
dibular stress syndrome.
Ans.
TMJ pain dysfunction Mandibular stress syndrome
syndrome
It is a syndrome made up of It is a disorder generally confined to highly
one of the following: developed communities and thus most
1. Joint clicking frequently associated with neurotic tension
2.Periodic inability to open and emotional stress. The patient displays
the jaw fully (locking) one or a combination of the following clinical
3.Pain associated with the features:
joint and the muscles of 1. Pain and/or tenderness over the joint
mastication 2. Joint noises
3. Altered mandibular function.
58. What is Dautreys procedure?

Ans. Repeated dislocation of a condyle can be treated by inten-
tional fracture of the zygomatic areas and reunion. This procedure
is known as Dautreys procedure.
59. What is Kabans protocol for the management of TMJ
ankylosis?
Ans. It was given by Perrot and Fisher in 1990.
i. Early surgical intervention
ii. Aggressive resectiona gap of atleast 1 to 1.5 cm should
be created
iii. Ipsilateral coronoidectomy and temporalis myotomy are
done in most of the cases
iv. Contralateral coronoidectomy and temporal myotomy
are necessary
v. Lining of the glenoid fossa region with temporalis fascia
vi. Reconstruction of the ramus with a costochondral graft

vii. Early mobilization and aggressive physiotherapy for the
period of atleast six months postoperatively
viii. Regular long-term follow-up
ix. When the growth of the patient is complete, perform the
cosmetic surgery at the later stage.
60. How can joint cavity be examined without much surgical
intervention?
Ans. It is done with the help of arthroscopy.
Cysts of the Jaws chapter
and Oral Cavity 12

1. Define cyst.
Ans. Cyst is defined by different authors as follows:
i. Killey and Kay: Cyst is a pathologic cavity occurring in hard
and soft tissues with a liquid or semi-liquid or air content.
It is surrounded by a definitive connective tissue wall or
capsule and usually has an epithelial lining
ii. Kramer: A cyst is a pathologic cavity having fluid, semi-
fluid or gaseous contents which is not created by the
accumulation of pus. It is frequently but not always lined
by epithelium.
2. List the epithelial developmental odontogenic cysts.
Ans. i. Dentigerous cyst (follicular cyst)
ii. Odontogenic keratocyst (primordial cyst)
iii. Gorlin cyst (calcifying odontogenic cyst)
iv. Gingival cyst
v. Periodontal cyst.
3. List the epithelial inflammatory odontogenic cysts.
Ans. i. Radicular cyst
ii. Residual cyst
iii. Paradental cyst.
4. List the non-epithelial cysts.
Ans. i. Aneurysmal bone cyst (ABC)
ii. Traumatic or hemorrhagic bone cyst
iii. Staynes idiopathic bone cyst.
Cysts of the Jaws and Oral Cavity 179
5. List the fissural cysts.

Ans. These are non-odontogenic epithelial cysts:
i. Globulomaxillary cyst
ii. Nasopalatine duct (incisive canal) cyst
iii. Nasolabial (nasoalveolar) cyst
iv. Median palatine cyst
v. Median mandibular cyst.
6. List the examples of parasitic cysts.
Ans. i. Hydatid cyst
ii. Cysticercosis
iii. Trichinosis.
7. List the congenital cysts.
Ans. i. Thyroglossal cyst
ii. Dermoid and epidermoid cyst
iii. Brachiogenic cyst.
8. Which are the soft-tissue cysts of mouth, face and the neck
region?
Ans. i. Dermoid and epidermoid cyst
ii. Lymphoepithelial (branchial cleft) cyst
iii. Thyroglossal duct cyst
iv. Gingival cyst
v. Salivary gland cyst
vi. Nasolabial cyst.
9. Which cysts are related to the maxillary antrum?
Ans. i. Benign mucosal cyst of the maxillary antrum
ii. Surgical ciliated cyst of the maxilla.
10. List the pseudocysts.
Ans. i. Traumatic cyst/hemorrhagic cyst/extravasation cyst/
unicameral bone cyst/simple bone cyst/idiopathic cyst
ii. Aneurysmal bone cyst (ABC)
iii. Stafnes/Static bone cyst/defect in the mandible/lingual
mandibular bone cavity.
11. List the bone cysts.

Ans. i. Solitary bone cyst
ii. Aneurysmal bone cyst (ABC)
12. What are heterotopic cysts?
Ans. i. These are oral cysts with gastric or intestinal epithelium
ii. Incidence is high in infants and young children
iii. Site: Sublingual region, apex and dorsum of the tongue
iv. Cysts are lined by partially stratified squamous epithelium
and partially by gastric mucosa, gastric glands, goblet
cells and muscularis mucosa
v. Surgical excision is the line of treatment.
13. What are the theories to explain the cyst enlargement?
Ans. These are classified by Harris in 1974 as follows:
i. Mural growth
ii. Peripheral cell division
iii. Accumulation of the contents
iv. Hydrostatic enlargement
v. Secretion (transmutation/or exudation).
14. Which mechanisms explain the cyst enlargement?
Ans. The following mechanisms are forwarded to explain the
enlargement of the cystic lesion:
i. Increase in the volume of the contents
ii. Increase in the surface area of the sac or the epithelial
proliferation
iii. Resorption of the surrounding bone
iv. Displacement of the surrounding soft tissue.
15. What are the cardinal features of the dentigerous cyst?
Ans. The cardinal features of the dentigerous cyst are as follows:
i. It is one of the epithelial odontogenic developmental
cysts. It is also known as follicular cyst or pericoronal cyst.
It is defined as a cyst that produces an enlargement of
the follicular space about the whole or part of the crown
of the tooth
ii. Various types are central, lateral, circumferential, crown

with odontoma
iii. Radiographically cystic lesion appears with supernume
rary unerupted or malposed tooth with resorption of the
root of the adjacent teeth
iv. Histologically there is fluid with cholesterol and the lining
is not keratinzed
v. It is managed by cyst enucleation if the cyst is small and
marsupialization followed by cyst enucleation if the cyst
is large.
16. What are the cardinal features of odontogenic keratocyst
(OKC)?
Ans. The cardinal features of OKC are as follows:
i. It is one of the epithelial, developmental odontogenic
cyst. It also known as primordial cyst associated with bifid
rib syndrome and nevoid basal cell carcinoma syndrome
ii. It is defined as a cyst arising from the tooth bearing areas
of the jaw having thin fibrous capsule and a lining of
keratinized squamous epithelium
iii. High recurrence rate due to thin fragile lining and the
tendency to multiply. It contains creamy white suspen
sion of keratin that appears like pus without an offensive
smell
iv. It is aggressive in nature and known to change to the
malignant lesion. These cysts are known to carry the
satellite daughter cyst
v. It can be managed by cryosurgery, chemical cauterization
(known as Carnoys solution) and routine marsupialization
and cyst enucleation.
17. What is the difference between radicular cyst and residual
cyst?
Ans. i. Radicular cyst (periodontal cyst): It may be periapical and
lateral. It will be found where the pulp of the involved
tooth has undergone necrosis from an extension of gross
caries
ii. Residual cyst: When a radicular cyst is overlooked

following an extraction of the causative permanent
tooth, it is designated as residual cyst.
18. What is the peculiarity of the globulomaxillary cyst?
Ans. i. Nonodontogenic cystdevelopmental cyst
ii. It is also known as intra-alveolar cyst
iii. It occurs in the globulomaxillary area
iv. It appears pear-shaped
v. It is located between the roots of maxillary lateral incisor
and canine.
19. What is the peculiarities of thyroglossal cyst?
Ans. i. Small cystic swelling in the anterior region of the neck
ii. It moves on swallowing
iii. It moves on the protrusion of tongue.
20. What are the characteristics of traumatic or hemorrhagic
bone cysts?
Ans. i. It rarely expands the cortices
ii. It does not displace the teeth.
21. What is the peculiarity of the nasopalatine cyst?
Ans. i. It is seen between the central and lateral incisor
ii. It appears as a heart-shaped radiolucency in the midline
iii. Teeth next to the radiolucency are vital.
22. What are the ten peculiarities of Stafnes bone cavity?
Ans. i. It is also known as mandibular salivary gland, depression,
latent bone cyst and static bone cavity
ii. Actually Stafnes bone cavity is not a cyst. It is included
in the cystic lesions because of their clinical similarity to
the cyst of jaw
iii. It may be due to the developmental defects that are
occupied by a lobe of normal submandibular salivary
gland
iv. They have been reported below the inferior alveolar
canal, approximately in line with the position of the third
molar tooth
v. Radiographically, it appears as a rounded or oval defect

below the inferior alveolar canal, posterior to the first
mandibular molar
vi. Pathologically, it may be empty cavity or may be
containing normal salivary gland tissue or lymph node
tissue or abdominal glandular tissue
vii. Cystic lesion without epithelial lining
viii. There is empty cavity
ix. Air on aspiration
x. No surgical intervention is warranted.
23. What are the cardinal features of Gorlins cyst?
Ans. i. It is also known as calcifying epithelial odontogenic cyst.
ii. Developmental odontogenic epithelial origin. It
resembles to the calcifying epithelioma of Malherbe. It
was first described by Gorlin during 1962-1964
iii. The most common site is anterior part of mandible
iv. It produces a saucer-shaped depression in the bone and
it is symptomless
v. Radiographic: It appears as irregular radiopaque specs.
The cyst may be associated with a complex odontoma
or an unerupted tooth
vi. Pathology: There is a lining of stratified squamous
epithelium
vii. Simple enucleation is the choice of treatment.
24. What are Bohns nodules?
Ans. It is also known as Gingival cyst of the newborn or cystic
swelling of neonates. They are asymptomatic cystic lesions that arise
from the remnants of the dental lamina. They appear as discrete
white swellings and can be single or multiple. Histologically, there
is thin epithelial lining and keratin.
25. What is the relationship of basal cell nevus syndrome with
cystic lesion of jaw?
Ans. Multiple cysts are a common finding in basal cell nevus
syndrome. The cyst may be follicular, primordial and periodontal
in nature with all types of histological variations in the epithelial

lining. There is a preponderance of the keratocyst. Congenital cysts
generally develop earlier than the skin lesions. Therefore, it may be
the first to encounter and identify this syndrome by an oral surgeon
in the jaw.
26. What are the features of the basal cell nevus syndrome?
Ans. i. Bifid rib
ii. Multiple radiolucent lesions of the jaw
iii. Multiple basal cell nevi
iv. Falx cerebri calcification.
27. What are the peculiarities of the nasoalveolar cyst?
Ans. i. Swelling in the labial sulcus
ii. Difficulty in breathing
iii. No radiolucent lesion of the bone
iv. On aspiration, straw-colored fluid
v. Entirely located in the soft tissue.
28. What are the peculiarities of Aneurysmal Bone Cyst (ABC)?
Ans. i. Cystic lining has no epithelial lining.
ii. On aspiration (fine needle aspiration), blood may aspirate
(brisk red color)
iii. Mandible is commonly affected.
iv. It is considered as pseudocyst.
v. It is a primary lesion of bone. It initiates as an osseous
and arteriovenous fistula.
29. What are the different treatment modalities of the cystic
lesion oral cavity and jaws?
Ans. Different modalities of management are:
i. Cyst enucleation of the cyst and primary closure
ii. Cyst enucleation and open packing:
With the removal of the tooth
With tooth conservation
Combined with Caldwell-Luc operation
Combined with the fixation of the pathological fracture.
iii. Marsupialization:
Partsch I operation (Decompression operation)
Partsch II operation
iv. Combination procedure: Marsupialization followed by
enucleation after the cavity shrinks, also known as
Partsch II operation.
30. What are the basic principles and objectives of management
of cystic lesion of oral cavity?
Ans. Basic principles of management are as follows:
i. To eliminate the lesion
ii. The lining should be removed or rearranged in order to
eliminate it from the jaw
iii. The tooth germ of the unerupted tooth or partially
erupted tooth should be conserved as far as possible
and should be allowed to erupt
iv. Preservation of the adjacent vital structure like neuro-
vascular bundle, nasal or antral lining mucosa, etc.
v. Restore the normal function.
31. What are the features of the plug used in marsupialization
in management of the cystic lesion?
Ans. i. Plug should be retentive and maintain the patency of
the cavity
ii. It should not irritate the mucosa
iii. The plug should never reach the depth of the cavity as
this would interfere with the bone regeneration and
filling process
iv. The plug can be attached to the dentures in the case of
edentulous patients
v. The plug should not build pressure within the cavity
vi. The plug should be designed such that it is neither
swallowed nor inhaled by the patient
vii. It should be removed after every meal for cleaning the
cavity.
32. What is the choice of treatment of the large cyst?

Ans. Waldrons technique is a combination of marsupialization
followed by enucleation. First marsupialization is performed to
reduce the intracystic pressure and cavity is allowed to shrink. When
the cavity becomes smaller, then enucleation is performed and the
cystic lining is completely removed.
33. Which solution is used for chemical cauterization in OKC
and what is the composition of the chemical solution used
for cauterization?
Ans. Carnoys solution is used for chemical cauterization in OKC.
The composition of the Carnoys solution is as follows:
i. Alcohol6 ml
ii. Chloroform3 ml
iii. Glacial acetic acid1 ml
iv. Ferric chloride1 gm.
34. Why is the name Plunging Ranula so-called?
Ans. A rare suprahyoid type of ranula termed as plunging or
cervical ranula occurs due to herniation of the spilled mucin through
the mylohyoid muscle producing swelling within the neck.
35. What is bay cyst?
Ans. It refers to an island of squamous epithelium, which have
developed from the odontogenic rests of malassez and which can
also be found in periapical granuloma without cystic transformation.
This granuloma is referred to as bay cyst.
36. What is the choice of treatment in the following cases:
i. Case of large radicular cyst with apical involvement of
four vital teeth
ii. Traumatic bone cyst.
Ans. i. Marsupialization is the choice of treatment
ii. Opening of the cavity and induced bleeding.
37. By which method is the radicular cyst treated?
Ans. Curettage.
38. The complete enucleation of the cyst in the palatal area

carries the danger of:
Ans. The tear of nasal mucosa.
39. What is the diagnostic finding in case of fine needle
aspiration in a patient with keratocyst?
Ans. A low protein content of less than 4 gm/dl is typical for all
keratocysts (for other cysts5 to 11 gm/dl).
40. On fine needle aspiration, brisk red colour fluid comes out
from the cavity. What is the possible diagnosis?
Ans. Traumatic or hemorrhagic or aneurysmal bone cyst. It is
usually filled with brisk red color fluid.
41. There is a case of 12-year-old boy with a radiographic
finding of dentigerous cyst corresponding to the crown of
mandibular canine. What is the choice of treatment?
Ans. Expose the crown and maintain the same.
42. What is the best method to differentiate between
dentigerous cyst and ameloblastomaby radiographic
examination or by microscopic examination?
Ans. Microscopic examination is the best method.
43. Cystic fluid containing cholesterol crystals is the result of
the breakdown of which cells?
Ans. RBCs and exfoliated epithelial cells.
44. Why cystic fluid have increased osmotic pressure?
Ans. It contains protein with high molecular weight.
45. What is the cause of mucocele?
Ans. i. Obstruction of salivary duct
ii. Trauma of salivary duct
iii. Congenital atresia: It is managed by excision with the
adjacent gland (minor salivary gland).
46. Which cyst forms over an erupting tooth?

Ans. Dentigerous cyst or eruption cyst.
47. Which method is used to treat the bone cysts that are less
than 2 cm in diameter?
Ans. Enucleation method.
48. What is the reason for bone swelling in the case of cyst?
Ans. It is due to new subperiosteal deposition.
49. What are the causes of the high recurrence rate of kerato
cyst?
Ans. i. Its fragile thin lining
ii. Presence of daughter cyst in the cystic lining
iii. Presence of daughter cyst in the capsule of the cyst.
50. In which conditions does the cystic lining become thick and
adherent?
Ans. i. Infection
ii. Already decompressed earlier
iii. The tooth has been extracted without treating the cyst.
51. What is the differential diagnosis in case large soft swelling
is noticed in the floor of the mouth?
Ans. i. Thyroglossal cyst
ii. Mucous retention cyst
iii. Dermoid cyst.
52. Reply for the following questions:
i. In which condition is the Nikolskys sign present?
ii. Port wine stain is a type of what?
Ans. i. Pemphigus vulgaris
ii. Hemangioma.
53. What are the exact locations of the following cysts?
Ans. i. Globulomaxillary cyst: Located between the maxillary
central incisor and canine
ii. Median palatine cyst/incisive canal cyst/nasopalatine cyst:
Located between roots of maxillary central incisors
iii. Fissural cyst: Located in the maxilla

iv. Solitary bone cyst: Located in the mandible
v. Brachial cyst: Lateral side of the neck.
54. The following cysts are located with which syndromes?
Ans. i. Multiple OKC: Gorlin-Goltz syndrome
ii. Multiple odontogenic cyst: Marfans syndrome.
55. Give the synonyms of the following cysts:
Ans. i. Odontogenic keratocyst:
Primordial cyst
Benign cystic neoplasm
ii. Globulomaxillary cyst: Intra-alveolar cyst
iii. Traumatic bone cyst:
Solitary bone cyst
Hemorrhagic cyst
iv. Dentigerous cyst:
Follicular cyst
Pericoronal cyst
v. Nasopalatine duct cyst: Incisive canal cyst
vi. Nasolabial cyst: Nasoalveolar cyst
vii. Stafnes cyst
Static bone cyst
Latent bone cyst
Lingual mandibular bone cyst
viii. Aneurysmal bone cyst: Blow-out of the bone
ix. Gorlin cyst: Calcifying odontogenic cyst
x. Gingival cyst: Bohns nodules.
chapter
Tumors 13
1. What is the difference between tumor and cancer?
Ans. i. Tumor (neoplasm): A circumscribed non-inflammatory
abnormal growth arising from the body surface
ii. Cancer: A general term used to indicate any malignant
neoplasm which shows invasiveness and resulting in the
death of the patient.
2. Give the synonyms of the following tumors.
(i) Ameloblastoma; (ii) Pindborg tumor; (iii) Cementifying
fibroma; (iv) Evaginated odontoma; (v) Pagets disease of
bone; (vi) Osteopetrosis; (vii) Brown tumor; (viii) Cherubism;
(ix) Ewings sarcoma; and (x) Giant cell granuloma.
Ans. i. Ameloblastoma:
Adamantinoma
Ewings disease
ii. Pindborg tumor:
Calcifying odontogenic epithelial tumor
iii. Cementifying fibroma:
Multiple cementoma
Peripheral fibros dysplasia
iv. Evaginated odontoma:
Leongs odontomes
Tratmans odontomes
v. Pagets disease of bone:
Osteitis deformans
vi. Osteopetrosis:
Albers-Schnberg disease
Marble bone disease
Tumors 191
vii. Brown tumor:

Giant cell lesion of hyperparathyroidism or nodes
viii. Cherubism:
Familial fibrous swelling of jaw
Disseminated juvenile fibrous dysplasia
ix. Ewings sarcoma:
Endothelial myeloma
Round cell sarcoma
x. Giant cell granuloma:
Central reparative giant cell granuloma.
3. Enumerate odontogenic tumor
Ans. i. Ameloblastoma (Adamantinoma)
ii. Pindborg tumor (Calcifying epithelial tumor)
iii. Odontogenic/Cementinoma/Myxoma/Fibroma
iv. Odontoma
v. Adenoid odontogenic tumor.
4. Enumerate the non-odontogenic tumors.
Ans. i. Lipoma
ii. Osteoma
iii. Fibroma
iv. Myxoma
v. Chondroma
vi. Ewings sarcoma
vii. Ossifying fibroma
viii. Ossifying chondroma
ix. Osteoid osteoma
x. Osteoid blastoma
5. Explain odontogenic fibroma and odontogenic myxoma.
Ans. i. Odontogenic fibroma: A benign relatively rare connective
tissue tumor that contains a variable amount of inactive
odontogenic epithelium. Odontogenic origin of this
tumor is confirmed by its formation only in the jaw and
by the presence of epithelial rests. It is found to be both
intraosseous and extraosseous
ii. Odontogenic myxoma: It is benign, non-encapsulated,

slow growing, infiltrative tumor of mesenchymal tissue.
Odontogenic tumor is based on the evidence that it is
distributed in the jaws and the facial skeleton.
6. Explain the following terms.
(i) Cementoma; (ii) Osteoma; (iii) Lipoma; (iv) Myxoma; and
(v) Fibroma.
Ans. i. Cementoma: It is the term given to a group of lesions of
the jaw producing cementum-like calcifications. These
tumors contain either acellular or cellular cementum.
ii. Osteoma: Osteomas are benign odontogenic tumors
that consist of a mature, compact, cancellous bone
and are found most frequently in the mandible. They
are characterized by proliferation of either compact or
cancellous bone usually in an endosteal or periosteal
location
iii. Lipoma: The lipoma is a slow growing benign tumor of
adipose tissue developing anywhere in the oral cavity
where fat tissue is present
iv. Myxoma: It is one of the rare soft tissue intraoral non-
odontogenic tumor. It is made up of the tissue resembling
primitive mesenchyme. It is composed of stellate cell in a
loose mucoid stroma. The lesion is benign and does not
metastasize but frequently infiltrates adjacent tissue
v. Fibroma: Non-odontogenic benign tumor arising from
the submucous and subcutaneous connective tissue of
the mouth and face after trauma or it may arise from the
periosteum of the jaw. It is usually rounded and firm. It
may be sessile or pedunculated. It may grow big in size
and may become traumatized from denturation and
mastication.
7. What do you understand by the term fibro-osseous lesion?
Ans. i. Fibro-osseous lesions of the jaws are disease with similar
cellular component
Tumors 193
ii. They replace the normal bone by fibrous connective

tissue and deorganized calcified component
iii. They are benign lesions composed of collagen fibers and
fibroblast
iv. Radiographic picture depicts a diffused ground glass
appearance.
8. What do you understand by the term giant cell lesions?
Ans. i. Giant cell lesions are a group of lesions which contain
numerous multinucleated giant cells.
ii. Current study indicates that giant cell lesions of jaws
exhibit a range of activity from benign classic giant cell
reparative granulomatous aggressive neoplasm.
9. Enumerate the various giant cell lesions.
Ans. i. Central giant cell granuloma
ii. Peripheral giant cell granuloma
iii. Aggressive central giant cell lesion
iv. Giant cell lesion of hyperparathyroidismBrown tumor
v. Giant cell tumor
vi. Giant cell tumor of Pagets
vii. Cherubism
viii. Osteoblastomagiant osteoid osteoma.
10. Enumerate the various fibro-osseous lesions.
Ans. i. Fibrous dysplasia
ii. Fibrous osteoma
iii. Ossifying fibroma
iv. Ossifying cementifying fibroma
v. Fibro-osseous neoplasm.
11. List key points of Ameloblastoma.
Ans. i. Ameloblastoma is also known as adamantinoma,
adamantoblastoma, and Ewings disease
ii. A unique feature of the tumors is wide range of biological
behaviors that they express
iii. Robinson (UNIAC) has defined Ameloblastoma as

a unic entric, non-functional, intermittent growth,
anatomically benign and clinically persistent
iv. It is derived from the epithelial rests of Malessez,
offshoots of cells from the enamel organ
v. It may be intraosseous or extraosseous
vi. It is mainly found in mandible, 80% in the molar and
ramus region. Only 20% is found in the maxilla. The age-
group ranges from 20 to 40 years
vii. It is a slowly enlarging, painless, ovoid or fusiform bony
hard swelling of the jaw. It expands the bone rather than
perforate it
viii. Radiographic picture describes a lesion having honey-
comb or soap-bubble configuration
ix. Histological picture reveals mainly two major
morphological configurationsfollicular and plexiform
types
x. It is managed by the conservative treatment approach,
e.g. curettage, chemical cauterization (Carnoys solution),
electrocauterization. Surgically, it is managed by en bloc
resection, jaw resection with or without reconstruction.
12. Which are the different types of ameloblastoma based
on histopathological examination and which is the most
common among these?
Ans. i. Follicular type
ii. Plexiform type
iii. Acanthomatous type
iv. Basal cell type
v. Granular cell type
vi. Desmoplastic type
Follicular type ameloblastoma is the most common among
these.
Tumors 195
13. What is the best treatment for odontogenic tumor just

1 cm above the lower border of the mandible?
Ans. En bloc is the best treatment. It involves removing the
entire tumor with the rim of the normal bone which maintains the
continuity of the jaw.
14. What is the line of treatment for adenoameloblastoma?
Ans. They can be managed by enucleation because they are
encapsulated tumor.
15. List the different treatment modalities to manage odonto
genic tumor of jaws.
Ans. i. Curettage
ii. Chemical cauterization (carbolic acid)
iii. En bloc resection (marginal mandibular resection)
iv. Electrocauterization
v. Segmental resection
vi. Jaw resectionhemi/complete
vii. Jaw resection with reconstruction.
(i) Curettage; (ii) En bloc resection; (iii) Segmental resection;
and (iv) Chemical cauterization.
Ans. i. Curettage: Curettage involves removal of the pathologic
tissue by means of vigorous scrapping
ii. En bloc resection: In this procedure, the tumor is removed
along with a rim of uninvolved bone while maintaining
the continuity of the jaw (maintaining the inferior border
of mandible)
iii. Segmental resection: In this procedure, the inferior border
of the mandible is not maintained depending on the
extent of involvement
iv. Chemical cauterization: One of the treatment modalities
for jaw cyst and tumor. The reason is the invasion of
tumor cells into the bony trabeculae beyond the clinical
and radiographic interpretations. The bed of tumor is

cauterized with concentrated carbolic acid. After this,
thorough curettage, small cotton pellets soaked in
carbolic acid are applied over the tumor followed by
irrigation with normal saline.
17. What is the difference between complex odontoma and
compound odontoma?
Ans. In general, odontoma means malformation of the dental
tissue.
i. Complex odontoma consists of an irregular calcified mass
of hard and soft dental tissues revealing a disorderly and
haphazard arrangement of calcified dental structure
ii. Compound odontoma consists of calcified tooth-like
structure or miniature teeth
Odontomes can be managed by surgical excision of
lesion.
18. List the key points of Pindborg tumor.
Ans. i. It is also known as calcifying epithelial odontogenic
tumor arising from the epithelial elements of the enamel
organ.
ii. Mandible is more affected in the molar and premolar
regions. It is found mainly along with the impacted or
embedded teeth.
iii. Radiographic feature reveals the diffused radiopacities
within the lesion giving the driven snow appearance.
iv. Histological study shows a prominent crenate-like
shapeLiesegang ring. It may occur the amyloid area.
v. Marginal and segmental resection is the treatment of
choice but enucleation is more conservative treatment
option.
19. List the peculiarities of Pagets disease?
Ans. i. Loss of hearing
ii. Some loss of visual acuity
iii. Enlargement of maxilla.
Tumors 197
20. What is Rathkes pouch tumor?

Ans. i. It is also known as pituitary ameloblastoma and cranio
pharyngiome
ii. It is derived from cell rests of the craniopharyngeal duct
formed by Rathkes pouch
iii. Neoplasm of the CNS that grows in a pseudoencapsulated
mass in the suprasellar or intrasellar area after destroying
the pituitary gland
iv. Histological study shows irregular calcified masses and
foci of metaplastic bone or cartilage, ghost cells and
sometimes tooth material
v. It is managed by curettage, en bloc resection, peripheral
osteotomy and segmental resection.
21. List the cardinal features of Cherubism.
Ans. i. Cherubism is a rare developmental jaw condition
that is generally inherited as an autosomal dominant.
Mesenchymal alteration during the development of jaw
bones as a result of reduced oxygenation secondary to
perivascular fibrosis is the suggested possible cause for
this condition
ii. There is painless bilateral swelling of the lower face
(mandible is enlarged)
iii. Involvement of anterior maxillary segment produces the
characteristic deformity. Inverted V shape of the palate
is due to the maxillary expansion
iv. It is considered as a giant cell lesion due to the presence
of cellular and vascular fibrous tissue containing many
multinucleated giant cells
v. Surgical intervention consisting of curettage, reconturing,
repeated procedure may be necessary to provide the
desired result.
22. What is teratoma?
Ans. i. This is a non-odontogenic true neoplasm
ii. It is made up of a number of different type of tissues

which are not native to the area in which the tumor
occurs
iii. It may be benign or malignant
iv. Benign are usually cystic lesions and often certain hair,
sebaceous material, teeth, epithelial appendages, like
hair, sweat glands, salivary glands, thyroid and pancreas.
v. At times, the respiratory epithelium and nervous tissue
may also be present.
23. List the cardinal features of Ewings sarcoma.
Ans. i. Ewings sarcoma is also known as endothelial myeloma
or round cell sarcoma
ii. Ewings sarcoma is an uncommon malignant neoplasm
which occurs as a primary destructive lesion of bone. It is
believed to arise from the endothelial lining of the blood
or lymph vessel
iii. Pain is intermittent in nature and swelling of the involved
bone is often the first clinical sign and symptom of
Ewings sarcoma. When there is an involvement of jaws,
there is facial neuralgia and lip paresthesia
iv. Sunrays appearance is seen on radiographic study
v. It is managed by surgery, multiagent chemotherapy and
radiotherapy.
24. List the pecularities of fibrous dysplasia.
Ans. i. Fibrous dysplasia is one of the non-neoplastic pathologic
conditions of the bone. It is of unknown etiology. It is
self-limiting condition, slowly progressive in nature.
Fibro-osseous lesion was introduced by Lichtenstein
ii. In this lesion, normal medullary bone is gradually
replaced by an abnormal fibrous connective tissue
proliferation
iii. It is mainly of two types: Solitary or monostotic and
multifocal or polyostotic lesions.
Tumors 199
iv. Radiographic study reveals a ground glass appearance

in mature stage. Orange peel appearance, a fingerprint
bone pattern can also be seen
v. Monostotic involving single bone, asymptomatic painless
oral firm and smoothly contouring swelling of the
affected jaw
vi. Histological study shows bony trabeculae scattered
haphazardly, giving Chinese character appearance
vii. Polyostotic fibrous dysplasia is related with McCune
Albright syndrome
viii. It involves the skull and both jaws. It may cause
asymmetry and hockey stick deformity of femur is seen
ix. Well-defined, generally unilateral tan macules on the
trunk, thigh, oral mucosa are seen. It is known as Caf-
au-lait spots or Coffee with milk pigmentation and
sexual precocity in females. It is one of the endocrine
manifestations.
x. Management ranges from observation for minor lesions
to radical resection. Radiotherapy is contraindicated
because of its potential for malignant transformation
and development of postirradiation bone sarcoma.
25. Comment on Brown Tumor (Nodes).
Ans. i. It occurs in hyperparathyroidism and giant cell
granuloma, both clinically and cytologically considered
as a giant cell lesion
ii. These are primary, secondary and tertiary. Primary is due
to an adenoma or hyperplasia of gland. Secondary is due
to compensatory hyperplasia of gland. Tertiary is due to
an autonomous adenoma
iii. It may produce smooth painless swelling in both jaws
and a reddish or purple hue to the thinned mucosa
iv. Histological name is derived from the color imparted to
the tissue by hemosiderin and tumor accomplished by
widespread of the giant cell
v. Radiographic examination shows demineralized

surrounding bone or has a ground glass appearance and
root resorption
vi. Lab finding shows increase in serum calcium and
inorganic phosphorus also increases but alkaline
phosphatase value is normal and abnormal protein
picture is also seen
vii. It is managed by surgical removal of the overactive
parathyroid. This will allow the brown tumor to heal once
calcium metabolism is restored to normal.
26. What is pregnancy tumor?
Ans. i. It arises on the gingival tissues of the jaw bones as
pedunculated growth during pregnancy as a result of
an obscure normal reaction.
ii. They appear about the second or third month of
pregnancy and persist until parturition
iii. It may interfere with mastication
iv. It may be multiple also
v. Treatment of tumor is local excision followed by
electrocoagulation.
27. An odontogenic tumor is managed by simple curettage but
recurs frequently. What is the possible diagnosis?
Ans. Odontogenic myxoma: The extension of odontogenic myxo-
ma occurs beyond the radiographic limits of main tumors. So,
curettage is unlikely to cure and results in recurrence of lesion.
Excision of the lesion including the normal marginal free bone is
the treatment of the lesion.
28. What is the risk involved in enucleation of palatal tumor?
Ans. Damage to the nasopalatine nerve.
29. A patient reports with a radiolucent lesion and biopsy shows
giant cell. What is the differential diagnosis?
Ans. i. Giant cell granuloma
ii. Brown tumor
iii. Cherubism
Tumors 201
30. Give one-word answers for the following questions:

Ans. i. Sunrays radiographic appearance seen in: Giant Osteoid
Osteoma (Osteoblastoma)
ii. Radiotherapy is contraindicated in: Fibrous dysplasia and
central giant cell granuloma
iii. Examples of miscellaneous giant cell
Large Aschoff cells of Rheumatic nodule
The Reed-Sternberg cell of Hodgkins disease
Warthin Finkeldey giant cells of measles
Epithelial giant cell in Herpes infection.
iv. In which condition is one of the pathologic features
Droplets of cementum or rounded masses of cementum
seen: Cementifying fibroma.
v. Capillary hemangioma is also known as: Port Wine stain
vi. Painless lump in the tongue, cheek or lip is seen in:
Myomas (muscle tissue tumor)
vii. Schwannoma (Neurilemoma) is a benign tumor of
Schwann cell origin, and it is also known as: Perineural
fibroblastoma, peripheral glioma and neurinoma
viii. von Recklinghausens disease (neurofibromatosis):
Hamartia disturbances of neuromatous character that is
congenital, usually hereditary and occasionally familial
ix. Amputation neuroma (traumatic neuroma) is described
as: An exaggerated reaction hyperplasia of the peripheral
neural elements
x. Hand-Schuller-Christian disease (chronic disseminated
histocytosis): It is an evolving systemic extension of the
basic histiocytic lesion of eosinophilic granuloma
xi. Letterer-Siwe disease (acute disseminated histiocytosis)
is an acute disseminated form of histiocytosis which
occurs predominantly in infants (younger than 3 years).
General chapter
Maxillofacial Trauma 14
GENERAL MAXILLOFACIAL TRAUMA

1. How will you define fracture clinically and radiographically?
Ans. Fracture can be defined as a discontinuity on the hard bony
surface or step deformity on a hard bony surface. Radiographically,
it can be defined as irregular, radiolucent margin on the hard bony
surface.
2. What is ABCDE with reference to maxillofacial trauma?
Ans. In the management of a patient with maxillofacial trauma,
the primary or first aid is as follows:
i. Airway
ii. Breathing
iii. Circulation
iv. Drug therapy/Defibrillation
v. Exposure or environmental influences.
3. What is the proper way to take the history of a patient with
maxillofacial injury?
Ans. The following should be inquired about:
i. Who: Patients name
ii. When: Date and time of injury
iii. Where: Surrounding of the injury place. It may cause
bacterial or chemical contamination
iv. How: The mode of injury
v. What type of treatment provided earlier if referred from
another center
General Maxillofacial Trauma 203
vi. What is the general health of the patient

vii. Previous history of trauma should be recorded
viii. Length of unconsciousness should be recorded
ix. Any history of pain/vomiting/unconsciousness/amnesia/
headache/visual disturbances/confusion after accident,
malocclusion should be noted
x. History of amount of bleeding
xi. Information about the patients routine medication
xii. Blood group of the patient.
4. How will you classify a fracture depending on the
mechanism of the fracture?
Ans. It can be classified as follows:
i. Avulsion fracture
ii. Bending fracture
iii. Burst fracture
iv. Countercoup fracture
v. Torsional fracture.
5. Which nerves should be examined in maxillofacial injuries?
Ans. The following nerves should be examined:
i. Facial nerve: Ask the patient to use the muscle of the facial
expression
ii. Infraorbital nerve: In case of ZMC fracture and Le Fort II
fracture
iii. Olfactory nerve: Fracture of midface that involves cribri
form plate of the ethmoid
iv. Oculomotor nerve: Presence of the dilated pupil indicates
that oculomotor nerve damage usually results from
intracranial nerve compression due to increasing
intracranial pressure
v. Abducent nerve: Injury to this nerve results in lateral rectus
muscle dysfunction
vi. Optic nerve: Injury to this nerve results from the fractures
surrounding the optic foramen, which may result from
the compressing bone.
6. What preoperative procedure is to be performed before

undergoing closed reduction of the mandibular fracture?
Ans. i. Medical history
ii. Physical examination
iii. Complete blood count
iv. Urine analysis.
7. What is the general outline for the management of a patient
with maxillofacial trauma?
Ans. The management is considered in four following headings:
i. First-aid treatment:
Maintenance of airway
Arrest of hemorrhage
Prevention of shock
Relief of pain and anxiety
Temporary immobilization
ii. Preliminary treatment at the hospital:
General care
Injection ATS 750-1,500 units
Prevention of dehydration
Tracheostomy, if required
Cleaning and dressing of wound
Temporary immobilization
Control of infection
iii. Definitive treatment:
Reduction of fractured fragment in normal anatomical
position
Fixation of fractured fragment in normal anatomical
position
Immobilization of jaws (if required)
iv. Rehabilitation: Medical and oral and maxillofacial:
8. What is the most important thing to note first in a patient
with head injury?
Ans. His/her ability to open the eyes.
9. What is the aim of Glasgow coma scale?

Ans. To ascertain the level of consciousness.
10. What is the first step in the management of head injury
secure airway or blood transfusion?
Ans. The first step in the management of head injury is to secure
airway. If the patient is unconscious, he/she should be carried in
lateral position. This allows clearing of blood and mucous from the
mouth and nasopharynx and escape of further secretions.
11. What signs are included in the Glasgow coma scale?
Ans. i. Eye opening
ii. Motor response
iii. Verbal response.
12. Which clinical sign does always indicate an obstruction of
airway?
Ans. Stertorous breathing indicates an obstrcution of airway.
13. A patient is in shock after gross comminuted fracture. What
is the immediate treatment to be started with Ringers
lactate or whole transfusion?
Ans. Ringers lactate should be started immediately. Usually after
trauma, hypovolemic shock is developed due to severe blood loss.
Ringers lactate solution should be given because due to its high
osmotic value, it maintains the fluid in the vascular compartment.
14. What is the safest initial approach to maintain the patent
airway in the maxillofacial trauma?
Ans. Head tilt-chin lift.
15. After the facial injury if a patient loses voluntary control of
the tongue, what is the best emergency treatment to avoid
the tongue falling back?
Ans. Towel clipping of the tongue.
16. An average-built patient is affected with maxillofacial
trauma. How much daily sodium and potassium is required?
Ans. 100 mmol per day of sodium and 60 mmol per day of
potassium.
17. What is the immediate danger to a patient with severe facial

injuries?
Ans. Respiratory obstruction is the immediate danger.
18. A patient is affected with maxillofacial injury to the middle
cranial fossa. What are the clinical complications?
Ans. i. Regurgitation
ii. Absence of gag reflex
iii. Weakening of voice.
19. A patient with maxillofacial injury should be carried in
which position?
Ans. Lateral position.
20. In which condition is the patient with maxillofacial injury
carried in the supine position?
Ans. Spinal and cervical injuries.
21. Which facial bone is most frequently fracturedMaxilla or
Zygomatic bone or Nasal bone?
Ans. Zygomatic bone is most frequently fractured because of its
prominency.
22. What is the immediate management of nasal bleeding in
facial injuries?
Ans. Paraffin gauze packing.
23. During nasal bleeding and CSF leakage, what is the compli
cation of placing a nasal pack?
Ans. Meningitis.
24. What is the earliest measurable circulatory sign of shock?
Ans. Tachycardia.
25. What are the common forms of shock encountered in the
trauma patients?
Ans. Most common is hypovolemic shock. They may also suffer
from neurogenic shock, cardiogenic shock or septic shock.
26. What is the common cause of shock in a trauma patient?

Ans. Hemorrhage.
(i) Cardiogenic shock; and (ii) Neurogenic shock.
Ans. i. Cardiogenic shock: It occurs when the blood flow
decreases due to an intrinsic defect in the cardiac
function either the heart muscles or the heart valves.
ii. Neurogenic shock: It is caused by sudden loss of the
descending sympathetic nervous system control of the
smooth muscle in the vessel wall.
28. What is the common complication of an open fracture?
Ans. Infection is the common complication.
29. What is the ideal time for the facial wounds to be closed as
primary closure?
Ans. It should be within 24 hours.
30. What are the conditions in maxillofacial injuries in which a
tongue tie is indicated?
Ans. i. Bilateral parasymphysis fracture
ii. Unconscious patient
iii. Chin has been destroyed in a gun-shot.
31. What is the importance of the examination of pupils in the
maxillofacial injuries?
Ans. It is important to examine the pupils because of the following
reasons:
i. It indicates trauma to the brain
ii. It indicates trauma to the optic tract
iii. It indicates progress of the patient after trauma.
32. What does golden hour of trauma refer to?
Ans. It refers to the period of time exactly one hour after the trauma
is sustained.
33. What does the matchbox injuries of the maxilla- mandibular

region refer to?
Ans. Fracture to the middle third of the facial skeleton.
34. Which are the fracture sites in the maxillofacial region that
may cause anterior open bite?
Ans. i. Bilateral condylar fracture
ii. Horizontal fracture of the maxilla, e.g. Le Fort I fracture.
35. What is the optimal urinary output for a trauma patient?
Ans. In an adult patient, at least 0.5 ml/kg/hr. In the patients older
than 1 year, it should be 1 ml/kg/hr.
36. What should be the patients position in case of a suspected
cervical fracture?
Ans. Body and neck should be extended.
37. A patient with maxillofacial injuries presents with ecchy
mosis in the sulci, floor of mouth and hard palate. Generally,
there are more chances of abrasion or fracture?
Ans. There are more chances of fracture.
38. What is the minibone plate system?
Ans. Monocortical system.
39. What is the minimum number of screws required for the
fixation of miniplate?
Ans. Minimum two screws on each side of the fracture site are
required for the fixation of miniplate.
40. The spherical gliding principle is a feature of:
Ans. ASIF plating.
41. What is the spherical glinding principle?
Ans. In compression osteosynthesis, bicortical screws are used.
As a screw is tightened in the vertical direction, the fractured bone
ends move horizontally. This is called spherical gliding principle.
42. What should be the position of miniplate to prevent injury

to the apices of teeth?
Ans. At a distance, twice the height of the clinical crown below the
alveolar crest.
43. In general, elastic traction is used to reduce the facial
fractures. It does so by overcoming?
Ans. i. The active muscular pull that distracts the fragments
ii. The organized connective tissue at the fracture site
iii. The malposition caused by the direction and force of
trauma.
44. Why the gunshot fractures of the facial bones should not
be treated via open reduction?
Ans. The numerous small fragments will lose their vitality when
the periosteum is reflected.
(i) Non-union of fracture fragment; (ii) Delayed union; and
(iii) Malunion
Ans. i. Non-union of the fractured fragment: Non-union of the
mandible implies a failure of the fracture hematoma to
become transformed into an osteogenic matrix so that it
is ultimately converted into non-osteogenic fibrous tissue.
Non-union is considered a terminal condition of failed
osteogenesis, which is identified by the mobility of the
bone ends in all planes after an interval of time-period of
10 weeks.
ii. Delayed union: If the bone fragments are in their correct
apposition and the formation of the bone is slower than
the expected rate for the age of the individual, a delayed
union will occur but the functional and esthetic results
will be normal.
iii. Malunion: If accurate alignment has not been affected but
bony union is achieved, either within the normal period
of time or after a protracted period, a state of malunion

will exist.
46. What are the different types of forceps used for the
reduction of different types of fractured fragments in the
oral and maxillofacial regions?
Ans. i. Mandible fracture: Lions bone-holding forcep
ii. Maxilla fracture: Rowes disimpaction forcep/Hayton-
Williams forcep
iii. Zygomatic fracture: Freer elevator/zygomatic bone hook/
Dingman zygomatic elevator
iv. Zygomatic arch fracture: Bristows elevator/periosteum
Elevator can also be used
v. Nasal fracture: Walshs nasal forceps.
47. Differentiate between primary bone healing and secondary
bone healing.
Ans. There are mainly two types of bone healing:
i. Secondary bone repair: Fractures which are generally
treated by method of only relatively rigid external
immobilization (casts, splints, bandages and traction).
This method of union is called secondary union.
Sequence of secondary bone healing:
a. Initial stage: 0 to 5 days after fracture
b. Cartilaginous callus or soft callus formation: 4 to 40
days after fracture
ii. Primary bone repair: Under the circumstances where
fractures are immobilized by extremely rigid internal
fixation, e.g. application of a rigid compression plate or
the application of a rigid external device, the mechanism
of fracture healing is called primary bone union. The
sequence of primary bone healing is:
a. Gap healing: 0.3 mm up to 1 mm. Gap healing begins
almost immediately
b. Contact healing: In this, contact is achieved when
the interfragment gap is essentially zero. Healing
occurs through the bone metabolizing unit or bone

remodelling unit. A special process of bone formation
occurs, which is known as contact healing. Vascular
and cellular growth cannot proceed in this process.
48. What is mnemonic to assess the patients level of conscious
ness in maxillofacial injuries?
Ans. AVPU is the mnemonic used.
AAlert
VResponds to vocal stimuli
PResponds to pain stimuli
UUnresponsive.
49. List the aims/objectives and goals of management of the
jaw fracture.
Ans. The objectives of treatment are:
i. To avoid infection
ii. To provide immobilization
iii. To maintain oral hygiene
The goals of management are:
i. Symmetrical facial contour
ii. Normal functional activity.
50. What is the basic difference between closed reduction and
open reduction of jaw fracture?
Ans. Closed reduction: This is a procedure by which the fractured
fragment is brought together in alignment without exposing the
fractured bone ends. Occlusion is key to reduction.
Open reduction: It is a procedure in which fractured fragment is
exposed (fractured bone ends) and brought into alignment under
direct vision. The fractured fragment can be exposed intraorally or
extraorally.
51. Which examinations are included in the patients with respi
ratory distress in maxillofacial injuries?
Ans. The following examinations should be included:
i. Attention to mandibular mobility
ii. The size and mobility of the tongue
iii. The state and fragility of dentition

iv. The amount and viscosity of secretions
v. The presence of hemorrhage or masses in the oral cavity
and pharynx.
52. What are the contraindications of endotracheal intubation?
Ans. Contraindications are rare but relative contraindications
include the following cases:
i. Cervical spine injury
ii. Presence of CSF rhinorrhea or fracture of anterior cranial
fossa
iii. Presence of retropharyngeal swelling
iv. A fractured larynx may make endotracheal intubation
impossible.
53. On an emergency basis, what are the indications of
tracheostomy?
Ans. Following are the indications of tracheostomy:
i. Upper airway obstruction caused by trauma, soft tissue
swelling, fracture, infection, hemorrhage or foreign bodies
ii. Facilitation of tracheobronchial toilet
iii. Anticipated prolonged mechanical ventilation
iv. Facilitation of management of concomitant problems
such as cervical spine injuries.
54. What are the additional advantages of cricothyroidotomy
over tracheostomy?
Ans. Following are the additional advantages of cricothyroidotomy:
i. In emergency situations, the cricothyroidotomy can be
performed rapidly, generally in less than 2 minutes
ii. Extensive knowledge of neck anatomy is not necessary
iii. Rate of operative complications is low
iv. The airway entrance in cricothyroidotomy can be isolated
from the operative site
v. There is potential improved cosmetic of the resultant
scar.
55. What are the ten cardinal points to summarize heart injury
in maxillofacial trauma?
Ans. i. Bruise on sternum
ii. Fractured sternum
iii. Cyanosis of upper half of body
iv. Unexplained hypotension
v. Massive hemothorax
vi. Pericardinal tamponade
vii. Atrial or ventricular arrhythmias
viii. ECG evidence of myocardial ischemia or infarction
ix. New cardiac murmurs
x. Muffled heart tones.
56. What is the proper order to examine the oral cavity in the
maxillofacial region?
Ans. i. Oral examination as follows:
Soft tissue
Nerves
Skeleton
Dentition.
ii. Maxillofacial examination as follows:
Soft tissues
Nerves
Skeleton.
57. At the primary level, how can mandible be immobilized in
case of jaw fracture?
Ans. Extraorally, it can be immobilized with the help of:
i. Barrel bandage
ii. Four-tailed bandage
Intraorally, it can be immobilized with the help of:
i. Temporary direct teeth wiring
ii. If wire in not available, it can be done with the help of
suture.
58. What are the stages of healing of fracture?
Ans. i. Clotting of blood of the hematoma
ii. Organization of the blood of the hematoma
iii. Formation of fibrous callus
iv. Formation of primary bone callus

v. Formation of secondary bony callus
vi. Functional reconstruction of the fractured bone.
59. Explain the Golden Hours in critical care.
Ans. i. In emergency, the term Golden Hour refers to the first
hour following trauma
ii. Platinum 10 minutes are first 10 minutes after trauma
and refers to the importance of starting first aid within
10 minutes to reduce the chances of death
iii. Door to ECG: Time is an important terminology in the
treatment of heart attack or MI
iv. Door to needle time: In acute case, MI is the time before
which the clot dissolving drug should be given
v. Door to Balloon time: It is for angioplasty
vi. Door to Doctor time: More than 10 minutes in stroke
when the mortality is high
vii. Door to neurologic time: Less than 15 minutes in case of
stroke
viii. Door to CT Scan time: Less than 25 minutes in suspected
stroke
ix. Door to CT interpretation: Less than 45 minutes
x. Door to CPA (tissue plasminogen activator) time: In the
treatment window in stroke within 60 minutes
xi. Door to antibiotic times: In Community Acquired
Pneumonia (CAP), it is the time to start antibiotics.
60. What is the Champys principle and Champys plate?
Ans. Champys principle: Mini plates are applied using the Champys
principle, which states that Natural line of compression exists in the
lower border of the mandible. Plates are fixed on the ideal line of
osteosynthesis, which is known as Champys line of osteosynthesis.
Miniplates with self-tapping screw are applied on the outer cortical
plate.
Champys plate: Semirigid fixation with monocortical screws.
Champy et al work with intraoral application of the monocortical
miniplate for the treatment of mandibular angle fracture.
MANDIBLE FRACTURE
(i) Closed fracture; (ii) Compound fracture; (iii) Comminuted
fracture; (iv) Complicated or complex fracture
Ans. i. Closed fracture: It is also known as simple fracture. It does
not produce a wound open to the external environment,
e.g. Through mucosa or skin
ii. Compound fracture: It is also known as open fracture. It
produces an external wound through mucosa or skin
which communicates with breake in the bone
iii. Comminuted fracture: A fracture in which the bone is
splintered or crushed
iv. Complicated or complex fracture: A fracture in which
there is considerable injury to the adjacent soft tissue
or adjacent part. It may be closed or compound.
2. How much energy is required to fracture the mandible?
Ans. 45 to 75 kg/m.
3. What are the weak areas in mandible?
Ans. i. Angle of mandible
ii. Canine region
iii. Symphysis menti
iv. Neck of condyle
v. Presence of foramina
vi. Presence of teeth.
4. Which is the most common site of fracture in the mandible?
Ans. Angle of mandible is the common site of fracture. Because of
the sudden change in angulation, angle is considered as the weakest
part of the mandible.
5. What is FLOSA?
Ans. It is AO classification of the mandible based on clinical and
radiographic finding:
i. FFracture number
ii. LLocalization
iii. OOcclusion
iv. SSoft tissue involvement
v. AAssociated fracture
6. How will you classify the angle fracture of mandible?
Ans. Angle fracture of mandible is classified as:
i. Favorable horizontal angle fracture
ii. Unfavorable horizontal angle fracture
iii. Favorable vertical angle fracture
iv. Unfavorable vertical angle fracture.
7. Which radiograph is the best to visualize horizontal and
vertical fractures of the angle of mandible?
Ans. i. Orthopantomography (OPG) is the best to visualize
horizontal fracture
ii. Occlusal view is the best to visualize vertical fracture
(favorable or unfavorable).
8. What are the eight cardinal common features of the
mandible fracture?
Ans. The eight cardinal common features of the mandible fracture
are as follows:
i. Change in occlusion
ii. Abnormal mandibular movement
iii. Anesthesia or paresthesia of the lower lip
iv. Loose teeth
v. Crepitation on palpation/step deformity
vi. Laceration/hematoma/ecchymosis
vii. Change in facial contour and mandibular arch form
viii. Pain/swelling/redness/localized heat (all signs of
inflammation)
9. What are the cardinal features of an angle fracture of the
mandible?
Ans. The cardinal features are:
i. It results from the blow over the same side of the
mandible between canine and second molar regions
ii. It also results from violence to the chin on the opposite

side
iii. Intraorally undisplaced fracture revealed by the presence
of tell-tale hematoma formation
iv. Anesthesia or paresthesia on the lower lip on the same
side
v. Step deformity behind the last molar intraorally.
10. What are the cardinal features of the subcondylar fracture
of mandible?
Ans. The cardinal features are:
i. Most cases results from the trauma to the TMJ region
ii. In most cases, condylar fracture results in restricted
mouth opening
iii. In most cases, occlusion is disturbed.
11. Which is the least common site of the fracture of the
mandible?
Ans. Coronoid process of the mandible.
12. What is the reason for the forward displacement of the
condyle in the condylar fracture?
Ans. Lateral pterygoid muscle.
13. To which side is the mandible deviated on protrusion in
case of subcondylar region fracture?
Ans. To the same side.
14. Which mandibular fractures are likely to be missed on
panoramic radiograph?
Ans. Symphysis and parasymphysis region fractures of the
mandible are likely to be missed on panoramic radiograph because
panoramic radiograph is 2D view (flat view) taken by a movable X-ray
beam that displays the entire mandible as a flat structure and some
overlap and blurring is usually seen. Mandibular condyle is difficult
to detect and, when detected, it is difficult to ascertain the degree
of displacement of the fracture.
15. What is the fracture of the tooth-bearing segment of the

mandible known as?
Ans. It is known as compound or open fracture.
16. What are the growth centres in the mandible?
Ans. Symphysis menti and condylar regions.
17. Why is bone fixation avoided in symphysis menti and
condylar regions in the fracture cases for children below
12 years?
Ans. These two areas are growth centers. If bone plate is fixed in
these areas, growth may be deferred.
18. In which condition bucket handle type of fracture is seen?
Ans. It is seen on edentulous patient. The molar area is weakened
following alveolar resorption and becomes the site for bilateral
fracture of edentulous mandible. There is downward and backward
movement of the anterior part of the mandible under the influence
of diagastric and mylohyoid muscles.
19. Eburnation is seen in which condition?
Ans. It is seen in non-union of fracture and radiograph shows
rounding off and sclerosis of bone cells.
20. Which clinical sign is always present in the bone fracture?
Ans. Tenderness (pain at the fracture site) is always present.
21. Direct impact on bone causes which type of fracture?
Ans. Comminuted fracture (more than one fracture line is joined
together).
22. A swelling behind the ear suggests fracture of which area?
Ans. Condylar fracture.
23. Gunning splints are used in which cases?
Ans. They are used in edentulous patients.
24. What is the other name for parade ground fracture?
Ans. Guardsman fracture.
25. Guardsman fracture or parade ground fracture is commonly

seen in which condition?
Ans. It is commonly seen in an epileptic patient.
26. A patient gives history of trauma along with the complaint
of bleeding from the ear. Which area fracture is suspected
from history?
Ans. It suggests the subcondylar fracture.
27. Tell-tale hematoma is seen in which type of fracture?
Ans. It is seen in coronoid process fracture.
28. If angle fracture occurs during the removal of impacted
mandibular third molar, what is the immediate line of
treatment?
Ans. i. Superior border transosseous wiring
ii. Intermaxillary fixation (IMF).
29. What are the indications for removing a tooth in the line of
fracture?
Ans. The indications for extracting a tooth in the line of fracture
are as follows:
i. Presence of obvious pathology such as caries or period
ontal disease
ii. Gross mobility of the involved teeth
iii. Teeth that prevent adequate reduction of fractures
iv. Teeth with fractured roots
v. Teeth whose root surfaces or apices are exposed in the
fracture site.
30. What are dynamic compression plating, eccentric dynamic
compression plating and passive plating?
Ans. i. Dynamic compression plating: Dynamic compression
plates compress the fracture site by providing axial
guiding inclines for the screw heads to slide down as the
screw is tightened.
ii. Eccentric dynamic compression plating: It provides comp
ression forces in more than one direction by changing
the direction of the guiding incline in the outer holes of

the plate.
iii. Passive plating: It provides rigid fixation without compres
sion.
31. What is the best treatment of green-stick fracture of the
mandible?
Ans. Bringing the teeth into occlusion with interdental wiring.
32. What is the most common complication of the condylar
injuries in the growing children?
Ans. Ankylosis is the most common complication. To avoid such
a complication, early mobilization is indicated.
33. Direct interdental wiring is also called as:
Ans. Eyelet wiring.
34. What is the acceptable treatment modality for fracture of
mandible in 8-year-old patient?
Ans. Circummandibular splinting.
35. What is the reason for high rate of fracture at the canine
region of the mandible?
Ans. It is due to the long root of the mandibular canine.
36. Which fracture is responsible for the respiratory
embarrassment?
Ans. Bilateral parasymphysis fracture of the mandible.
37. Which structures may get injured during circummandibular
wiring?
Ans. i. Facial artery
ii. Facial vein
38. Why should the submandibular incision in the angle region
be a finger width below the lower border of the mandible?
Ans. To prevent injury to the marginal mandibular nerve.
39. Which structures are responsible for the posterior

displacement of anterior segment of the mandible in the
case of bilateral parasymphysis fracture of the mandible or
canine region?
Ans. It is due to the action of:
i. Geniohyoid muscle
ii. Genioglossus muscle
iii. Anterior belly of the digastric muscle.
40. What is the reason for the tongue to fall back in case of
bilateral parasymphysis fracture of the mandible (canine
region)?
Ans. Removal of tongue attachment to the mandible may allow
the tongue to fall back and obstruct the oropharynx. Geniohyoid,
genioglossus and anterior belly of the digastrics muscle will tend
to pull the mandible back.
41. Which extraoral radiograph is the best to demonstrate the
subcondylar fracture?
Ans. Townes projection.
42. Which structures are divided when the angle of mandible
is exposed through a submandibular incision?
Ans. From the outer to inner layers, the structures are:
i. Skin
ii. Superficial fascia
iii. Platysma muscle
iv. Deep cervical fascia
v. Masseter muscle
43. What is the average period of immobilization?
Ans. 6 to 8 weeks in adults.
44. A patients below 12 years of age is present with subcondylar
fracture with normal occlusion. What is the line of treat
ment?
Ans. If occlusion is not disturbed, no immobilization and no active
treatment are required. If occlusion is disturbed, IMF is required for
one to two weeks with intermittent mouth exercise.
45. In case of subcondylar fracture, in which direction does the

condyle move and also name the muscle which influences
the movement or displacement of the condyle?
Ans. Condyle moves in the anteromedial direction. The lateral
pterygoid or the external pterygoid muscle influences the
movement.
46. In angle fracture of the mandible, the proximal segment
usually displaces in which direction and which muscles are
responsible for it?
Ans. The proximal segment gets displaced in the anterosuperior
direction. It gets influenced by the pull of the medial pterygoid,
masseter and temporalis muscles.
47. How will you manage a case of a fracture of the mandible
in canine region in a child below 12 years?
Ans. The use of acrylic cap splint with circumferential wiring is the
best treatment modality.
48. Which is the best treatment option for unfavorable fracture
of the angle of mandible?
Ans. The best treatment modality is open reduction with rigid bone
fixation.
49. Which are the sites for bone plating in the mandible?
Ans. i. Inferior border of the mandible
ii. Superior border of the mandible
iii. Zone of tension.
50. Greenstick fracture is most commonly seen in which age-
group?
Ans. It is most commonly seen in children. One end bends like
green stick.
51. Compression osteosynthesis heals the fracture in the
mandible by which method?
Ans. Primary union without callus formation.
52. What is the other name for direct interdental wiring?

Ans. Glimers wiring. It is a simple method.
53. What is the clinical sign for a patient with left subcondylar
fracture?
Ans. Such patients are unable to deviate the mandible towards the
right side. It is due to the ineffective action of the lateral pterygoid
muscle on the fracture side.
54. If there is a fracture of the mandible distal to last molar,
how will you manage such cases?
Ans. Open reduction with bone plating.
55. If there is an undisplaced fracture of the mandible with full
set of teeth, how will you manage such cases?
Ans. It can be successfully treated by intermaxillary fixation with
arch bar for 6-8 weeks in adults.
56. Which type of fracture of the mandible causes anterior open
bite?
Ans. Bilateral condylar fracture.
57. Which is the most commonly used splint for dentulous
mandibular fracture?
Ans. Cap splint is used in the dentulous patients.
58. Which type of wiring is indicated in the symphysis fracture
of the mandible?
Ans. Risdons wiring.
59. Why a displaced, unfavorable fracture is difficult to treat?
Ans. It is because of the destruction of the fractured fragment by
muscle pull.
60. Which area is suitable for miniplate fixation?
Ans. Zone of tension.
61. What is Stout wiring?
Ans. It is also known as Col. Stout multiple loop wiring. Here four
posterior quadrants are used for wiring followed by intermaxillary
fixation.
62. Answer the following:

i. Give example of closed fractures of the mandible.
ii. Which mandible fracture is always a compound
fracture?
iii. Which mandible fracture does never get displaced and
why?
Ans. i. Condyle and coronoid fractures of the mandible is one
example of closed (simple) fracture of the mandible. They
are never exposed either extraorally or intraorally.
ii. Fractures involving tooth-bearing areas are always
compound fractures. They are open either extraorally or
intraorally.
iii. Ramus fracture of the mandible never gets displaced
because of the pterygomasseter sling (masseter muscle
and medial pterygoid muscle) make a sandwich and
prevent displacement.
63. List the various classifications for condylar fracture and
what is the criteria for classification?
Ans. i. First classification: It was given by Lindahl on the basis of
radiographic reading, e.g.
Fracture level
Relationship of condylar fragment to the mandible
Relationship of condylar head to fossa
ii. Second classification: It is on the basis of relationship of
the fractured fragment to the mandible. It is also known
as clinical classification.
iii. Third classification: Simple classification and it is classified
as:
Intracapsular
Extracapsular.
64. What are the different methods for indirect skeleton fixation
and immobilization of jaw fracture?
Ans. After the closed reduction the methods for indirect skeletal
fixation are:
i. Direct interdental wiring

ii. Indirect interdental wiring
iii. Ivy loop or eyelet wiring
iv. Continuous or multiple loop wiring
v. Arch bars
vi. Cap splint
vii. Gunning type splint
viii. Pin fixation
ix. Essigs wiring
x. Gilmers wiring
xi. Risdons wiring
xii. Col. Stouts multiple loop wiring.
65. What are the different methods for direct skeletal fixation
and immobilization of jaw fracture?
Ans. After open reduction, the methods for direct skeletal fixation
are:
i. Direct wiring or osteosynthesis or transosseous wiring
ii. Bone plating
iii. Intramedullary pinning
iv. Titanium mesh
v. Circumferential straps
vi. Bone clamps
vii. Bone staples
viii. Lag bone screw.
66. What is elephant foot deformity?
Ans. In case of edentulous mandible fracture, many times non-
union of fracture is seen due to the impaired blood supply or the
presence of infection. During open reduction, there is a typical
eburnation of the ends of the fractured fragments. In radiograph,
this eburnation is seen as the elephant foot deformity.
67. In reference to condylar fracture, define the following
terms:
(i) Dysarthrosis; (ii) Metarthrosis; and (iii) Pseudoarthrosis.
Ans. i. Dysarthrosis: Morphological change is seen in unreduced
fracture dislocation producing non-articulating
deformed condyle. The patient will have pain and limited

movement.
ii. Metarthrosis: It is the result of healed fracture in malposi
tion but it produces no symptoms. Joint with altered
anatomy but functionally accepted.
iii. Pseudoarthrosis: False joint, very painful during excur
sions.
68. In reference to management of the mandible fracture, what
are the roles of the following materials?
(i) Kirschner wires (K wires); and (ii) Lag screws.
Ans. i. Kirschner wires (K wires): They are rarely used for
temporary fixation of the fracture of the mandible. The
fractured segments are held together in position. More
recently K wires are also used for comminuted fractures
of the body of the mandible.
ii. Lag screws: Compression of the fractured fragments can
be accomplished by means of lag screws. This technique
was applied for the treatment of oblique fracture in long
bones. Few oblique mandibular fractures can be treated
through this method.
(i) Strain lines; (ii) Champys lines; and (iii) Lines of bone
(Trajectories of bones).
Ans. i. Strain lines: Strain lines are the lines of tension which are
opposite to the site of force application. For example,
symphysis menti, mental foramen and condylar neck.
ii. Champys lines: It is also known as or lines of tension
forces. Small plates will take these loads.
iii. Lines of bone Trajectories of bones: These are the lines
of orientation of bony trabeculae corresponding to the
pathways of the maximal pressure.
For example:
a. Horizontal buttress
b. Vertical buttress.
i. Nasomaxillary
ii. Zygomatic maxillary
iii. Pterygomaxillary.
70. What is the simple guide to the time of immobilization for
fracture of the jaw (tooth-bearing area)?
Ans. i. Young adult with angle fracture in which tooth is
removed from the fracture line = 3 weeks
ii. Tooth retained in fracture line = 3 + 1 weeks
iii. Fracture at the symphysis region = 3 +1 weeks
iv. Age 40 years and over = 3 + 2 weeks
v. Children and adolescents = 3 1 weeks
MAXILLA FRACTURE
1. How is the facial skeleton divided?
Ans. Facial skeleton can be divided into three parts:
i. The upper part, i.e. forehead. It is formed by the frontal
bone.
ii. The lower part is formed by the mandible.
iii. Middle third of the facial skeleton:
Superiorly it is bounded by the frontozygomatic
suture on both the sides and frontonasal suture in
the middle.
Inferiorly it extends up to the occlusal surface of the
maxillary teeth.
2. How many bones make up the middle third of the facial
skeleton?
Ans. Following bones make up the middle third of the facial
skeleton (total 17 bones):
i. Two maxillae
ii. Two zygomatic bones
iii. Two zygomatic processes of the temporal bone
iv. Two palatine bones
v. Two nasal bones
vi. Two lacrimal bones

vii. The vomer
viii. The ethmoid and its attached conchae
ix. Two inferior conchae
x. The pterygoid plexus of sphenoid.
3. Who was Le Fort? What is Le Fort fracture?
Ans. Rene Le Fort was a French surgeon. He was interested in
the lines of weakness on the face and the pattern of midfacial
fracture. He performed a number of experiments on fresh
cadaver heads. He determined three basic fault lines along which
the face fractured.He observed that fractures of the midface
occurred in three typical patterns and were often bilateral and
could be mixed.
4. A patient with Le Fort II, Le Fort III and nasoethmoidal
fracture with IMF. What is the best way to intubate such a
patient?
Ans. Submental intubation is the option because due to IMF, oral
intubation is not possible. Nasoethmoidal fracture may create
difficulty for nasal intubation. Tracheostomy may be considered as
one of the alternatives.
5. List the synonyms of Le Fort I fracture.
Ans. Le Fort I fracture is also known as:
i. Low level fracture of maxilla
ii. Horizontal fracture of maxilla
iii. Guerin fracture
iv. Telescopic fracture.
6. List the synonyms of Le Fort II fracture.
Ans. Le Fort II fracture is also known as:
i. Pyramidal fracture
ii. Infrazygomatic fracture.
7. List the synonyms of Le Fort III fracture.

Ans. Le Fort III fracture is also known as:
i. Suprazygomatic fracture
ii. Craniofacial disjunction
iii. High level fracture.
8. A patient with facial trauma with bleeding from the nose
(antrum) or bleeding into the antrum. This suggests the
fracture of which region?
Ans. Le Fort I fracture of the maxilla.
9. Which type of maxilla fracture may cause open bite?
Ans. Le Fort I facturehorizontal fracture of the maxilla.
10. In which fracture cases is the floating maxilla typically
found?
Ans. In case of Le Fort I or Guerin fracture.
11. Name the forcep which is used for the maxillary fracture
disimpaction?
Ans. Rowes disimpaction forceps. It is used bilaterally and simulta
neously. It is a paired instrument.
12. Why is Le Fort I fracture also known as telescopic fracture
or impacted fracture?
Ans. In case of Le Fort I fracture, sometimes there is an upward
displacem ent of the entire fragment, locking it against the
superior intact structure. Such fracture will be called as impacted
or telescopic fracture.
13. What is the course of the line of Le Fort I fracture?
Ans. The course of the line of Le Fort I fracture is:
i. Floor of the nose
ii. Lower third of the maxilla
iii. Palate
iv. Pterygoid plate.
14. What is the course of the line of Le Fort II fracture?
Ans. Fracture line traverses from:
Thin portion of the frontal process

extended laterally through the
Lacrimal bone
Floor of the orbit
Zygomatic maxillary suture
Infraorbital foramen
continues through the
Lateral wall of the maxilla
through the
Pterygoid plates
into the
Pterygoid maxillary fossa
15. What is the course of the line of Le Fort III fracture?
Ans. These essentially run parallel to the base of the skull.
i. Nasofrontal suture
ii. Floor of the orbit
iii. Zygomatic frontal suture
iv. Zygomatic arch.
16. What are the cardinal features of Le Fort I fracture?
Ans. Following are the cardinal features of Le Fort I fracture:
i. Mobility of the upper dentoalveolar portion of the jaw
ii. Ecchymosis in the labial and buccal vestibule
iii. Nasal bleeding may be observed
iv. Swelling (may be slight), edema and laceration of upper
lip and intraoral mucosa may be seen
v. Occlusion may be disturbed
vi. A classic anterior open bite may be seen
vii. Percussion of maxillary teeth produces dull cracked pot
sound.
17. What are the cardinal features of Le Fort II fracture?
Ans. Following are the cardinal features of Le Fort II fracture:
i. Step deformity at the infraorbital margins

ii. Mobility of midface
iii. Anesthesia or paresthesia of cheek
iv. Orbital floor injury with possible diplopia
v. Pupils tend to be levelled
vi. Nasal bones move with midface as a whole
vii. CSF rhinorrhea may not be clinically detectable
viii. No tenderness over the zygomatic bones and arch.
18. What are the cardinal features of Le Fort III fracture?
Ans. Following are the cardinal features of Le Fort III fracture:
i. Tenderness and separational at frontozygomatic suture.
This will produce lengthening of face
ii. Tenderness and deformity of zygomatic arches
iii. Characteristic dish-face deformity
iv. Hooding of eyes
v. Often profuse CSF rhinorrhea
vi. Enophthalmos
vii. Disorganization of nasal skeleton
viii. Gross edema of face with panda facies within 24 to 48
hours
ix. Tilting of occlusal plane with gagging on one side only
x. Raccoon eyes (bilateral circumorbital/periorbital/ecchy
mosis and gross edema of eyes).
19. List the common features of Le Fort II and III fractures.
Ans. Common clinical features of Le Fort II and III fractures are as
follow:
i. Dish-face deformity
ii. Gross edema of middle third of facial skeleton
iii. Bleeding from nose or nasal obstruction
iv. Bilateral circumorbital edema/ecchymosis/hemorrhage
v. CSF rhinorrhea (sometimes it appears)
vi. Diplopia and enophthalmos
vii. Retroposition of maxilla and gagging
viii. Difficulty in mouth opening. Mobility of the upper jaw.
ix. Cracked pot sound on tapping the teeth.

x. Hematoma of the palate.
20. Cerebrospinal fluid rhinorrhea is found in which conditions?
Ans. It is associated with:
i. Le Fort II
ii. Le Fort III
iii. Nasoethmoidal fracture. Associated with comminuted
cribriform plate of ethmoid.
21. Epiphora is seen in which fracture and what is the cause?
Ans. Epiphora (water from the eyes) is seen in Le Fort II and Le
Fort III fracture and severe nasal complex injuries due to partial or
complete obstruction of nasolacrimal duct.
22. Panda facies and Raccoon eyes is seen in which cases?
Ans. It is seen in Le Fort II fracture. Due to edema and ecchymosis
around the eyes, the patient develops black circles around the eyes,
which is known as Raccoon eyes.
23. Paresthesia is seen with either zygomaticomaxillary fracture
or subcondylar fracture?
Ans. Zygomaticomaxillary fracture.
24. Diplopia is commonly seen in either nasal fracture or
zygomaticomaxillary complex?
Ans. Diplopia is generally seen in zygomaticomaxillary complex
fracture and Le Fort II and Le Fort III when fracture line passes above
the Whitnalls tubercle.
25. How can diplopia be checked and recorded?
Ans. The diplopia can be tested with forced conduction test and
degree of diplopia can be accurately recorded by the method of a
Hess Chart.
26. What is the role of pack in maxillary sinus?
Ans. i. To support comminuted fracture of the body of zygomatic
complex
ii. To support and reconstitute comminuted orbital floor
fracture.
27. Hooding of the eyes is seen in which type of fracture?

Ans. Le Fort III fracture: If the fracture line passes above the Whitnalls
tubercle, it removes the support given to the eye by Lockwoods
suspensory ligament and the upper eyelid follows the globe down.
That producing hooding of the eyes.
28. Which is the most common site of the leakage of CSF
rhinorrhea?
Ans. Cribriform plate is the common site.
29. What is Guerins sign?
Ans. Ecchymosis at greater palatine foramen in Le Fort I fracture.
30. Moon face appearance is seen in which cases?
Ans. Le Fort II and Le Fort III fractures due to gross edema of soft
tissue overlying the middle third of the facial skeleton.
31. Which are the most common complications of the CSF
rhinorrhea?
Ans. i. Ascending meningitis
ii. Pneumocephalus
32. Which anatomical structure is important during Gillies
approach?
Ans. Superficial temporal artery.
33. Why is Le Fort III fracture rarely seen in children below eight
years of age?
Ans. It is rarely seen in children due to the lack of poorly developed
ethmoidal and sphenoidal sinus.
34. What is dish-face deformity?
Ans. It occurs in Le Fort III fracture. The patient presents with
characteristic disc face because the middle third of the face is
pushed back or posterior and downward movement of maxilla.
35. What is Battles sign and its clinical significance?
Ans. Battles sign is ecchymosis posterior to ear. It is generally
indicative of basilar skull fracture involving the middle cranial fossa.
It is a relatively late sign presenting approximately 24 hours after
injury.
36. The typical cracked pot sound on percussion of upper teeth

is indicative of which fracture?
Ans. Le Fort I and Le Fort II fracture.
37. Why there is CSF rhinorrhea in Le Fort III frontal bone
fracture?
Ans. It is because of the following reasons:
i. Fracture of the cribriform plate of the ethmoid
ii. Fracture of the posterior wall of the frontal sinus
iii. Fracture of the roof of the sphenoidal air sinus.
38. Why does a subconjunctival hemorrhage remain bright red
in color for a long time?
Ans. It is because of the permeability of the conjunctiva to oxygen.
39. Why is penicillin (IM or oral) not effective in the presence
of infection in Le Fort II and Le Fort III fracture?
Ans. Penicillin does not pass into the CSF in adequate therapeutic
concentration and also if a Le Fort II or III fracture is present even
without the CSF rhinorrhea. The patient should be given a course
of sulfonamide therapy. An initial dose of Sulphadiazine 2 gm is
followed by 1 gm 6 hourly and the course is continued for atleast
5 days or longer if there is an established CSF leakage.
40. What is the basic difference between CSF rhinorrhea and
CSF Otorrhea?
Ans.
CSF Rhinorrhea CSF Otorrhea
Discharge of CSF through the nose Discharge of CSF Otorrhea through
due to skeletal disruption in the base the ear due to skeletal disruption in
of anterior cranial fossa produces CSF the base of the middle and posterior
rhinorrhea. cranial fossa produces CSF otorrhea.
41. What is the method used to confirm CSF rhinorrhea?

Ans. Handkerchief test: CSF Rhinorrhea (leakage of CSF from the
nose) is generally associated with bleeding. CSF in the blood can
be detected with the help of a single test in which a drop of fluid is
placed on the handkerchiefthe classic Bulls eye ring develops. It
is also identified by the Tram-line pattern.
42. What is diplopia and which muscle is frequently associated

with it?
Ans. Diplopia is also known as ambiopia or double vision. It is
blurred vision and defined as the perception of two images of a
single object. The muscle associated with it is inferior rectus muscle.
43. What are the tests for diplopia?
Ans. i. Test for the eye-movementNine Gauze test: A finger is
held in front of the patient and moved in all the directions
as the patients eyes follow the finger. The patient is asked
to report any double vision. Diplopia should be tested in
all the nine directions of the gauze.
ii. Test for the cause of diplopiaForced Duction test: It is
carried out under GA with the tissue holding the force of
the forcep. Hold the tendon of the inferior rectus muscle
and the patient is asked to carry out the entire range of
the eye movement. A failure to rotate the eyes superiorly
indicates paralysis or entrapment of the muscle within
the fracture fragment.
iii. Hess test: Hess test is used to measure the degree of
diplopia. The test helps in showing which extraocular
muscle is not functioning. When done on every
alternative day, the progress of diplopia can be
monitored.
44. What is the logical sequence of events to manage the
fracture of the middle third of the facial skeleton?
Ans. The well-established principles are:
i. Tracheostomy
ii. Facial laceration
iii. Reduction of associated mandible fracture
iv. The occlusion
v. Zygomatic fracture
vi. Disimpaction and reduction of the maxillae
vii. Open reduction
viii. Skeletal fixation
ix. Temporary intermaxillary fixation IMF

x. Nasal fracture
xi. Definitive IMF.
45. Which syndromes are considered as the complications for
the middle third the facial skeleton fracture?
Ans. i. Superior orbital fissure syndrome:
It is attributed to poor reduction of Le Fort III fracture
or malunited zygomatic complex fracture
Hematoma within the fissure affects third, fourth and
fifth cranial nerves
The optic nerve is not involved
It may result in ophthalmoplegia, proptosis and
retrobulbar pain.
ii. Zygomatic syndrome: In addition to facial deformity in the
form of flatness of the cheek, pain may be experienced
constantly due to impingement of the coronoid process
on the opening of mouth
iii. Orbital syndrome: The orbital injury may produce
proptosis and blindness due to transverse fractures of the
middle third facial skeleton. The impingement, laceration
or hemorrhage of the nerve sheath of optic nerve may
produce blindness.
ZYGOMATIC COMPLEX/ORBITAL/
NASOETHMOIDAL FRACTURE
1. What are the diagnostic features of the zygomatic complex
fracture?
Ans. The diagnostic features of the zygomatic complex fractures
are as follow:
i. Flattening of cheeks
ii. Periorbital hematoma
iii. Subconjunctival hemorrhage
iv. Intraorally ecchymosis (buccal sulcus) and tenderness
over zygomatic buttress
v. Diplopia
vi. Restricted mandibular movement
vii. Tenderness and step deformity of the infraorbital margin
viii. Tenderness and separation of frontozygomatic suture
ix. Enophthalmos
x. Lowering pupil level
xi. Epistaxis
xii. Possible gagging on the injured side.
2. List the clinical features of the isolated zygomatic arch
fracture.
Ans. The features of the isolated zygomatic arch fracture are as
follow:
i. Flattening of cheeks
ii. Partial trismus (restricted mouth opening)
iii. Depression over the zygomatic arch region
iv. Tenderness and step deformity in the zygomatic arch
region
v. Intraorally buccal sulcus ecchymosis and tenderness.
3. List the clinical features of the blowout fracture.
Ans. i. Circumorbital edema and/or circumorbital ecchymosis
ii. Proptosis
iii. Diplopia
iv. Enophthalmos.
4. List the clinical features of blowin fracture.
Ans. i. Proptosis
ii. Restricted ocular motility
iii. Diplopia
iv. Superior orbital fissure syndrome
v. Optic nerve injury.
5. Which elevator is used to reduce the zygomatic arch
fracture?
Ans. Bristows elevator is used for the reduction of the zygomatic
arch fracture.
6. In Gillies temporal approach for the reduction of the

zygomatic arch fracture, where is the elevator placed?
Ans. The elevator is placed between the temporal fascia and
temporalis muscle.
7. Hanging drop appearance is seen in which fracture and
which radiographic view is advisable?
Ans. Hanging drop appearance is seen in blowout orbital fracture
and waters projection of the face (PNS view) is advisable.
8. After trauma, diplopia is due to the entrapment of:
Ans. Diplopia is due to the interference with the action of
extraocular muscles, mainly due to the inferior rectus and inferior
oblique muscle.
9. What is the normal intercanthal distance and case of
traumatic telecanthus?
Ans. Normal intercanthal distance is 25 mm. In traumatic
telecanthus, it increases to 35 to 40 mm.
10. Why does subconjunctival hemorrhage remain bright red
color for a long time?
Ans. Subconjunctival hemorrhage remains bright red in colour
for a long time because oxygenations of hemoglobin cannot take
place through thin conjunctiva.
11. Which incision is used for the treatment of traumatic tele
canthus?
Ans. Bicoronal incision gives excellent exposure of the
nasoethmoidal complex.
12. In the patients with zygomatic fracture, there is paresthesia
of the upper lip over the nasal area. What is the cause of
paresthesia?
Ans. It is because of involvement of the infraorbital nerve on the
same side.
13. How will you recognize the depressed fracture of the

zygomatic area clinically?
Ans. The following features help to recognize the fracture of the
zygomatic area:
i. Concavity of the overlying tissue in the zygomatic area
ii. Difficulty in jaw movement
iii. Partial trismus restricted mouth opening.
14. What does detachment of suspensory ligament cause?
Ans. Lowering of the papillary level of the eyeball.
15. What is the ring fracture of the middle third of facial
skeleton?
Ans. In some severe fracture of the nasal complex, the fracture
lies at the center of the ring. Fracture of the middle third of the face
passes from the frontal bone downward on each side across the
medial orbit wall, the infraorbital rim and the anterior wall of the
maxillary sinus to link up beneath the anterior nasal spine. Such a
fracture causes considerable depression of the central part of the
face without any disturbance of the occlusion.
16. What is tripod fracture?
Ans. The zygomatic bone is closely associated with the maxilla/
frontal/temporal bones. They are usually involved when a zygomatic
bone fracture is referred to as zygomatic complex fracture or
zygomaticomaxillary complex fracture or tripod fracture.
17. What are blood-shaded eye and double vision?
Ans. Subconjunctival hemorrhage is also known as blood-shaded
eye. Diplopia is also known as double vision or blurred vision.
18. When is the nasal packing indicated after the treatment of
the nasal fracture?
Ans. After the successful reduction of a nasal fracture, intraseptal
packing is often used for the following purposes:
i. To control bleeding
ii. To prevent postoperative septal hematoma
iii. To splint the nasal septum into the position
iv. To prevent synechiae.
19. What are the indications of the posterior nasal packing?

Ans. i. It is indicated when posterior nasal area bleeds
ii. It is indicated if a posterior nose bleed is visualized
iii. Bleeding cannot be controlled with a well-placed anterior
pack.
20. How long should a posterior nasal pack be left in place?
Ans. For 3 to 5 days.
21. How soon should a nasal fracture be reduced after the
injury?
Ans. Nasal fracture should be reduced within the first few hours
after injury. If this is not done within this period, edema makes of
the reduction difficult. The next window of opportunity occurs 3 to
14 days after the injury when edema has resolved but before the
bony union.
22. What are the late complications of the nasal fracture?
Ans. i. Airway obstruction
ii. Nasal deformity or saddle nose deformity or dorsal hump
iii. Nasal deviation
iv. Septal perforation
v. The formation of synechiae
vi. Recurrent epistaxis
vii. Recurrent sinusitis
viii. Headache.
23. What is a saddle nose deformity?
Ans. It is the concave appearance of the nasal dorsum, sometimes
following the nasal trauma.
24. What is the difference between telecanthus and hyper
telorism?
Ans. i. Telecanthus: Widening of the distance between the
medial canthi, usually as a result of trauma. For example,
nasoethmoidal fracture. Normal distance is 33 mm
approximately.
ii. Hypertelorism: It is the widening of the orbits themselves

and is measured as the interpupillary distance, normally
60 mm.
25. What is Marcus Gunn pupil?
Ans. It is an afferent papillary defect resulting from the lesions
involving the retina or optic nerve back to the chiasm. With this
defect, a light shown in the unaffected eye produces normal
constriction of the pupils of both the eyes but a light shown in the
affected eye produces a paradoxical dilation rather than constriction
of the affected pupil.
26. What is the incidence of anesthesia of the infraorbital floor
with orbital floor fracture?
Ans. The incidence is 90 to 95%.
27. What is the most common complication of the untreated
orbital floor fracture?
Ans. i. Diplopia
ii. Enophthalmos
28. What are the causes of traumatic ptosis?
Ans. Ptosis refers to the dropping of the upper eyelid. Disruption
of the sympathetic fibers, (e.g. Horners syndrome) leads to ptosis.
Injury to the cranial nerve III (oculomotor nerve) or muscle also
results in ptosis. Alteration in the globe position may result in the
appearance of ptosis.
29. What is hyphema and how is it managed?
Ans. Hyphema is the layering of blood in the anterior chamber of
the, globe, usually from the tearing of blood vessels at the root of
the iris. It may present with pain/blurred vision and photophobia.
Intraocular pressure, treated with topical beta blockers and
mannitol, if necessary. Aspirin is absolutely contraindicated.
30. In depressed zygomatic arch fracture, impingement of
which structure causes difficulty in mouth opening?
Ans. Coronoid process.
31. Which is the best radiographic view to visualize the

zygomatic arches?
Ans. Submentovertex or jug-handle view.
32. What is the use of Walsham forceps?
Ans. Reduction of the fracture of the nasal bones.
33. Traumatic telecanthus is associated with which injury?
Ans. Nasoethmoidal injury.
34. What is the cause of epiphora (watering from the eyes)?
Ans. Blockage of the nasolacrimal duct.
35. Which is the weakest part of the orbit: Floor of the orbit or
medial wall of the orbit?
Ans. Floor of the orbit is the weakest part of the orbit because of
frequent fracturing of the orbital floor.
36. What is the best time for the reduction of the fractured
malar bone?
Ans. i. When periorbital edema has subsided
ii. Three to five days after injury
iii. When chemosis has subsided.
37. Why is the orbital fracture called pingpong ball?
Ans. Orbital blowout fracture occurs when a rounded object strikes
the protruding eyeball, resulting in the fracture of the orbital floor.
38. What is the difference between blowout and blowin
fracture?
Ans. i. Blowout fracture refers to the fracture of the floor of the
orbit. It is accompanied by the displacement of orbital
contents into the maxillary sinus
ii. Blowin orbital fracture refers to the inward displacement
of the orbital rim or walls, resulting in decreased orbital
volume.
39. What is pure and impure orbital blowout fracture?
Ans. i. Pure orbital blowout fracture: Fracture of the orbital floor
into the maxillary antrum without the involvement of
the orbital rim is called pure orbital blowout fracture.
ii. Impure orbital blowout fracture: If the orbital rim is

involved, it is called as impure orbital blowout fracture.
40. Which different materials are used to reconstruct an orbital
floor?
Ans. i. Alloplastic: Polyethylene, polyvinyl sponge, gelfilm,
hydroxyapatite, polymeric silicon
ii. Allogenic: Lyophilized dura, allogenic bone and cartilage
iii. Autologous: Graft.
41. What are the aims and objectives of the management of
the zygomatic complex fracture?
Ans. i. To restore the normal contour of the face for cosmetic
reasons
ii. To re-establish the skeletal protection for the globe of
the eye
iii. To correct diplopia
iv. To remove any interference with the range of the
movement of the mandible.
42. Which different incisions are used for zygomatic complex
fracture and arch?
Ans. i. Periorbital incisions:
Supraorbital eyebrow incision
Lower lid or blepheroplasty incision
Infraorbital incision
Subtarsal incision
Subciliary incision
Transconjunctival incision
ii. Alkayat and Bramley incision
iii. Coronal incision (bifrontal flap).
43. What are the different methods for the external fixation of
the zygomatic complex fracture?
Ans. The different methods for external fixation are as follow:
i. Either by pin or wire
ii. Halo frames
iii. Plaster of Paris head cap
iv. Box frames.
44. What is the exact site of incision for the fractured zygomatic
arch reduction?
Ans. i. Gillies temporal fossa approach:
Extraoral approach: An incision of about 2.5 cm length
is made between the two branches of the superficial
temporal artery at an angle of 45 of the upper limit
of the attachment of the external ear.
Reduction is done with the help of Bristows elevator.
Another alternative is to use a long periosteal elevator.
ii. Keens approach:
Intraoral approach: Intraoral buccal vestibular incision
is taken in the first and second maxillary molar regions
behind the zygomatic buttress
Reduction is done with the help of Boon Hook or
Monks pattern pointed elevator or long curved
periosteal elevator.
45. List the complications of the zygomatic complex fracture.
Ans. i. Functional ophthalmic disturbances
ii. Esthetic or cosmetic deformities
iii. Neurosensory deficiencies
iv. Masticatory compromise.
46. Which neurological and ophthalmic complications can arise
due to the malunion of the zygomatic complex fracture?
Ans. i. Neurological:
Paresthesia
Dysesthesia or anesthesia, mainly infraorbital nerve
may be present
ii. Ophthalmic:
Change of the ocular level
Diplopia
Enophthalmos
Occulorotatory restriction.
47. Which are the radiological projections for the nasal bone
fracture?
Ans. i. Lateral view of the nasal bone
ii. 15 or 30 occipitomental projection
iii. CT scan for higher-level fracture of the nose.
48. What is there open sky technique for the nasal injuries?
Ans. Open sky approach demonstrates multiple fractures of
the nasal bones that can be repaired under direct vision
H or open sky technique is originally described by
converse. The technique combines bilateral medial
canthal incisions with a transverse nasal bridge incision
giving access to the bony nasal skeleton. Direct wiring of
multiple fragments is possible via this approach.
49. List the cardinal signs of fracture of the nasoethmoid
complex.
Ans. The cardinal signs of fracture of the nasoethmoid complex
are as follows:
i. Frontal depression
ii. Nasal deformity
iii. Traumatic telecanthus
iv. CSF rhinorrhea
v. Diplopia
vi. HemorrhageDue to the rupture of the anterior and
posterior branches of the ethmoid artery
vii. Accentuation of the nasofugal skinfold.
50. What are the objectives of the management of the nasal
fracture?
Ans. The overall objectives are as follows:
i. Obtaining a normal airway with maximum esthetic
improvement
ii. Restoring the septum to midline
iii. Maintaining a normal semirigid partition and non-
producing a flaccid septum
iv. Retaining as much support as possible to resist

subsequent trauma
v. Preventing the complications of saddle deformity,
columella retraction, etc.
vi. Preventing postoperative stenosis and scaring
vii. Avoiding interference with growth in children by minimal
disturbance or removal of normal structure.
51. In which type of fracture is submental intubation an
alternative of tracheostomy?
Ans. In the case of pan-facial fracture
52. What are the late sequelae of the nasal fracture?
Ans. They are summarized as follows:
i. Relative hump
ii. Wide lateral bony vault
iii. Depression of the cartilaginous dorsum
iv. External twist and deviation of the radix nasi
v. Splayed cartilaginous dorsum and tip
vi. Loss of septal and upper lateral cartilage support
vii. Saddle deformity
viii. Caudal dislocation of the septum
ix. Columella retraction with an absence of cartilage
x. Depression of the caudal nasal bone
xi. Flattened or asymmetrical nostrils
xii. Distorted or fractured lower lateral cartilage
xiii. Septal deflection, fibrous union, complex angulation
xiv. Intranasal scarring
xv. Synechiae
xvi. Septal perforations
53. In reference to the orbital fracture, what do you understand
by the term hot angry eye?
Ans. i. Retrobulbar hemorrhage (looks like hot angry eye)
condition that can result in the loss of vision where
bleeding into the orbital space can result in compression
of the optic nerve leading to ischemia and eventually
blindness
ii. It can be because of the trauma and surgery to the orbital

region.
54. Explain the terms proptosis and ptosis.
Ans. i. Proptosis: Hematoma and swelling of orbital tissues.
Subperiosteal hematoma notably of the orbital
root. Persistent proptosis associated with downward
displacement of the globe. For example, in the orbital
fracture, Graves disease.
ii. Ptosis: Lesion of oculomotor nerve. Ptosis is defined as
drooping of the upper eyelid. It is also referred to as
Blepharoptosis and can affect either one or both the
eyes. It is seen as a result of the oculomotor nerve (third
cranial nerve). Due to drooping of the eyelid only white
sclera is visible. For example, Horners syndrome.
55. What are the signs of frontal sinus fracture?
Ans. Following are the signs of frontal sinus fracture:
i. History of a blow to the forehead, resulting in laceration,
contusion or hematoma should be suspected to be
associated with a possible injury of the frontal sinus
ii. Depression of the forehead
iii. Supraorbital numbness
iv. Subconjunctival hematoma
v. Eyelid ecchymosis
vi. Subcutaneous air crepitus
vii. Cerebrospinal rhinorrhea.
Preprosthetic chapter
Surgery 15
1. What are the objectives of the preprosthetic surgery?
Ans. i. Correcting the conditions that preclude the optimal
prosthetic function
ii. Enlargement of the denture-bearing area
iii. Provision for placing the tooth root analogs by means of
osseointegrated dental implants.
2. Which are the preprosthetic surgical procedure and
corrective preprosthetic surgical procedure?
Ans. i. Preprosthetic surgical procedures:
a. Augmentation
Onlay
Interpositional
b. Vestibuloplasty
c. Implants
d. Combination of augmentation, vestibuloplasty and
implants.
ii. Corrective surgical procedures:
a. Soft tissue corrective procedure
To eliminate frena and scars, etc.
To eliminate soft-tissue deformities
Labial frenectomy
Ankyloglossia (lingual frenectomy)
Buccal frena
Double lip
Scar contracture
Preprosthetic Surgery 249
b. Hard tissue corrective procedures:

Alveoloplasty
Removal of exostosis (torus palatins, torus mandi
bularis)
Mylohyoid ridge reduction
Genial tubercle reduction
c. Secondary preparation to improve:
Hypermobile tissue
Epulis fissuratum
Papillomatosis of the palate
iii. Combination of hard and soft tissue deformation.
3. How will you classify alveolar ridge deficiency?
Ans. i. Class I: Alveolar ridge is adequate in height but
inadequate in width
ii. Class II: Alveolar ridge is deficient in both height and
width
iii. Class III: Alveolar ridge has been resorbed to the level of
the basilar bone
iv. Class IV: There is resorption of the basilar bone producing
pencil-thin flat mandible or maxilla.
(i) Alveoloplasty; (ii) Alveolectomy; (iii) Zygomaticoplasty;
(iv) Vestibuloplasty (sulcoplasty); (v) Tuberoplasty; (vi) Torus
(Tori); and (vii) Exostosis.
Ans. i. Alveoloplasty: Surgical contouring of the alveolar ridge
ii. Alveolectomy: Surgical removal of the alveolar process
iii. Zygomaticoplasty: Surgery for the vestibular extension
of the atrophied maxilla to improve the maxillary flange
height in the buttress region
iv. Vestibuloplasty (sulcoplasty): Procedure of deepening
of the sulcus to provide relative ridge extension
deepening vestibular sulcus
v. Tuberoplasty: Procedure to height on distal aspect of the
maxillary tuberosity
vi. Torus (Tori): It is a benign slow growing bony projection.

It has dense cortical bone and varying amount of
cancellous bone
vii. Exostosis: It is overgrowth of cortical/corticocancellous
bone which is localized to a particular area. Asymptomatic,
benign and slow growing. Usually the origin is unknown.
5. What are the different types of alveoloplasty?
Ans. i. Simple alveoloplasty
ii. Deans alveoloplasty/interseptal alveoloplasty
iii. Obwegesers technique
iv. Labial and buccal cortical alveoloplasty
v. Reduction of the genial tubercle
vi. Reduction of the knife-edge ridge
vii. Reduction of the mylohyoid ridge.
6. What is the difference between alveoloplasty and vesti
buloplasty?
Ans. i. Alveoloplasty: It is the hard tissue preprosthetic corrective
surgical procedure defined as recontouring of the
alveolar ridge
ii. Vestibuloplasty: Soft tissue preprosthetic surgical proce
dure. It is defined as deeping of vestibule or increase in
the depth of vestibule.
7. What are the purpose and aim of alveoloplasty?
Ans. To eliminate the undercuts that interfere with the seating of
the denture and to conserve the bone.
8. What are the different techniques of vestibuloplasty?
Ans. i. Mucosal advancement vestibuloplasty:
Closed submucous Obwegesers vestibuloplasty
Open view submucous vestibuloplasty
ii. Secondary epithelization vestibuloplasty:
Kazanjians technique
Clarks technique
Godwins method
Lip switch method

Tortorellis modification or periosteal fenestration
iii. Grafting vestibuloplasty/lingual vestibuloplasty/
sulcoplasty:
Trauners technique
Caldwells technique
Obwegeser technique.
9. Which are the possible graft donar sites for vestibuloplasty?
Ans. i. Skin
ii. Palatal mucosa
iii. Buccal mucosa.
10. The lip switch procedure is used for which purpose?
Ans. For sulcoplasty.
11. How will you detect sharp and irregular ridges of the bone?
Ans. The best way is to place a finger onto the soft tissue flap and
palpate.
12. How will you make an incision for the operation of the
tongue tie or ankyloglossia?
Ans. Make an incision longitudinally along the lingual frenum on
both the sides.
13. Which are the techniques to correct the abnormal frenum
attachment?
Ans. i. Z-plasty
ii. V-Y advancement
iii. Diamond excision.
14. Which nerve should be protected during the removal of the
mylohyoid ridge in an edentulous patient?
Ans. The lingual nerve should be protected.
15. By which method are the maxillary tori usually removed?
Ans. They are usually removed with the help of burs and chisels
as indicated to section and remove tubulation.
16. For which purpose, the Z-plasty or Y-V plasty procedure is

commonly used.
Ans. i. Ankyloglossia
ii. Interfering labial frenum.
17. In case of lowering of the floor of the mouth, which muscles
should be detached?
Ans. i. Mylohyoid
ii. Genioglossus.
18. In which condition is a postoperative acrylic splint advised?
Ans. In the case of torus palatines reduction.
19. Accidentally during the removal of the maxillary torus,
the mid-portion of the palatine process of the maxilla is
removed. Which complication can arise in this case?
Ans. There are chances of opening into the nasal cavity.
20. During the removal of the torus palatinus, it may cause
fracture of the portion of the palatal bone. What is the
cause?
Ans. The palatal torus should be excised with the help of burs and
rongeurs by splitting it into small segments only. Nasal perforation
occurs when it is excised with the help of chisel.
21. To allow space for dentures tuberosity reduction may be
achieved by.
Ans. Only soft fibrous tissue removal instead of removing large
part of the bone.
22. How will you manage a case of retromolar pad contacting
tuberosity?
Ans. Surgical reduction of tuberosity carefully otherwise may cause
oroantral communication.
23. What is the lip switch procedure?
Ans. Lip switch procedure is a transpositional flap vestibuloplasty.
An incision is made in the labial mucosa. A thin mucosal
flap is elevated. The mucosal flap is sutured to the depth of
the vestibule covering the anterior aspect of the mandible

and the denuded tissue on the inner surface of the lip
heals by secondary intention.
24. What is tuberoplasty?
Ans. Tuberosity is humular notch deepening. The humular notch
occurs where the posterior border of the maxillary denture rests. In
tuberoplasty, a curved osteotome is used to fracture the pterygoid
plates free from tuberosity and displace them in the posterior
direction. The tissue is then sutured to the depth of the area creating
a new notch.
25. What is combination syndrome?
Ans. Combination syndrome is excessive resorption of the anterior
maxilla caused by the forces generated by the opposition of the
natural mandibular anterior teeth.
Precancerous
Lesion/Condition chapter
and Oral Cancer 16

1. What is the difference between carcinoma and sarcoma?
Ans. i. Carcinoma: Malignant growth arising from the epithelium
(ectoderm and endoderm)
ii. Sarcoma: Malignant growth arising from the connective
tissue (mesoderm).
2. What are the precancerous lesions and precancerous
conditions?
Ans.
Precancerous lesions Precancerous conditions
1. Leukoplakia 1. Oral submucous fibrosis
2. Erythroplakia 2. Syphilis
3. Stomatitis nicotina palatini 3. Sederopenic dysphagia
4. Carcinoma in situ 4. Oral lichen planus
5. Bowens disease 5. Dyskeratosis congenita
6. Actinic keratosis 6. Lupus erythematous
7. Cheilitis 7. Xeroderma pigmentosum
8. Elastosis 8. Epidermolysis bullosa
3. Which is the most common form of oral cancer?

Ans. Squamous cell carcinoma.
4. Which is the best imaging modality to diagnose invasive
squamous cell carcinoma?
Ans. i. Soft tissue invasion is best assessed by magnetic
resonance imaging (MRI).
Precancerous Lesion/Condition and Oral Cancer 255
ii. Osseous invasion is best assessed by conventional

computed tomography (CT) or DentaScan imaging.
5. What is the clinical presentation of squamous cell
carcinoma?
Ans. i. An indurated ulcer with poorly defined borders
ii. The lesion is characteristically painless unless inflamma
tion is there from the infection.
6. How is the degree of malignancy classified on the basis of
histological study?
Ans. Malignant neoplasms are histologically classified as:
i. Well differentiated
ii. Moderately differentiated
iii. Poorly differentiated (anaplastic). They have high degree
of malignancy.
7. Which patients are characteristically suggestive of a malig
nant neoplasm of the oral cavity?
Ans. i. Malnourishment
ii. Halitosis
iii. Difficulty in speech and deglutition
iv. Drooling.
8. What is the staging system for oral cancer?
Ans. The tumor, node, metastasis (TNM) is the staging system for
oral cancer.
9. What are different levels of lymph nodes?
Ans. According to the American Joint Committee Staging Manual
1998:
i. Level I A = Nodes in submental triangle (submental
group)
ii. Level I B = Nodes in submandibular triangle (submandi
bular group)
iii. Level II = Upper deep jugular nodes (skull base to carotid
bifurcation)
iv. Level III = Midjugular group of nodes (carotid bifurcation

to omohyoid)
v. Level IV = Lower jugular group of nodes (omohyoid to
clavicle)
vi. Level V = Nodes in posterior triangle
vii. Level VI = Nodes in anterior triangle (central compartment
group)
viii. Level VII = Upper mediastinal group of nodes.
10. What is the base of TNM classification?
Ans. The base of TNM classification is as follows:
T: Extent of the primary tumor
N: Nodescondition of the regional lymph nodes
M: Metastasisabsence/presence of distant metastasis.
11. Comment on squamous cell carcinoma of the tongue.
Ans. i. One of the most common sites for oral cancer
ii. There is presence of mass which is painless if located
on anterior 2/3rd of the tongue. If it is located on the
posterior 1/3rd, it may be painful and sore throat is
present
iii. Often it is exophytic associated ulceration with indurated
margin
iv. Histopathologic study shows keratinization, number
of mitosis because smoking is one of the major causes
of this condition. It is also known as opium smokers
tongue. It consists of a keratotic lesion and sometimes
it becomes neoplastic
v. It is managed by local surgery/local radiation therapy.
12. Explain carcinoma in situ.
Ans. i. It is also known as intraepithelial carcinoma and it is one
of the precancerous lesions.
ii. Carcinoma in situ is a lesion which arises frequently on
the skin but also occurs on mucous membrane
iii. Some authorities believe that this lesion represents a
precancerous dyskeratotic process but others believe
that it is a laterally spreading intraepithelial type of

superficial epithelioma or carcinoma
iv. Common site is floor of mouth, tongue and lip
v. White and ulcerated lesion.
13. What is the classification of neck dissection?
Ans. The current classification is as follows:
i. Radical neck dissection (RND)
It includes:
a. Removal of all cervical lymphatics and lymph nodes
from IV level
b. Sacrifice of spinal accessory nerve
c. Sacrifice of sternocleidomastoid muscle
d. Sacrifice of internal jugular vein (IJV)
ii. Modified radical neck dissection (MRND)
It includes:
a. Removal of all cervical lymphatics and lymph nodes
from IV level
b. One or more non-lymphatic structures are sacrificed
The spinal accessory nerve
Sternocleidomastoid muscle
Internal jugular vein (IJV)
iii. Selective neck dissection (SND)
This refers to a cervical lymphadenectomy in which
there is preservation of one or more lymph node
groups along with the preservation of all the three
structures (spinal accessory nerve, sternocleido-
mastoid muscle, internal jugular vein)
iv. Extended neck dissection (EXND)
When the lymph node groups or non-lymphatic
structures, other than the ones removed in RND (ASN,
SCM and IJV), need to be removed.
For example, ECA, Level VI lymph node.
14. A patient with cancer of the tongue and enlarged lymph
nodes. What is the treatment planning?
Ans. Commando operation.
15. What is commando operation?

Ans. It includes:
i. En bloc resection of the primary tumor with the involved
adjacent osseous structure
ii. Total radical neck dissection
iii. Palliative therapy
iv. The tumor which is not resectabledebulking procedure
is done.
Reconstruction following resection or oral carcinoma is
designed both to repair the cosmetic defect and to re-
establish the function of the lost tissue.
16. A patient with squamous cell carcinoma of lip, invasion into
alveolus. What is the treatment planning in an edentulous
patient?
Ans. Radical neck dissection.
17. What is the difference between biopsy and atopsy?
Ans. i. Biopsy is the removal of a tissue specimen, either totally
or partially for microscopic examination and diagnostic
from the living subject.
ii. Atopsy is the term used to indicate the removal of a tissue
from a dead body.
18. List the different types of biopsies.
Ans. i. Soft tissue biopsy
ii. Hard tissue biopsy
iii. Open tissue biopsy
iv. Oral cytology
Different types of soft and hard tissue biopsies are as
follows:
Excisional biopsy: Excision of the entire small lesion
Incisional biopsy: To remove a part of the lesion
Exploratory biopsy
Punch biopsy
Needle biopsy
Curettage biopsy
Unplanned biopsy
Open tissue biopsy.
19. What is the difference between premalignant lesions and
premalignant conditions?
Ans. i. Premalignant lesions: A morphologically altered tissue in
which cancer is more likely to occur than in its apparently
normal counterpart
ii. Premalignant conditions: A generalized state associated
with a significantly increased risk of cancer.
20. What are 6 S for etiology for leukoplakia?
Ans. i. Smoking
ii. Spirit
iii. Syphilis
iv. Sepsis
v. Systemic disease
vi. Sharp edge of tooth.
21. List five peculiar points about leukoplakia.
Ans. i. It is also known as idiopathic leukokeratosis. It means
white patch. It is defined as a white keratotic patch or
plaque occurring on the surface of the oral mucous
membrane which will not rub or strip off
ii. It is seen more in males over the age of 40 years. It is seen
on hard and soft palates, gingival, etc. Etiologic factors
include tobacco, vitamin deficiency, etc.
iii. Clinically, it appears as wrinkled/rough white grey to
yellowish white non-palpable thick papillomatous
indurated patches
iv. Histological study shows dysplasia of the surface
epithelium
v. It is managed by administration of vitamins A
and B-complex, surgical excision, skin grafting and
cryosurgery.
22. Comment on lichen planus.
Ans. i. One of the precancerous conditions and generalized
dermatological conditions.
ii. In the mouth, lichen planus usually appears as a series

of radiating white or grey lines which cross each other
and rub or strip off
iii. The buccal mucosa in the molar area is most commonly
affected and lesions often have a violaceous hue
iv. The oral condition may be asymptomatic but the patient
complains of a burning sensation
v. Recent reports suggested carcinomatous changes in the
lesion.
23. Classify oral submucous fibrosis?
Ans. i. On the basis of functional stage:
Stage A: Mouth opening more than 30 mm
Stage B: Mouth opening 11 to 20 mm
Stage C: Mouth opening less than 10 mm
ii. On the basis of mouth opening:
Stage A: Mouth opening more than 45 mm
Stage B: Mouth opening 22 to 44 mm
Stage C: Mouth opening less than 20 mm.
24. Comment of oral submucous fibrosis.
Ans. It is also known as atropia idiopathic mucous oris.
i. It is defined by Pindborg as an insidious chronic disease
affecting any part of oral cavity or even pharynx. It is
slowly progressive disease in which leather-like fibrous
bands form in the oral mucosa
ii. Common site is buccal mucosa, soft palate, lips and
tongue. The etiologic factors are tobacco, spicy food,
vitamin deficiency, malnutrition, etc.
iii. The disease is always associated with a juxta epithelial
inflammatory reaction followed by a fibroelastic change
of the lamina propria resulting in stiffness of the oral
mucosa. Mucosa becomes blanched causing trismus,
inability to eat along with a burning sensation
iv. The patient is unable to masticate, to open the mouth,
there is difficulty in deglutition, there is inability to freely
move the tongue and jaw
v. The treatment includes restricted habit, high doses

of vitamin supplements, antioxidants, corticosteroids
(both locally and systemically), excision of fibrous
band, placement of skin graft, buccal pad fat, collagen
membrane, etc.
25. How does a blanched mucosa look like in oral submucous
fibrosis?
Ans. Marble-like appearance is there.
26. What factors are to be considered in the evaluation of a
patient before the radiation therapy of the head and neck
region?
Ans. i. Age of the patient
ii. Condition of dentition
iii. Level of oral hygiene
iv. Radiation field and dose
v. Urgency of radiation treatment.
27. What is the protocol for dental management before
radiation treatment?
Ans. i. Complete oral examination and treatment plan
ii. Any necessary extraction/surgery
iii. Maintenance of teeth and caries control
iv. Restoration of carious teeth
v. Prosthetic examination to prevent postradiation trauma
and also prevent ill-fitting denture.
28. List the guidelines for extraction before the radiation therapy.
Ans. i. All carious teeth in the field of radiation should be
restored
ii. All questionable teeth should be extracted
iii. Full bony impacted teeth can be left in place
iv. Extractions are done at least 2 weeks before radiation
v. Extraction can be done 4 months after the completion
of the therapy
vi. Perform radical alveolectomy with primary soft tissue
closure following extraction.
29. What are the effects of radiation on a bone?

Ans. The decreased vascularity of the bone causes delayed healing
after any trauma to the bone. These effects may become chronic. In
the long-time, it may result in osteoradionecrosis.
30. What are the effects of radiation on teeth and periodontium?
Ans. The radiation therapy effects on oral tissue are as follows:
i. Erythema of the oral mucosa
ii. Friable and easily injured gingival tissue
iii. The gingival tissue also becomes less cellular and fibrotic
iv. Radiation caries
31. What is radiation caries?
Ans. Radiation caries is characterized by circumferential decay of
the cervical portion of numerous teeth. The contributing factors are
xerostomia, change in oral flora, pulpal death, dentine dehydration
and enamel loss. Radiation caries is most severe within the radiation
field.
32. Does the radiation affect the TMJ and muscles of masti
cation?
Ans. When the TMJ and muscles of mastication are within the field
of radiation, the effects of radiation are as follows:
i. Trismus and fibrosis of the muscle of mastication
ii. Fibrous ankylosis of TMJ
iii. Myofacial pain.
33. How will you manage a postradiation patient who needs
both oral and maxillofacial surgeries?
Ans. The surgery should not be performed four months before the
completion of the radiation therapy. The surgery should be done
after prophylactic hyperbaric oxygen treatment.
34. How will you manage the case of irradiation mucositis and
xerostomia?
Ans. The treatment is mostly symptomatic:
i. Keep mouth and teeth moist and plaque-free
ii. Avoid peroxide rinses for more than three days. Avoid
denture adhesive, citrus and spicy food
iii. Sugarless candy and gum chewing are encouraged

iv. Avoid alcohol and tobacco
v. Use saliva substitute (xerotube)
vi. Do not wear denture
vii. Use water or lubricant to moisten the mouth
viii. If toothpaste is irritating, use baking soda.
35. How will you manage the pain caused by irradiation
mucositis and xerostomia?
Ans. i. Viscous lidocaine 2% half an hour before meal
ii. Ulcer can be coated with sucralfate suspension
iii. Analgesics start from the ibuprofen to narcotics as
needed.
36. What are the principal methods employed for radiotherapy
in the management of oral malignancies?
Ans. The principal methods are:
i. X-ray therapy
a. Superficial X-ray therapy 45100 kV
b. Kilovoltage X-ray therapy 300 kV
ii. Electron therapy
iii. Surface applicator (radium mould)
iv. Interstitial implantationradium or equivalent source.
37. List the common adverse effects of radiation therapy on
oral and paraoral tissues?
Ans. i. Rampant caries
ii. Radiation mucositis
iii. Xerostomia
iv. Difficulty in swallowing
v. Radiation dermatitis
vi. Varying degree of trismus.
38. What is the most common laser used in oral and maxillofacial
surgery?
Ans. Carbon dioxide (CO2) laser.
39. What are the four basic tissue interactions associated with
lasers?
Ans. i. Reflection (bouncing off the tissue)
ii. Transmission (going through the tissue)
iii. Scatter (breaking up inside the tissue)
iv. Absorption.
40. What are the four main reactions seen in a tissue after laser
energy absorption?
Ans. i. Photothermal
ii. Photochemical
iii. Photoablative
iv. Photoacoustic.
41. How is the particular laser chosen?
Ans. In general, laser choice is determined by matching the
wavelength of the laser with the absorption of that wavelength by
the intended target tissue. The greater the absorption, the greater
is the effect in that tissue.
42. What are YAG lasers?
Ans. The crystal of these lasers is made of yttrium, aluminum and
garnet is doped with rare earth elements (e.g. neodymium [Nd],
holmium [Ho] or erbium [Er]) as the active lasing medium.
43. Define sentinel node?
Ans. The sentinel node is any lymph node receiving direct
lymphatic drainage from a primary tumor site.
44. What is the main difference between carcinoma in situ and
invasive carcinoma?
Ans. i. Carcinoma in situ: It is an epithelial dysplasia that includes
all the layers of the epithelium but does not extend the
basal layers
ii. Invasive carcinoma: Malignant cell penetrate the basal
layer into the lamina propria and tumor extends deeper
into the tissue involving fat, muscle or other structures.
45. What is a chromophore?
Ans. A chromophore is a target tissue for a specific laser wave
length.
Cleft Lip/Palate,
Dental Implants chapter
and Distraction 17
Osteogenesis
1. Define dental implant.
Ans. It is a device of biocompatible material placed within or
against the mandibular or maxillary bone to provide additional or
enhanced support for a prosthesis or tooth. Various systems and
various implant configurations are found in each system.
2. Classify dental implant:
Ans. It is based on various criteria:
i. Depending on the implant tissue interface:
Direct bone implant interface = Endosseous implant
Indirect interface blade and subperiosteal implant
ii. Involving the design, implantation, tissue implant
response, location:
Submucous
Supraperiosteal
Subperiosteal
Endosseous
Transosseous
Endodontic
iii. Based on the function:
Retentive implants
Supportive implants
iv. Depending on the implant material:
Metallic implant
Polymer implant
Ceramic implant
Vitreous carbon implant
v. Based on biologic consideration:

Biocompatibility of the implant
Stable implant tissue interface
Acceptable load transfer
vi. Based on implant design:
Branemark implant
Core-vent implant
IMZ implant
Stryker implant.
3. What are the criteria for a bone for the placement of
implant?
Ans. i. Bone height
ii. Bone width
iii. Bone length
iv. Bone angulation.
4. Which is the most common type of implant in use?
Ans. Endosteal type of implant is used most commonly and it can
be:
i. Root form
ii. Plate form.
5. What are the advantages of root form implant over plate
form implant?
Ans. The advantages are:
i. Greater surface area
ii. Fewer pontics
iii. Greater bone density.
6. In which part of the body, an endosteal implant is inserted.
Ans. It is inserted into the bone.
7. What is the role of transfer coping in an implant?
Ans. To position an analog in the impression.
Cleft Lip/Palate, Dental Implants and Distraction Osteogenesis 267
8. What are the ideal features of an osseointegrated implant?

Ans. It is anchored directly to the lining bone as determined by
the radiographic analysis.
9. What is the reason for the lack of osteointegration?
Ans. i. Premature loading of the implant system
ii. Placing the implant with too much pressure
iii. Overheating the bone during preparation.
10. What are the indications of implant placement?
Ans. i. Inability to wear a removable or complete denture
ii. Unfavorable number and locations or natural tooth
abutment
iii. Single tooth loss.
11 . In reference to implants, what is the importance of 1 mm/
2 mm/3 mm/4 months/6 months/10 mm?
Ans. i. 1 mm = distance between the implant and postligament
of the adjacent teeth
ii. 2 mm = distance between the implant and the superior
aspect of the inferior alveolar canal
iii. 1 mm = leave bone between the floor of the sinus and
the implant
iv. 2 mm = minimum safe distance between an endosteal
implant and any adjacent anatomical structure
v. 3 mm = distance between the implant and the mental
foramen
vi. 3 mm = minimum space between an implant
vii. 4 months = is the recommended time-interval between
surgery and placing load in the posterior mandible
viii. 6 months = is the recommended time-interval between
surgery and placing load in the maxilla
ix. 6 months = time taken for integration of implant in
maxilla
x. 10 mm vertical and 6 mm horizontal = ideal amount of
bone under soft tissue.
12. What is ailing implant?

Ans. If the implant has lost some bone support and the bone loss
is arrested, it is termed as ailing implant.
13. What is the protocol for HBO therapy when used before
implant placement in an irradiated patient?
Ans. Protocol consists of:
i. Strict oral hygiene regimen before and after implant
placement
ii. Use of the longest and widest implant type
iii. Implant surgery delayed until 6 months after irradiation
iv. Cessation of smoking
v. Preoperative HBO
vi. Overengineered implant supported prosthesis
vii. A similar protocol for implants in irradiate maxilla and
mandible.
14. What are signs present in case of the failure of an implant?
Ans. i. Loss of bone around the implant body
ii. Horizontal mobility greater than 5 mm
iii. Pain during percussion.
15. What is the most useful radiographic sign of an implant
failure?
Ans. Loss of crestal bone. Rapid progressive bone loss indicates
failure. This is accompanied by pain on percussion or function.
16. In a two-stage implant, when is the second surgical
procedure involved?
Ans. i. In the mandible after 3 months
ii. In the maxilla after 6 months
17. What are the surgical complications of an implant therapy?
Ans. i. Preoperative conditions leading to complications:
Limited jaw opening
Inadequate alveolar width
ii. Intraoperative complications:

Malalignment
Nerve injury
Acute or chronic infection at the insertion site
Sinus or nasal floor perforation
Complete displacement of implant into the maxillary
sinus or maxillary incisive canal
iii. Complications in flapless implant placement:
Implant fracture
Loose implant
Excessive insertion/compression leading to necrosis
iv. Postoperative complications:
Postoperative pain
Bone loss during the healing period
Implant periapical lesionImplantitis
18. What is peri-implantitis?
Ans. i. Peri-implantitis is an implant related condition which
is increasingly being noticed in the clinical setting
contributing to a significant proportion of implant failure
ii. It is defined as a nonspecific inflammatory reaction in
the host tissue
iii. It is due to plaque accumulation and overloading of
implant
iv. On the radiograph, there is an evidence of bone loss
v. Clinically, there is formation of pocket, pain, swelling and
bleeding on probing
vi. It is managed by the removal of bacterial biofilm, control
of plaque formation and reosseointegration.
19. What are the primary requirements for successful implant
placement?
Ans. i. Mucosal seal
ii. Adequate transfer of force
iii. Biocompatibility.
20. How much force is applied to check the implant mobility?

Ans. 500 grams.
21. How many pharyngeal arches are in the human embryo?
Ans. There are six pharyngeal arches in the human embryo:
i. 1st or maxillomandibular arch
ii. 2nd or the hyoid arch
iii. 3rd and 4th arches
iv. 5th and 6th or rudimentary arches.
22. What does the merger of the mandibular processes form?
Ans. The merger of mandibular processes forms the following:
i. Mandible
ii. Lower lip
iii. Lower part of the face.
23. How does a cleft lip develop?
Ans. A cleft lip develops from the failure of fusion of the medial
nasal process and the maxillary process.
24. Which orofacial muscles are anatomically abnormal in the
cleft lip and cleft palate?
Ans. i. Cleft lip: The main muscle involved is the orbicularis oris
muscle
ii. Cleft palate: Several muscles are usually involved
depending on one extent of the cleft
iii. Complete cleft palate: Levator veli palatini, tensor veli
palatini, uvular, palatopharyngeus muscles are involved.
25. What are the common skeletal deformities in the cleft lip
and cleft palate patients?
Ans. i. Midface deficiency
ii. Maxillary transverse deficiency
iii. Class 3 skeletal and occlusal deformity
iv. Prognathic mandible.
26. What are the common clefts in orofacial region?

Ans. i. Lateral facial clefts
ii. Oblique facial clefts
iii. Median cleft of the upper lip
iv. Median cleft of the lower lip
v. Median maxillary anterior alveolar cleft
vi. Clefts of lip and palate.
27. What are the factors influencing incidence of cleft lip/cleft
palate during pregnancy?
Ans. i. Viral infection
ii. Exposure to radiation
iii. Anemia
iv. Anorexia.
28. What is the embryological defect involved in the formation
of CL/CP?
Ans. Failure of lateral nasal process to make contact with medial
nasal process.
29. What are the problems associated with cleft palate?
Ans. i. Marked underdeveloped maxilla
ii. Ineffective sucking
iii. Airway obstruction.
30. Cleft palate shows problem in which activities.
Ans. i. Hearing
ii. Deglutition.
31. Which rule is followed for the management of cleft lip and
palate?
Ans. Millards rule of ten.
32. Explain Millards rule of ten.
Ans. Traditionally, the time of repairing of cleft lip was based on the
rule of ten. According to this rule, the defect can be closed when
the infant is:
i. 10 weeks old
ii. 10 g/dl Hb
iii. 10 lb pounds in weight.
33. At what age should the first surgical intervention for repair
of cleft lip be carried out?
Ans. 3 to 6 months.
34. Before one to one and a half years, which structure or defect
repair should be carried out?
Ans. First lip repair and then palate repair is done.
35. What are complete and incomplete cleft lips?
Ans. A complete cleft lip is the cleft of the entire lip and underlying
premaxilla or alveolar arch. An incomplete cleft lip involves only the
lip.
36. What are the goals of successful cleft palate repair?
Ans. i. Separation of the nasal and oral cavities through closure
of both the mucosal surfaces.
ii. Construction of a watertight velopharyngeal valve.
iii. Preservation of facial growth
iv. Good development of esthetic dentition and functional
occlusion.
37. What are the basic techniques for repairing the cleft lip?
Ans. The techniques are:
i. Lip adhesion procedure
ii. The Millards rotation advancement flap
iii. Tennison-Randall triangular flap.
38. What are the basic techniques of cleft palate closure?
Ans. i. V-Y pushback
ii. Two-flap palatoplasties
iii. von Langenbeck operation
iv. Vomer flap
v. Four-flap palatoplasty
vi. Furlow palatoplasty
vii. Wardill-Kilner operation

viii. Schweckendicks primary veloplasty.
39. Which is the ideal bone for alveolar cleft repair?
Ans. Bone with cancellous marrow is the best choice for grafting
an alveolar cleft because the osteoinductive and osteoconductive
qualities are most predictable.
40. What is the sequence of procedure to manage a patient
with cleft lip and palate?
Ans. i. Primary procedures:
Closure of the lip
Closure of the palate
ii. Secondary procedures:
Closure of the palatal fistulae
Pharyngoplasty
Alveolar bone grafting
Orthodontic treatment
Orthognathic treatment
Rhinoplasty
Scar revision of the lip.
41. What is the traditional sequence of treatment for cleft lip
and palate?
Ans. i. At birth, the cleft lip and palate team evaluate the child
ii. At 10 weeks, the cleft lip is repaired.
iii. At the age of one year, the child is re-evaluated by the
cleft lip and cleft palate team
iv. At 12 to 18 months, the soft and hard palates are repaired
v. At 5 to 8 years, interceptive orthodontics is done
vi. At 5 to 7 years, the pharyngeal flap (if necessary) is done.
42. Explain Abbe Flap in reference to the repairing of the cleft
lip?
Ans. In case of the cleft lip:
i. Due to the lack of tissue and short appearance of the
upper lip, normal lower lip may look protuberant
ii. In a cleft patient, upper lip usually lies on the bony maxilla
iii. In some patients, the original lip repair may not result in
normal cupids bow.
In such cases, transferring a wedge of full thickness
flap from the lower lip to upper lip and form a bridge
of tissue, which divides the mouth opening into two.
This remains in place for 10 to 14 days after which the
bridge is divided and both top and bottom lip scars
are completed.
43. What is the most common postoperative complication of
the cleft palate?
Ans. i. Hypernasal speech is the most common.
ii. Oral nasal fistula is also common.
44. Who first reported distraction osteogenesis on membranous
bone of the craniofacial skeleton?
Ans. McCarthy in 1992.
45. What do you understand by distraction osteogenesis?
Ans. i. This procedure was first introduced by Dr GA Ilizarov for
correcting deficiencies, in which both the bone and soft
tissue are expanded
ii. In this procedure, a corticotomy and osteotomy cut is
given on the deficient side of the jaw and then a distractor
is applied. The distractor is then activated daily advancing
the bone segment by 1 mm to induce the formation of
new bone and soft tissue. The newly created bone is
formed in the distracted gap, which is then allowed to
ossify.
46. Classify the types of distractors.
Ans. They are classified as:
i. Extraoral distractors
ii. Intraoral distractors.
47. What are the indications of distraction osteogenesis?

Ans. i. Unilateral hypoplasia of the mandible
ii. In the case where osteotomies are not possible like in
Treacher Collins syndrome, Pierre Robin syndrome
iii. Mandibular resection
iv. Mandibular hypoplasia due to trauma and/or ankylosis
of TMJ
v. Hypoplasia of the upper and middle third of face
vi. Cleft palate
vii. Apert syndrome.
48. What is the latency period of distraction osteogenesis in
adults and in younger patients?
Ans. i. 5 to 7 days in adults
ii. 1 to 2 days in younger patients
Initial healing is to occur by callus formation in order
to bridge the cut bony segment.
49. What is the duration of consolidation phase in distraction
osteogeneis?
Ans. Four to six weeks.
50. What are the four identifiable stages of mature bone
formation?
Ans. i. Stage of fibrous tissue
ii. Stage of extending bone formation
iii. Stage of bone remodelling
iv. Stage of mature bone formation.
51. What are the advantages of intraoral distractors?
Ans. i. They are simple to apply and use.
ii. The devices are concealed, so there is better patient
compliance
iii. No external scar
iv. Simple activation
v. No damage to the facial nerve.
52. What is rhinoplasty?

Ans. Final nose and lip revision.
53. What is the age, generally rhinoplasty carried out?
Ans. It is carried out between 16 and 18 years of age.
54. How much time is required for a biological process to
achieve osseointegration in humans?
Ans. It requires four months time to achieve osseointegration.
55. What are the features of Pierre Robin syndrome?
Ans. i. Cleft palate
ii. Mandibular micrognathia
iii. Glossoptosis.
56. Why is breastfeeding or sucking difficult for the cleft palate
patients?
Ans. i. Air in oral cavity
ii. Absence of negative pressure in the mouth
iii. Tongue obstruction.
(i) Cheilorrhaphy; and (ii) Palatorrhaphy.
Ans. i. Cheilorrhaphy: It is the surgical correction of the cleft lip
deformity. This term is derived from cheilo meaning lip
and rhaphy meaning junction by seam or suture. It is
usually the earliest operative procedure used to correct
the cleft deformities
ii. Palatorrhaphy: It is usually performed in one-stage
operation but occasionally it is performed in two stages
also. In two-stage operation, the soft palate closure (e.g.
staphylorrhaphy) is usually performed first and the hard
palate closure (e.g. uranorrhaphy) is performed second.
58. Explain rhytidectomy.
Ans. Rhytids are skin folds, creases or wrinkles. Rhytidectomy
or removal of skin wrinkles is more commonly called as face-lift
surgery. Face-lift surgery can result in an elevated cheek contour
and a refined mandibular neckline. The most common technique
uses a type of lazy S incision from the temple around the ear and
into the posterior hairline.
(i) Blepharoplasty; (ii) Septorhinoplasty; and (iii) Otoplasty.
Ans. i. Blepharoplasty: Blepharoplasty (eyelid rejuvenation)
is one of the most common facial esthetic procedure
performed in females and males. Aging eyelids exhibit
a puffy, dropping and baggy appearance. These are the
result of eyelid skin laxity, orbicularis muscle hypertrophy
and orbital fat herniation out into the eyelids.
ii. Septorhinoplasty: Nasal surgery or rhinoplasty can alter
a patients nasal appearance. When the nasal septum is
also modified the procedure is called septorhinoplasty.
Appearance changes may include modifying the nasal
profile.
iii. Otoplasty: Otoplasty is altering the appearance of the
ears. Common ear deformity is overly prominent or
protruding cupped ears.
(i) Facial aging; and (ii) Facial liposuction.
Ans. i. Facial aging: Facial aging involves the changes to the skin
itself and resultant effects on the skins appearance and
those of the underlying soft tissue
ii. Facial liposuction: Facial liposuction is used to reduce
submental and neck fullness. These excessive fat deposits
are typically located superficial to the platysma. This can
be detected by having the patients tense their necks.
Orthognathic chapter
Surgery 18
1. What do you understand by the term orthognathic surgery?
Ans. Orthognathic (ortho means straight and gnathic means jaw)
surgery includes changing the deformed face from distortion to
proportion and from disharmony to harmony.
It is defined as the surgical correction of the deformities of the
jaw which presents with malocclusion of the jaws and the associated
facial disfigurement constitutes orthognathic surgery.
2. What are the goals of orthognathic surgery?
Ans. The goals of orthognathic surgery are as follows:
i. To correct jaw relationships prior to major restorative
procedures
ii. Shorten orthodontic treatment time and improve
orthodontic results
iii. Improve periodontal stability and periodontal prognosis.
3. Enumerate the various mandibular osteotomies.
Ans. i. Mandibular body osteotomies (intraoral)
Anterior body osteotomy
Posterior body osteotomy
Midsymphysis osteotomy
ii. Segmental subapical mandibular surgeries
Anterior subapical mandibular osteotomy
Posterior subapical mandibular osteotomy
Total subapical mandibular osteotomy
iii. Genioplasties
Augmentation genioplasty
Reduction genioplasty
Orthognathic Surgery 279
Straightening genioplasty
Lengthening genioplasty
iv. Mandibular osteotomies
a. Subcondylar ramus osteotomy
Extraoral subcondylar ramus osteotomy
(subsigmoid)
Intraoral subcondylar ramus osteotomy
(subsigmoid)
Arching ramus osteotomy (extraoral)
b. Intraoral modified sagittal split osteotomy.
4. Enumerate the various maxillary osteotomies.
Ans. i. Segmental maxillary osteotomies (intraoral)
Single tooth dentoosseous osteotomy
Interdental osteotomy
Anterior maxillary osteotomy
Posterior maxillary osteotomy
ii. Total maxillary surgery (Le Fort I, II and III osteotomy)
Superior repositioning of the maxilla
Superior repositioning of the maxilla leaving the nasal
floor intact (horse shoe-shaped osteotomy)
Advancement of the maxilla
a. Simultaneous expansion of the maxilla
b. Simultaneous narrowing of the maxilla
Inferior repositioning of the maxilla
Leveling of the maxilla.
5. In reference to the hard tissue analysis (cephalometric
analysis), explain the following terms:
(i) Sella (S); (ii) Nasion (N); (iii) Menton (Me); (iv) Prosthion
(Pr); (v) Pogonion (Pog); and (vi) Gnathion (Gn).
Ans. i. Sella (S): The point representing the midpoint of the
pituitary fossa or sella turcica
ii. Nasion (N): The most anterior point midway between the
frontal and nasal bones on the frontozygomatic suture
iii. Menton (Me): It is the most inferior midline point on the
mandibular symphysis
iv. Prosthion (Pr): The lowest and most anterior point on the
upper central incisors
v. Pogonion (Pog): It is the most anterior point of the bony
chin in the median plane
vi. Gnathion (Gn): It is the most anteroinferior point on the
symphysis of the chin.
6. In which syndromes the mandibular prognathism is
present?
Ans. i. Basal cell nevus syndrome
ii. Klinefelters syndrome
iii. Marfans syndrome
iv. Osteogenesis imperfecta
v. Wartenbergs syndrome.
7. Midface deficiency is associated with which syndromes?
Ans. i. Achondroplasia
ii. Aperts syndrome
iii. Cleidocranial dysplasia
iv. Crouzons syndrome
v. Marshalls syndrome
vi. Pfeiffers syndrome
vii. Sticklers syndrome.
8. Apertognathia is a condition in which case?
Ans. Open bite deformity.
9. What are the aims and protocol of mock surgery or model
surgery?
Ans. The aims of mock surgery are:
i. To locate the problem areas preoperatively
ii. To determine the feasible surgical plane
iii. To determine the direction of movement of dentosseous
segment
iv. To view the osteotomy sites directly
v. To obtain the measurement of osteotomies.
The protocol for mock surgery is as follows:

i. Cut the model exactly similar to surgery
ii. Avoid apices or root surfaces of teeth during cutting
iii. Detect the problematic area. Observe and note the move
ment of dentosseous segment, like rotation, expansion,
etc.
iv. Reposition the anterior maxillary segment first
v. Keep the mandibular model fixed in two-jaw surgery.
10. What is the basic protocol for osteotomies?
Ans. i. Design the soft tissue incision to maintain adequate
collateral blood supply and avoid injury to the vital
structure
ii. Provide optimum exposure to the site of osteotomy
iii. Minimum periosteal stripping
iv. Gentle soft tissue handling
v. Design the osteotomy cuts without damaging the
neurovascular bundle
vi. Design subapical osteotomy cut atleast 4 to 5 mm away
from the apices of the teeth
vii. Proper approximation and stable fixation of osteoto
mized segment
viii. Approximation of the osteotomized fragment in class I
canine and molar occlusion
ix. Adequate soft tissue coverage to prevent wound
dehiscence
x. Proper follow-up is also important.
11. Sagittal split osteotomy is used to correct which part of the
mandibular deformity?
Ans. It is used mainly in ramus. The osteotomy split is given in the
ramus and the posterior body of the mandible sagittally, which
allows either setback or advancement.
12. What is sagittal split osteotomy?
Ans. Obwegeser and Turner developed this procedure in 1957.
i. This is a very popular and most versatile procedure

performed on the mandibular ramus and body
ii. It is used for the correction of retrognathic or prognathic
mandible and open bite deformity
iii. It avoids the external scar and injury to the marginal
mandibular nerve.
13. What is Wassmund and Wunderer osteotomy?
Ans. i. Wassmund (1962) first reported anterior maxillary
osteotomy through the labial approach and repositioning
of the anterior maxillary segment.
ii. Wunderer developed a procedure to provide a palatally
oriented approach to the sectioning and repositioning
of the anterior maxillary segment.
14. How will you correct bimaxillary protrusion surgically?
Ans. By four premolars and anterior alveolar segment repositioning.
Anterior maxillary osteotomy (to correct maxillary prognathism) is
combined with anterior subapical mandibular osteotomy (to correct
the mandibular prognathism) to correct bimaxillary protrusion.
15. Who first reported subcondylar osteotomy for correction
of prognathism?
Ans. Robinson and Hinds.
16. What is the most common complication of subapical
orthognathic surgery?
Ans. Devitalization of teeth.
17. Intraoral vertical ramus osteotomy is done for.
Ans. Mandibular setback.
18. Genioplasty procedures are used for.
Ans. To modify the position of the chin.
19. Augmented genioplasty is done by which methods?
Ans. i. Bone graft
ii. Silicone implant
iii. Sliding horizontal osteotomy.
20. Which type of genioplasty is required in class III facial

profile?
Ans. Reduction type genioplasty in the symphysis region. The face
will have a straight profile.
21. What is visor osteotomy?
Ans. A visor osteotomy is a procedure to increase the vertical height
of the mandible by vertically splitting the anterior portion of the
mandible (anterior to the mental foramen) and repositioning the
lingual segment superiorly in relation to the buccal segment.
22. What is sandwich osteotomy?
Ans. The sandwich osteotomy horizontally splits the mandible. The
cranial fragment is repositioned superiorly and an interpositional
bone graft is placed. There is a modification called sandwich-visor
Osteotomy which is a combination of these two osteotomies.
23. Myoplasty and sulcus extension procedures are helpful in.
Ans. They are helpful in increasing retention and stability.
24. During genioplasty, there are chances of injury to which
nerve?
Ans. Injury to the mental nerve.
25. What is the basic advantage of sagittal split osteotomy?
Ans. No bone grafting is required when the defect is small (less
than 8 mm).
General chapter
Anesthesia 19
1. Define general anesthesia and general anesthetics?
Ans. General anesthesia is a medically induced coma and loss of
protective reflexes resulting from the administration of one or more
general esthetic agents. General anesthetics are the agents which
bring about loss of all modalities of sensation, particularly pain along
with reversible loss of consciousness.
2. What is ASA in the context of anesthesia?
Ans. American Society of Anesthesiologists.
3. Explain the term preanesthetic medication.
Ans. It is defined as preliminary medication. It refers to the drugs
with specific pharmacological action administered preoperatively
with specific goals to achieve.
4. What are the objectives of preanesthetic medication?
Ans. i. Relief of pain and anxiety
ii. Provide sedation
iii. Antisialagogue effect
iv. Prophylaxis against allergies and vasolytic action
v. Prevent nausea and vomiting
vi. Reduction of stomach acidity
vii. Amnesia of preoperative events.
5. List the examples of drugs used as preanesthetic medication.
Ans. The categories are as follows:
i. Sedative and hypnotics
a. Benzodiazpines
Diazepam
Medazolam
General Anesthesia 285
b. Barbiturates:
Pentobarbital
Secobarbital
ii. Antiemetic/sedative/antisialagogue
a. Phenergan
iii. Antihistamine (antiallergic/antiemetic/sedative)
a. Diphenhydramine (benadryle)
iv. Analgesic
a. Morphine
b. Pethidine
v. Anticholinergic agent (to prevent vasovagal attack, anti
sialagogue/sedation/amnesia)
a. Atropine
b. Glycopyrolate
vi. Aspiration prophylaxis
a. Ranitidine
vii. Antiemetic
a. Phenothiazine.
6. What are the different methods of the administration of
general anesthesia (GA)?
Ans. The methods are:
i. Open method (open drop procedure)
ii. Semiopen method
iii. Semiclosed method
iv. Closed method.
7. Comment on Boyles apparatus.
Ans. i. Boyles apparatus is the equipment for continuous flow
of anesthesia by which the operator can deliver a desired
concentration of a mixture of anesthetic agents. For
example, oxygen-nitrous oxide, air, etc.
ii. It has individual flow meter for setting the desired flow
of each gas
iii. Vaporizers are meant for setting the desired percentage
output concentration of the liquid anesthetic agent like
halothane, isoflurane, etc.
iv. The most dangerous hazard but fortunately rare that

can occur with the use of an anesthesia machine is that
the delivery of a hypoxic gas mixture leads to hypoxic
damage and coma. Even cardiac arrest and death can
occur.
v. To avoid this hypoxic gas mixture hazard, activate an
alarm, either auditory or visual.
8. What is a laryngoscope?
Ans. i. Laryngoscope is designed for performing direct laryngo
scopy (direct viewing of the vocal cords) and to pass an
endotracheal tube into the larynx under vision
ii. It has three parts: Handle, blade and light bulb
iii. The blade is available in different sizes, like neonate
(infant), pediatric (child and adult) and extra large. The
blade may be straight or curved
iv. The handle is a hollow cylinder containing two 1.5 volt
batteries.
9. What are the inhalational anesthetics?
Ans. i. Five volatile liquids
Enflurane
Halothane
Desflurane
Isoflurane
Sevoflurane
ii. One gas
Nitrous oxide.
10. What are the different colors of cylinders used in operation
theater for the supply of general anesthesia agents?
Ans. i. N2O: Blue
ii. CO2: Green
iii. O2: Black
iv. Central function pipe: Yellow.
11. What are the stages of general anesthesia?

Ans. The stages of general anesthesia are as follows:
i. Stage 1: Stage of analgesia
ii. Stage 2: Stage of excitement/delirium
iii. Stage 3: Stages of surgical anesthesia:
Plane 1
Plane 2
Plane 3
Plane 4
iv. Stage 4: Stage of medullary paralysis.
12. Guedel described the four stages of anesthesia with which
general anesthesia agent?
Ans. Ether.
13. What are the contraindications of general anesthesia?
Ans. i. Acute respiratory infection
ii. Hemoglobinopathies.
14. What is the common complication within the first day after
the surgery under general anesthesia?
Ans. Cardiac failure is the common complication.
15. Which emergency is most frequently encountered with
during outpatient general anesthesia?
Ans. Respiratory obstruction. Even death can occur due to
improper ventilation.
16. What is second gas effect?
Ans. This occurs when a particular gas speeds the rate of increase
of alveolar partial pressure of the second gas. In theory, the high
concentration of one gas (e.g. 70% N2O) could speed up the
induction of the second less soluble gas (e.g. halothane).
17. What are the hemodynamic effects of volatile anesthetics?
Ans. Volatile anesthetics depress the cardiovascular system and this
depression results in a reduced mean arterial pressure. Halothane
primarily causes a reduction in heart rate and contractility.
18. What adverse reaction can occur if halothane and epineph

rine are combined?
Ans. The potential for life-threatening dysrhythmic effects exists
between inhalational anesthetics and vasoconstrictors. The addition
of thiopental (pentothal), an ultra-short acting as a barbiturate
further enhances these dysrhythmic effects. This adverse reaction
is worst when anesthesia and surgery have just begun and local
anesthesia containing epinephrine is used by a surgeon. To prevent
this reaction, it has been proposed that a local anesthetic should
not be injected immediately after the induction of anesthesia with
halothane or thiopental. It is prudent to wait for 10 minutes.
19. What are the concerns of the administration of N2O-O2
sedation to an obstetric patient?
Ans. N2O crosses placenta and, therefore, has the potential to
cause teratogenic effects to the fetus. The greatest potential for the
problems exists during the 1st trimester of pregnancy when the
organs are forming. Recent researches have refuted the claim that
N2O gas is dangerous to the fetus. N2O-O2 sedation should always
be used for short procedures and no more than 50% N2O should
be administered.
20. What are neuromuscular blocking agents (NMBs)?
Ans. Neuromuscular blocking agents are basically called as muscle
relaxants. These drugs are used for skeletal muscle relaxation and
can be used to facilitate tracheal intubation. These drugs are very
dangerous and inhibit the function of all the skeletal muscles.
These drugs are classified into two groups:
i. Depolarizing NMBs (e.g. succinylcholine)
ii. Nondepolarizing NMBs (e.g. acetylcholine).
21. The heart is a muscle. Do muscle relaxants decrease the
contraction of pericardium?
Ans. Muscle relaxants have no effect on heart contractility. They
have no effect on the smooth muscles.
22. How do you manage a hypoxic event?

Ans. Before you ever try to make a diagnosis, give oxygen.
The first maneuver for an intubated patient is to hand-ventilate
with ambu bag. The mechanical ventilator and breathing circuit
must be examined for malfunction. Get a chest X-ray (to rule
out pneumothorax and to confirm the correct position of the
endotracheal tube). Review the recent premedication and
interventions.
23. In case of TMJ ankylosis, a patient is unable to open the
mouth. How will you intubate such a patient?
Ans. i. GA cannot be given by oral intubation
ii. It can be given by:
Blind nasal intubation
Fiberoptic assisted intubation.
24. A patient being operated under halothane not be given?
Ans. Lignocaine + Adrenaline.
25. Why glycopyrolate is used during general anesthesia?
Ans. To reduce secretions.
26. What are the alternatives of endotracheal intubation?
Ans. i. Mouth-to-mouth ventilation delivers 16% inspired O2
ii. Bag mask ventilation delivers 21% O2
iii. Bag mask ventilation with an O2 supply can deliver up to
100% of O2.
27. What is the advantage of endotracheal intubation?
Ans. A relatively secure airway.
28. How do you confirm that the endotracheal tube is in the
proper position?
Ans. i. Listen to both the lung fields
ii. Observe symmetric chest excursion with each tidal breath
iii. Listen over the epigastrium. These physical findings are
not very reliable. You should confirm the position with
a chest X-ray.
29. What should be the first consideration if we are unable to

ventilate a patient or intubate?
Ans. Foreign body airway obstruction. An attempt should be made
to visualize the foreign body directly and then remove it with suction
or Magill forceps.
30. Which of the anesthetic agents is used as a dissociative
agent?
Ans. Ketamine.
31. During general anesthesia O2 concentration of blood should
not fall below what level of oxygen concentration?
Ans. 90% oxygen concentration.
32. Which vein is the optimum site for IV sedation for an
outpatient?
Ans. Median cephalic vein.
33. In tracheostomy the entry into the trachea is through which
rings?
Ans. 2nd and 3rd tracheal rings.
34. What is the most common postoperative complication of
an outpatient general anesthesia?
Ans. Nausea and vomiting.
35. In which stage of anesthesia is endotracheal intubation
possible?
Ans. Third stage (stage of surgical anesthesia) plane 2.
36. Which is the convenient stage of general anesthesia in
which surgery can be performed?
Ans. Stage 3 (stage of surgical anesthesia).
37. What is the basis of Guedel criteria for the classification of
the depth of general anesthesia?
Ans. i. Respiration
ii. Eyeball movement
iii. Presence and absence of various reflexes.
38. Which stage of anesthesia describes the level of conscious

sedation?
Ans. Stage 1 (stage of analgesia).
39. Nitrous oxide inhalation sedation is contraindicated in
patients with.
Ans. i. Nasal obstruction
ii. Emphysema
iii. Emotional instability.
40. Which is the most common complication with N2O-O2
sedation?
Ans. Behavioral problem.
41. What does morphine-scopolamine premedication produce?
Ans. i. Amnesia and decreased salivation
ii. Psychic sedation
iii. Addictive effects with anesthetics.
42. Which drug is used to prevent laryngospasm due to GA?
Ans. Succinylcholine.
43. Succinylcholine is administered during GA for what?
Ans. Intubation.
44. Which symptom is seen in a patient administered with 20
to 40% N2O?
Ans. Floating sensation.
45. Which drug is used to reduce the induction phase of GA?
Ans. Thiopentone sodium.
46. If long acting muscle relaxants are used during GA, what is
used to terminate their action?
Ans. Neostigmine.
47. Which endotracheal tube for nasotracheal intubation is
used for GA in case of maxillofacial injuries?
Ans. Inflatable cuffed is used for nasotracheal intubation and for
oral surgical procedures, nasotracheal tube with throat pack is used.
48. At what level should the endotracheal tube be placed for

GA?
Ans. Above the cricoid.
49. Rotameter on Boyles trolley in GA is used to measure what?
Ans. Flow of gases in the tubes.
50. What does Goldman vaporizer consist of?
Ans. 50% N2O + 20% O2 mixture.
51. Why is N2O-O2 sedation not contraindicated in the asthmatic
patients unless that patient is allergic to N2O?
Ans. There are no contraindications to the use of N2O-O2 sedation
in asthmatic patients because anxiety is a symptom for asthmatic
attack. N2O-O2 sedation is actually beneficial for these patients.
52. Should a patient with URI be given N2O-O2 sedation with a
nasal hood?
Ans. No, because the patients with URI have nasal blockage, so
delivery of N2O is limited and the leakage of N2O around the blood
is more likely to occur. Therefore, the use of N2O is unwise.
53. Why is N2O sedation contraindicated in the patients with
the conditions involving closed gas spaces?
Ans. i. The oral and maxillofacial surgeons should be cautious
while treating the recent trauma cases (RTA victim). An
asymptomatic undiagnosed close pneumothorax can
double in size in 10 minutes after the administration of
70% of N2O.
ii. N2O-O2 sedation should be postponed in the patients
with gastrointestinal obstructions, middle ear infections
and sinus infections.
54. What are the important key points for nitrous oxide (N2O)?
Ans. i. Anesthetic property the first suggested by Humphrey
ii. Only inorganic gas is used for anesthesia
iii. It is a noninflammable gas
iv. It has a high patient acceptability
v. It has a sweet odor and is known as laughing gas.

vi. It produces analgesia at 65%.
55. Why is nitrous oxide not used alone for GA?
Ans. It may cause diffusion hypoxia because of the difficulty in
maintaining an adequate oxygen concentration. (A mixture of
70% N2O + 30% O2+ 0.2 to 2% other potent anesthetic agents is
employed for most surgical procedures).
56. What are the most common side-effects of N2O-O2?
Ans. i. Nausea
ii. Diffusion hypoxia
iii. Behavioral problems
iv. Emphysema
v. Emotional instability
vi. Upper respiratory tract obstruction.
57. What is the fate of N2O used as a GA agent?
Ans. N2O does not combine with Hb. It is carried in the form of a
physical solution. N2O does not decompose in the body. It is exhaled
unaltered by the lungs.
58. Which drug is called as white stuff in anesthesia?
Ans. Propofol.
59. What are the indications of propofol?
Ans. i. It is used for induction and maintenance of anesthesia.
ii. It causes sedation.
60. What is propofol?
Ans. Propofol (diprivan), a substituted isopropylphenol, is a IV
sedative hypnotic agent, used for induction and maintenance of
anesthesia. It can also be used during conscious sedation.
61. What are barbiturates?
Ans. Barbiturates are derivatives of barbituric acid. They exhibit a
dose-dependent CNS depression with hypnosis and amnesia. For
example, thiopental sodium (pentothal).
62. Why is propofol the best agent for an outpatients

anesthesia?
Ans. i. Rapid induction and recovery
ii. Lower incidence of nausea and vomiting
iii. Shorter recovery period.
63. What is ketamine?
Ans. Ketamine is a phencyclidine derivative. It produces
dissociative anesthesia. A ketamine 4 mg/kg IM can be administered
to an uncooperative patient to facilitate the completion of
short procedure. IV sedation dose for ketamine ranges between
0.25 mg/kg and 0.75 mg/kg.
64. What are the clinical uses of benzodiazepines?
Ans. i. Preoperative medication
ii. Intravenous sedation
iii. Induction of anesthesia
iv. Maintenance of anesthesia
v. Suppression of seizure activity.
a. Commonly used are:
Midazolam
Lorazepam
Diazepam.
65. What are the three commonly used anticholinergics?
Ans. i. Atropine
ii. Scopolamine
iii. Glycopyrrolate.
66. Give the key points related to Halothane.
Ans. i. It is irritating to the mucous membrane
ii. It produces incomplete muscle relaxation
iii. It tends to produce hypotension
iv. It sensitizes heart to epinephrine
v. It is explosive
vi. It is highly potent.
67. What is tramadol?

Ans. It is a unique analgesic with opioid-like activity. It is used
in acute and chronic pain management. The major side-effects
sedation and dizziness and the uncommon side-effect is seizures.
68. What is the other name of ether?
Ans. Sweet oil or vitriol.
69. What is entonox apparatus?
Ans. It is pressurized premixed N2O and O2 at a maximum cylinder
pressure of 2,000 lbs/sq inch.
70. During anesthesia, atropin is contraindicated in the case
of.
Ans. Tachycardia.
71. Oral airway is used for.
Ans. i. Protection of airway
ii. Prevent the tongue from falling back
iii. Prevent the tongue bite.
72. Who gave the first IAN (inferior alveolar nerve block) by
using 4% cocaine?
Ans. Niemann.
73. Who invented ethyl ether?
Ans. Horace Wells.
74. To achieve deep anesthesia, what anesthetic agent should
on achieve?
Ans. It should achieve higher alveolar concentration of the
anesthetic agent.
75. Which anesthetic agent results in the least loss of reflexes?
Ans. Nitrous oxide.
76. Which of thesepupillary dilatation or pupillary constric
tionis the positive sign during cardiac resuscitation?
Ans. Pupillary constriction is the positive sign.
77. How can the level of analgesia be monitored?

Ans. It can be monitored with the help of verbal response.
78. Where does the accidental inhalation of foreign body land
in?
Ans. Right bronchus.
79. In which condition is GA contraindicated?
Ans. Severe anemia.
80. What is the most common complication within 24 hours
after surgery under GA?
Ans. Atelectasis.
81. In Jorgensen technique of intravenous (IV) sedation for
dental procedures, which drugs are used?
Ans. It includes intravenous administration of opioids:
i. Pentobarbitol
ii. Scopolamine (hyoscine)
iii. Pethidine
iv. Meperidine.
82. What is the postoperative complication following aspiration
of liquid vomitus into the trachea and bronchus?
Ans. Bronchitis and chemical pneumonia.
83. What is the order of depression of different sites under GA?
Ans. i. Cortical centre
ii. Spinal and medullary.
84. Which is the last area of brain depressed by GA?
Ans. PONS.
85. What are the uses of laryngoscope?
Ans. i. Direct visualization of the larynx
ii. For endotracheal intubation
iii. For insertion of the Ryles tube.
86. N2O works on which nervous systemcentral or peripheral?
Ans. Central nervous system.
87. Explain the term conscious sedation.

Ans. It is a state of mind obtained by IV administration of the
combination of anxiolytic, sedative and hypnotics and/or analgesics
that render the patient in relaxed state and yet allow the patient to
communicate, maintain airway and ventilate adequately.
88. What are the advantages and disadvantages of intravenous
sedation?
Ans. The advantages of intravenous sedation are as follows:
i. Highly effective technique
ii. Rapid onset of action
iii. Control of the possible salivary secretion
iv. Nausea and vomiting is less common
v. Gag reflex, motor disturbances (epilepsy, cerebral palsy)
are diminished.
The disadvantages of intravenous sedation are as follows:
i. Venupuncture is necessary
ii. Delayed recovery
iii. More intensive monitoring is required
iv. Due to venupuncture, it may cause hematoma formation,
thrombophlebitis
v. Escord is needed.
89. What are the commonly used drugs in intravenous seda
tion?
Ans. i. Sedative hypnotics and antianxiety
a. Benzodiazepines
Diazepam
Midazolam
b. Barbiturates
ii. Nonbarbiturate hypnotics
Propofol
Ketamine
iii. Antihistaminics
Promethazine
iv. Narcotic agonists
Pethidine.
90. What do you understand by the term day stay surgery?

Ans. Short-duration surgery like impaction, cyst enucleation taking
20 to 40 minutes are suitable to be carried out on a day stay basis.
The advantages are:
i. Less chair side time
ii. Avoiding admission to a hospital
Certain criteria should be met:
i. The patient must be fit
ii. Surgery should not be for more than one hour
iii. No significant risk
iv. Recovery from anesthesia should be rapid.
chapter
Miscellaneous 20
1. List 15 key points for the successful extraction of tooth.
Ans. i. The following five points should be considered while
taking a patients history:
Past medical history
Past dental history
Any drug allergy
Present medical/dental history
The patient should not be empty stomach
ii. Dental chair height:
For maxillary teeth: 8 cm below the shoulder of the
operator
For mandibular teeth: 16 cm below the elbow of the
operator
iii. Operator position:
All maxillary and left mandibular teeth: The operator
should stand right in front of the patient
Right anterior teeth: Right in front of the patient
Mandibular right premolars: Just at the right side of the
patient
Mandibular first and second molar: Exactly at the right
side of the patient
Mandibular right third molar: Just behind the right side
of the patient
iv. Patient position:
For mandibular teeth: When the patient opens the
mouth, the lower border of the mandible should be
parallel to the floor
For maxillary teeth: The head should be at 45 to the

floor
v. Preparation of surgical tray
vi. Extraoral and intraoral preparations (with betadine
solution and gargle) and drapping
vii. Application of topical local anesthetic gel at the site of
the LA injection
viii. Proper knowledge of the nerve supply of particular tooth/
teeth
ix. LA techniqueBlock/infiltration.
x. Confirmation of subjective/objective symptoms
xi. Proper application of the instrument
xii. Step-by-step extraction of tooth
xiii. To achieve hemostasis and, if required, suturing the
extraction socket.
xiv. Postoperative instruction/care
xv. Postoperative medications and follow-up.
2. What is the rule of four?
Ans. i. Four points to describe any instrument:
Name of the instrument
Instrument made up of which material
Parts of the instrument
Indication of the instrument
ii. Four points to read a radiograph:
Name of the radiograph
Either extraoral or intraoral
Abnormalities in the radiograph
Comments on the abnormalities, like definition,
etiology, classification, clinical features, diagnosis,
treatment, complication, etc.
iii. Four points to describe any medicine:
Pharmacological name of the drug
Each ml concentration
Route of administration
Indication of the medicine
Miscellaneous 301
3. What is the significance of the following drugs used in

emergency cases?
Ans. i. Five drugs starting with A:
Avil (antihistamine): Antiallergic
Adrenaline: To control local bleeding. Systemic as
bronchodilator and in case of cardiac arrhythmias
Atropine: To prevent vasovagal attack/antisialagogue
Aminophylline (deriphyllin): Antiasthmatic
Aromatic spirit of ammonia: Inhalations to stimulate
late respiration in case of syncope
ii. Two drugs starting with B:
Betnesol: Anti asthmatic (Bronchial asthma)
Benadryl: Antiallergic (Antihistamine)
iii. Three drugs starting with C:
Coramine: Respiratory distress
Calmpose: Anticonvulsant
Calcium gluconate: Tetany
iv. Three drugs starting with D:
Dexona (Dexamethasone): The safest life-saving drug.
Shock/anaphylaxis
Dopamine: Hypotensive shock
Dextrose: Hypoglycemic attack
v. Two drugs starting with E:
Efcorlin: Hypotensive shock
Ethamsylate: Controls the bleeding
vi. One drug starting with F:
Fortwin: Severe pain
vii. One drug starting with G:
Glucose powder: Hypoglycemia (oral)
viii. One drug starting with M, N, and O:
Mephentine: Hypotension
Nifedipine: Hypertension
Oxygen: Hypoxia
ix. Four drugs starting with S:
Sodium bicarbonate: Acidosis
Sorbitrate: Angina pain
Sepguard: To control local bleeding

Steptobion: To control systemic bleeding.
4. Choice of drugs
Ans. i. Osteomyelitis: Clindamycin (500 mg/1 tds)
ii. Trigeminal neuralgia: Carbamazepine (1600 mg/day)
iii. Cavernous sinus thrombosis: Chloramphenicol (1 gram/
6 hourly IV)
iv. Brain abscess: Chloramphenicol (1 gram/ 6 hourly IV)
v. Patient allergic to penicillin: Erythromycin (4 times a day).
5. Give the full forms of the following abbreviations:
(i) CGCG; (ii) CPR; (iii) CEOT; (iv) MPDS; (v) OPD syndrome;
(vi) OKC; (vii) OSMF; (viii) OPG; (ix) PDL; (x) TNM Classification;
(xi) TMJ; (xii) WHO
Ans. i. CGCG: Central Giant Cell Granuloma
ii. CPR: Cardiopulmonary Resuscitation
iii. CEOT: Central Epithelial Odontogenic Tumor
iv. MPDS: Myofacial Pain Dysfunction Syndrome
v. OPD Syndrome: Oto-palatodigital Syndrome
vi. OKC: Odontogenic Keratocyst
vii. OSMF: Oral Submucous Fibrosis
viii. OPG: Orthopanthamogramph
ix. PDL: Periodontal Ligament
x. TNM Classification: Tumor (size), Nodes (involvement),
Metastasis (Presence or absence)
xi. TMJ: Temporomandibular Joint
xii. WHO: World Health Organization.
6. Give other names for the following lesions:
(i) Brown tumor; (ii) Iceberg tumor; (iii) Kuttner tumor;
(iv) Warthins tumor; (v) Potts Puffy tumor
Ans. i. Brown tumor: Giant cell lesion of hyperparathyroidism
ii. Iceberg tumor: Pleomorphic adenoma
iii. Kuttner tumor: Chronic sclerosing sialadenitis of sub-
mandibular gland
iv. Warthins tumor: Adenolymphoma of the parotid gland
Miscellaneous 303
5. Potts puffy tumor: It is a complication of bacterial frontal

sinusitis
It consists of a subperiosteal abscess and osteomyelitis of
the frontal bone.
7. Describe a patients position in different conditions.
Ans.
Condition Patient position
1. During recovery from syncope Trendelenburg position (100 head-
down position) and semi-reclined
2. During CPR Supine position
3. Syncope during pregnancy Left lateral position
4. Pregnant lady during surgery Upright position or her trunk adjusted
slightly to one side
5. Congestive heart failure patient Upright position
6. Cardiac arrest Patient laid flat on the floor with head
on one side
7. Respiratory arrest Patient laid flat on the floor and
pulling the mandible upward and
forward

(i) George winters imaginary lines; (ii) Campbells lines; (iii)
Trameline pattern; (iv) Langers lines; (v) Wrinkle lines or
natural lines; (vi) Trapnells line.
Ans. i. George winters imaginary lines: Particular depth and
position of the impacted mandibular third molar within
the mandible is described as George Winters three
imaginary lines, commonly known as war lines. These
lines are:
White line: It indicates the relative depth of the third
molar
Amber line: It represents the bone level covering the
Impacted tooth
Red line: It indicates the amount of resistance and
difficulty encountered with during the removal
ii. Campbells lines: (refer to Chapter No. 8)

iii. Trameline pattern: In case of facial trauma, cerebrospinal
fluid (CSF) rhinorrhea, septal hematoma occur. The CSF is
usually associated with bleeding. However, the presence
of CSF in the blood can be detected with the help of a
simple test in which a drop of fluid is on a handkerchief
and a classic bulls eye ring develops. It is also identified
by the trameline pattern. It is also called Bulls eye ring.
iv. Langers lines: These lines tend to run parallel with the
skin creases, which are generally perpendicular to the
action of the underlying muscle. Elective incisions should
be made in or parallel to the lines of facial expression or
natural skin lines, wherever possible.
v. Wrinkle lines or natural lines: These lines are different from
Langers lines which denote the collagen fiber direction
within the dermis. Elective incision can be made in or
parallel to the line of facial expression or natural skin.
vi. Trapnells line: Fifth line of Campbells line. Lower border
of the mandible from one angle to the other side of the
angle.
9. What are the conditions/lesions related to different types
of syndromes?
Ans. i. Dry socket: Postextraction syndrome
ii. Gustatory sweating: Freys syndrome or auriculotemporal
syndrome
iii. OKC: Bifid nevoid basal cell carcinoma syndrome
iv. Fibrous dysplasia: Albrights syndrome
v. Sjgren syndrome: Sicca syndrome.
10. What is the composition of the following:
(i) Bone wax; (ii) Carnoys solution; (iii) Monsels solution;
(iv) White head varnish; and (v) Talbots solution.
Ans. i. Bone wax:
Bees wax (yellow) = 7 parts
Olive oil = 2 parts
Phenol = 1 part
Miscellaneous 305
ii. Carnoys solution:

Alcohol = 6 ml
Chloroform = 3 ml
Glacial acetic acid = 1 ml
Ferric chloride = 1 gram
iii. Monsels solution:
Ferric sulfate
Act by precipitating proteins
iv. White head varnish:
Benzoin = 10 parts
Iodoform = 10 parts
Storax = 7.5 parts
Balsam of tolu = 5 parts
Ether (as solvent) = 100 parts
v. Talbots solution:
Iodine
ZnI
Glycerine
Water
11. What are the indications of the following:
(i) Bone wax; (ii) Carnoys solution; (iii) Monsels solution;
and (iv) White head varnish.
Ans. i. Bone wax: To arrest the bleeding from a hard bony surface
ii. Carnoys solution: Used as a chemical cauterizer, e.g.
odontogenic keratocyst, ameloblastoma
iii. Monsels solution: It is effective in arresting the capillary
bleeding and postextraction bleeding in the medullary
bone
iv. White head varnish: Used as an antiseptic dressing in cystic
cavity to reduce dead space and to check bleeding.
12. What are the false anatomic periapical radiolucencies?
Ans. i. Mental foramen
ii. Incisive foramen
iii. Maxillary sinus
iv. Dental papilla

(i) Glands of Zeis; and (ii) Glands of Moll
Ans. i. Glands of Zeis: The sebaceous gland of the eyelid
ii. Glands of Moll: The sweat glands of the eyelid.
14. What are the roles of the following instruments:
(i) Bone nibbler; (ii) Bone rongeur; (iii) Chisel; (iv) Osteotome
(v) Bone file; (vi) Giglisaw; and (vii) Bone gouge.
Ans. i. Bone nibbler: It is an end-cutting instrument. It is used to
remove small bony spicules and trimming of bone.
ii. Bone rongeur: It is a side-cutting instrument. It is used to
remove irregular bone margin and trimming of bone.
iii. Chisel: It is an unibeveled instrument. It is used to remove
bone on one side and split the tooth
iv. Osteotome: It is a bibeveled instrument. It is used to
remove the bone on the both sides, make a tunnel, and
split the bone through orthognathic surgery
v. Bone file: It is used to smoothen the sharp bony margin.
unidirectional movement
vi. Giglisaw: To cut the bone through and through
vii. Bone gouge: For making window in the maxillary sinus.
15. What are the basic differences between the following
diseases:
Ans.
Disease Deficient factor Bleeding Clotting PT
time time
Hemophilia A Factor 8: Antihemophilic N N
globulin
Hemophilia B Factor 9: Christmas factor N N
Hemophilia C Factor 10: Stuart factor N N
Parahemophilia Factor 5: Labile factor or N
proaccelerin
Miscellaneous 307
16. How will you recognize angina pectoris and myocardial

infarction clinically after chest pain?
Ans.
Angina pectoris Myocardial infarction
It is of shorter duration It is more severe and of prolonged duration
The condition is relieved after The condition does not subside after the
one dose of trinitroglycerine 0.4 dose of trinitroglycerine
mg/sublingually The dose should be repeated after three
minutes of the first dose.
17. List the differences between hypoglycemia and hypergly

cemia.
Ans.
Hypoglycemia Hyperglycemia
It is known as insulin shock It is known as ketoacidosis
It results from the mismatch of Usually there is reduction of insulin
insulin dose and serum glucose
It develops quickly Usually it develops progressively over a
period of several days
It is seen more frequently The factors that increase the amount of the
required insulin include infection, trauma,
surgery, pregnancy and emotional stress.
18. What are the 3-S muscles attached with the styloid
apparatus?
Ans. i. Styloid muscle
ii. Styloglossus muscle
iii. Stylopharyngeus muscle.
19. What are muscles attached to the labiobuccal surface of
the mandible?
Ans. i. Mentalis
ii. Depressor labii inferioris
iii. Depressor anguli oris
iv. Platysma
v. Buccinator
vi. Masseter
vii. Temporalis
20. List the autoimmune diseases.
Ans. i. Sjgrens syndrome
ii. Sialosis (Sialadenosis)
iii. Mikuliczs disease (salivary non-inflammatory disease)
iv. Cherubism
v. Fibrous dysplasia
vi. Ossifying fibroma
21. How many sinuses are present in the human body?
Ans. 57 different kinds of sinuses are present in the human body,
e.g. heart, brain, spleen, uterus, ankle, kidney, anus, skull and coccyx.
22. Describe the procedure for the external chest compression
in infants?
Ans. The ideal location for applying pressure for the external chest
compression in infants is one-finger width below the nipple. Use
two fingers to perform the compression.
23. How much hydrocortisone is produced by the adrenal
cortices in the body daily?
Ans. 20 mg/day.
24. What are the features of adrenal crisis?
Ans. i. Hypoglycemia
ii. Hypotension
iii. Shock.
25. Which is the most accepted theory for the conduction of
pain?
Ans. Gate control theory proposed by Melzack and Wall in 1965 is
the most accepted theory for the conduction of pain.
26. In which syndrome can a patient not smile/cry or close the
eyelid during sleep?
Ans. Mobius syndromecongenital facial dysplegia.
Miscellaneous 309
27. What is cryosurgery?

Ans. In cryosurgery, extreme cooling temperature, ranging from
20C to 18C is used. At this temperature range, the tissues,
capillaries, smaller arterioles and venules undergo cryogenic
necrosis. This is caused by dehydration and denaturation of the
lipid molecules.
28. Which agent is used in cryosurgery?
Ans. Nitrous oxide is used in cryosurgery.
29. At what temperature does the cell death occur in
cryosurgery?
Ans. When the temperature falls below 20C, the cell death occurs.
30. Where is dermatome used?
Ans. Dermatome is used to harvest skin graft. It is a special
instrument used for cutting the split skin graft.
31. What is the split thickness of split skin graft and full
thickness of skin graft in maxillofacial surgery?
Ans. The split thickness ranges from 0.3 mm to 0.5 mm whereas
full thickness ranges from 1 mm to 1.15 mm.
32. Which blood product is the choice for treatment in a
hemophilic patient?
Ans. Cryoprecipitate is the choice of blood product.
33. What is Tenons capsule?
Ans. It is a fascial structure that subdivides the orbital cavity into
two halvesan anterior or precapsular segment and a posterior or
retrocapsular segment.
34. What are six vital signs?
Ans. i. Blood pressure
ii. Heart rate and rhythm
iii. Respiratory rate
iv. Temperature
v. Height
vi. Weight.
35. What advantage do the patients with a pacemaker have?

Ans. Such patients do not require any antibiotic prophylaxis and
the vasoconstrictor can be administered safely.
36. What is the danger area of face, danger space of neck and
danger area of scalp?
Ans. i. Danger area of face: Infections from the face can spread
in a retrograde direction and cause thrombosis of the
cavernous sinus. This is specially likely to occur in the
presence of infection in the upper lip and in the lower
part of the nose. Hence, this area is called the danger
area of the face.
ii. Danger space of neck: According to Grodinsky and
Holyoke (1938), Space 4 is the danger space (potential
spaces of the head and neck region) between the alar
and prevertebral fascia. It extends from the base of the
skull to the posterior mediastinum.
iii. Danger area of scalp: Pericardium of scalp is the danger
area of the scalp because vessels attached with
pericardium may cause profuse bleeding.
37. How much hemoglobin concentration rises after one unit
of fresh blood transfusion?
Ans. One gram % after one unit fresh blood transfusion.
38. Why is epsilon-aminocaproic acid (EACA) replaced by
tranexamic acid?
Ans. The action of EACA is antifibrinolytic activity, which is replaced
by tranexamic acid because:
i. It is more potent
ii. It has longer acting properties
iii. It has less side-effects
39. Which are the best oral sedative drugs used in dentistry?
Ans. Benzodiazepines.
40. Which antibiotics are effective against the gram-negative
bacteria?
Ans. Aminoglycosides.
Miscellaneous 311
41. Which is the drug of choice for the treatment of anaphylaxis?

Ans. 0.2 to 0.5 ml of 1:1000 solution of adrenaline given by IM or
SC route.
42. What are the advantages of fresh whole blood against
stored blood transfusion?
Ans. Banked blood is a poor source of platelets. The factors which
are absent in stored blood are factor 5 (Labile factor or Proaccelerin)
and factor 8 (Antihemophilic globulin or Antihemophilic factor).
Fresh whole blood refers to the blood that is administered within
24 hours of its donation.
43. Which organisms are responsible for the following
condition:
(i) Acute bacterial endocarditis; (ii) Postoperative
endocarditis; and (iii) Subacute bacterial endocarditis.
Ans. i. Acute bacterial endocarditis: Staphylococcus aureus
ii. Postoperative endocarditis: Staphylococcus albus
iii. Subacute bacterial endocarditis (SABE): Streptococcus
viridans (Streptococcus sanguis).
44. What is the cardinal symptom of dehydration due to the
disturbance of fluid and electrolyte balance?
Ans. Polydipsia.
45. What is the characterstic feature of asthma?
Ans. Expiratory wheezes.
46. What is the rate of rescue breathing in an adult?
Ans. 12 times/minute is the proper rate of rescue breathing.
47. If a normal patient loses one liter of blood during surgery,
how much fluid replacement is required in this case?
Ans. 3 liters of colloidal fluids replacement is required.
48. What are the early signs of the following conditions:
(i) Syncope; (ii) Hypovolemic shock; and (iii) Want of oxygen.
Ans. i. Syncope: Pallor
ii. Hypovolemic shock: Tachycardia
iii. Want of oxygen: Tachycardia.
49. List the classic triad of the following conditions:

(i) Dry socket; and (ii) Osteoradionecrosis.
Ans. i. Dry socket:
Loss or necrosis of clot
Pain
Fetor oris
ii. Osteoradionecrosis:
Radiation
Trauma
Infection.
50. Which respiratory condition is the most alarming condition
during sedation of a patient on a dental chair?
Ans. Apnea is the most alarming condition.
51. What is acromegaly?
Ans. Acromegaly is the disease which is characterized by the
excessive growth of the bones and other parts, such as jaws, feet
and hands seen during adult life.
52. What is CVA?
Ans. CVA means cerebrovascular accident or stroke is a serious
complication. There is either hemorrhage or thrombosis resulting
in focal brain damage.
53. Which is the common site of rib for costochondral graft?
Ans. Commonly preferred is 5th or 6th rib but the range is between
5th and 9th ribs.
54. Which sign is seen on a dental chair after IV diazepam?
Ans. Verrills sign is seen on a dental chair which is characterized
by:
i. Partial ptosis (50%)
ii. Blurring vision
iii. Slurring speech that indicates the correct level after
diazepam sedation.
55. What is the depth of the external chest compression?
Ans. In adults: 1.5 to 2 inches
Miscellaneous 313
In children: 1 to 1.5 inches

In infants: 0.5 to 1 inch.
56. What is the rate of the external chest compression?
Ans. For adults: 100/minute
For children: 100/minute
For infants: at least 100/minute.
57. What is the duration of time for the assessment of pulse?
Ans. In infants, brachial pulse is assessed and for adults and
children, carotid pulse is assessed for 5 to 10 seconds.
58. What is the complication of external chest compression?
Ans. i. Rib and sternal fracture occur 80% of time
ii. Major cardiac or pericardial injuries
iii. Bone marrow and fat emboli.
59. What do the following indicate in reference to local
anesthesia:
(i) One cartridge; (ii) 2% lignocaine; (iii) Dose of one set of
action of LA; (iv) Maximum dose of LA with adrenaline; and
(v) Maximum dose of LA without adrenaline.
Ans. i. One cartridge: It contains 1.8 to 2 ml of LA solution
ii. 2% lignocaine: It means 20 mg lignocaine in one ml
iii. Dose of one set of action of LA: It is 3 to 5 minutes
iv. Maximum dose of LA with adrenaline: It is 20 ml
v. Maximum dose of LA without adrenaline: It is 14 ml.
60. Describe chest pain suggesting cardiac ischemia?
Ans. i. Uncomfortable squeezing pressure, fullness or pain in
the center of the chest lasting for more than 15 minutes
ii. Pain radiates to the shoulder, neck, arm and jaws
iii. Pain between the shoulder blades
iv. Chest discomfort with light headedness, fainting,
sweating and nausea
v. A feeling of distress and anxiety.
61. What are the meanings of the following terms:

(i) Tachycardia; (ii) Bradycardia; and (iii) Asystole
Ans. i. Tachycardia: It means rapid heart rate. The normal heart
rate is between 60 and 100/minute. If it goes more than
100/minute, it indicates tachycardia
ii. Bradycardia: It means slow heart rate. Normal heart rate
is 60 to 100/minute. If it goes less than 60/minute, it
indicates bradycardia
iii. Asystole: It indicates the absence of ventricular activity.
The patient will be without pulse.
62. What do you mean by the term heart block?
Ans. Heart block is used interchangeably with the correct term
arterioventricular block, which means a delay or interruption in
conduction between the arteria and the ventricles.
63. What are the four life-threatening conditions that
may mimic acute myocardial infarction and lead to
cardiovascular collapse?
Ans. i. Massive pulmonary embolism
ii. Cardiac tamponade
iii. Hypovolemic and septic shock
iv. Aortic dissection.
64. Which is the safest period of time to perform surgery on a
pregnant lady?
Ans. The second trimester.
65. Why are the first and third trimesters a less optimal time to
perform surgery on a pregnant lady?
Ans. During the first trimester, the fetus is the most vulnerable in
terms of organogenesis and response to exogenous insults. During
the third trimester, there is risk of inducing a premature delivery and
all its sequelae.
66. Which clotting factors are altered during pregnancy?
Ans. Factor XI (Antihemophilic factor) and Factor XII (Hageman
factor) are increased during pregnancy.
Miscellaneous 315
67. What is the position of the pregnant lady on a dental chair

during surgery?
Ans. During the second and third trimesters, a decrease in blood
pressure can occur while the patient is in a supine position. This
is attributed to a decreased venous return to the heart from the
compression of the inferior vena cava by the gravid uterus. This also
can compress the descending aorta and common iliac arteries. So
the chair position should be upright or the patients trunk should
be slightly on one side.
68. Which radiograph best demonstrates the subcondylar
fracture?
Ans. Townes projection.
69. During the apicectomy in the region of the maxillary incisor
teeth, why should one take care not to damage or peforate?
Ans. Care should be taken not to damage the floor of the nose
to avoid perforation of the nasal mucosa. Otherwise it may cause
profuse bleeding.
70. How will you manage irritational fibroma, which is asympto
matic?
Ans. It is managed by simple excision.
71. Nasal antrostomy is usually done from which structure?
Ans. It is done from the inferior meatus.
72. What criteria is to be considered while planning the third
molar transplantation?
Ans. i. The root is atleast half formed
ii. The width of the crown approaches the width of the
extracted tooth.
73. Eagles syndrome is associated with the elongation of which
structure?
Ans. Styloid process.
74. What is the purpose of taping the eyes shut before surgery?
Ans. To prevent corneal abrasion.
75. How is the visible bleeding of an artery best treated?

Ans. By clamping and ligation of the artery.
76. What is the aim of giving an antibiotic before surgery to a
patient with rheumatic heart disease?
Ans. To prevent subacute bacterial endocarditis.
77. What is heterograft?
Ans. If a graft is obtained from another species of different genetic
disposition, it is known as heterograft.
78. When is Vitamin K used in case of management of
postextraction bleeding?
Ans. In case of prothrombin deficiency.
79. In general, what is the common site for IV fluid therapy?
Ans. Common site is the dorsal vein at the back of the hand.
80. Should the eyebrows be shaved when facial lacerations are
repaired?
Ans. No. They provide a landmark for realignment of tissue edges
and do not always grow back.
81. Differentiate between an animal bite and human bite.
Ans. i. Infections of human bites are frequently caused by
Streptococcus and Staphylococcus organisms. Animal
bites are caused by pasteurella multocida
ii. In human bite, penicillin or amoxicillin or clavulanic acid
is recommended. In animal bite, amoxicillin clavulanic
acid is recommended
iii. Tetanus immunization is needed for all bites
iv. Rabies prophylaxis may be required when animals exhibit
suspicious behavior.
82. What are the common causes of graft failure?
Ans. i. Hematoma formation
ii. Failure of immobilization
Miscellaneous 317
83. What is the classification of free skin graft?

Ans. They are classified on the basis of thickness of the graft:
i. Thin = 0.008 to 0.012 inch
ii. Medium = 0.012 to 0.018 inch
iii. Thick = 0.018 to 0.030 inch
84. Classify the soft tissue injuries.
Ans. i. Contusions
ii. Abrasions
iii. Lacerations
iv. Flap-like lacerations
v. Avulsion injuries.
85. What is the role of irrigation of wound preparation?
Ans. Irrigation is essential in preventing infections because it
removes debris, dirt, microorganisms and devitalized tissue from
the wound, which results in the reduction of infection rate.
High pressure irrigation with normal saline has been shown to
decrease the bacterial count of the wounded tissue and decreases
the rate of infection. The use of concentrated povidone-iodine
hydrogen peroxide may cause significant tissue damage, which
should be avoided.
86. What are radioresistant lesions?
Ans. i. Pleomorphic adenoma of parotid gland
ii. Chondromas.
87. What is Darrows solution?
Ans. This is the only solution which contains more of K than
available in the plasma or ECF.
If K concentration is 36 meq/L, Na 124 meq/L , Cl 104 meq/L
and lactate 56 meq/L, obviously this is the best solution to combat
hypokalemia. It supplies K at a relatively safe rate provided alkalosis
is not present. The rate of infusion should be slower than other
solutions to avoid hyperkalemic state, which is more dangerous
and should be given more than 60 drops per minute.
88. In reference to the mid-face injury, the ecchymosis of the

following are indicating presence or signs of:
(i) Ecchymosis of the mastoid area; (ii) Ecchymosis at greater
palatine foramen area; (iii) Ecchymosis in sublingual area;
and (iv) Ecchymosis in zygomatic buttress area.
Ans. i. Ecchymosis of the mastoid area = Battles sign
ii. Ecchymosis at greater palatine foramen area = Guerins
sign
iii. Ecchymosis in sublingual area = Colemans sign
iv. Ecchymosis in zygomatic buttress area = Raccoons sign.
89. In reference to the maxillofacial injury what is the tongue
tie indicated in?
Ans. i. Bilateral parasymphysis fracture
ii. Chin has been destroyed in gun shot
iii. Unconscious patient.
90. What is the other name of isograft?
Ans. Syngraft is the other name.
91. What are the disadvantages of autogenous bone graft?
Ans. i. Extensive resorption after grafting
ii. Need for donor site surgery
iii. Two sites of surgery.
92. Generally bone marrow for grafting the defect is obtained
from where?
Ans. Iliac crest graft.
93. What are the characteristics of an ideal graft?
Ans. i. It should withstand the mechanical force
ii. It should not produce any immunologic response
iii. It should actively assist osteogenic potential of host.
94. What is the term used for bone transplant from one human
to another?
Ans. Homologous bone graft.
Miscellaneous 319
95. Which is the best graft utilized for the reconstruction of

large mandible defect?
Ans. Iliac crest graft is the best graft.
96. Ideally iliac crest graft should be taken from where?
Ans. Medial aspect of iliac crest.
97. What do the composite grafts consist of?
Ans. Bone and soft tissue.
98. Which is the choice of graft in a young patient treated
with ameloblastic resection free iliac crest graft or free
vascularized iliac crest graft?
Ans. Free vascularized iliac crest graft.
99. Hyperventilation in an anxious patient may cause?
Ans. Carpopedal spasm.
100. Which nerve is involved in Saturday night palsy?
Ans. Radial nerve is involved.
101. What are the conditions that indicate early oxygen
requirement?
Ans. i. Cyanosis
ii. Increased pulse ratetachycardia.
102. In an elective tracheostomy, where should the entry be made?
Ans. Below the cricoid cartilage.
103. What is factor IV and what is its peculiarity?
Ans. Factor IV is calcium. It is the only factor which is non-
proteinaceous.
104. What can happen if there is blow to the chin?
Ans. i. If on midline: Bilateral subcondylar fracture
ii. If on one side (left/right side): Fracture of opposite side of
angle
iii. Including both sides of chin: Bilateral parasymphysis
fracture of the mandible.
105. A patient taking warfarin sodium therapy. Which drugs are

contraindicated for him?
Ans. i. Ibuprofen
ii. Aspirin.
106. What is the rate of infusion of IV diazepam?
Ans. It should be 1 ml per minute.
107. For how many days is postoperative antibiotic therapy
continued in subacute bacterial endocarditis (SABE)
patient?
Ans. It should be continued for atleast two days.
108. What history does a patient suffering from diabetes mellitus
give?
Ans. i. Easily bruising
ii. Nocturia
iii. Excessive thirst
iv. Low resistance to infection.
109. A laboratory report indicates WBC count of more than one
lac. Most likely the patient is suffering from which disease?
Ans. Leukemia.
110. What are the possible clinical complications in a patient
with a history of congestive heart failure?
Ans. i. Dyspnea
ii. Orthopnea
iii. Edema of the ankle
iv. Palpitation.
111. What is the possible clinical complication in patients with
Hyperthyroidism?
Ans. i. Recent weight loss
ii. Fatigue
iii. Tremors
iv. Tachycardia
v. Tremors and sweaty palms on examination
vi. Anxious nervous patient.
Miscellaneous 321
112. Which among the two bony lesions is the most fatal
multiple myeloma or odontogenic myxoma?
Ans. Multiple myeloma is the most fatal which is characterized by:
i. Increased Bence-Jones proteinuria
ii. Multiple radiolucent area in the skull.
113. An obese patient during jogging falls and becomes uncon
scious. What points should be considered to differentiate
cardiac arrest from other reasons?
Ans. i. Pulse, carotid or femoral is present or absent
ii. Pupils are constricted or dilated
iii. Respiration is present or absent.
114. What is pinpoint hemorrhage on skin called asecchymosis
or petechiae?
Ans. It is called as petechiae.
115. Which among the two drugs salicylates or adrenaline is
contraindicated in a hyperthyroid patient?
Ans. Adrenaline is contraindicated.
116. What are the possible complications of blood transfusion?
Ans. i. Circulatory overload
ii. Thrombophlebitis
iii. Immediate and delayed hemolytic reaction.
(i) Autograft; (ii) Allograft; and (iii) Xenograft.
Ans. i. Autograft: It is transplanted from one region to another
into the same individual
ii. Allograft: It is transplanted from one individual to a
genetically non-identical individual of the same species
iii. Xenograft: It is transplanted from one species to another.
(i) Osteoinduction; (ii) Osteoconduction; and (iii)
Osteogenesis.
Ans. i. Osteoinduction: It refers to new bone formation from
the differentiation of osteoprogenitor cells derived from
primitive mesenchymal cell into secretory osteoblasts
ii. Osteoconduction: It is the formation of new bone from

host derived from or transplanted osteoprogenitor cells
along a biologic or alloplastic framework
iii. Osteogenesis: It is the formation of new bone from
osteoprogenitor cells:
Spontaneous osteogenesis is the formation of new
bone from osteoprogenitor cells in a wound
Transplanted osteogenesis is the formation of new
bone from osteoprogenitor cells placed into the
wound.
119. What is bone morphogenic protein (BMP)?
Ans. i. BMP is a protein complex responsible for initiation of
osteoinduction
ii. BMP is a part of cytokine family of growth factor which
occurs in the organic portion of the bone called the bone
matrix
iii. BMP is osteoinductive
iv. It acts on the progenitor cells to induce differentiation
into osteoblasts and chondroblasts
v. BMP may act as the main signal regulating skeletal forma
tion and repair and is known to induce bone formation
de novo
vi. BMP appears to be stored within the bone matrix and
released with resorptive activity.
120. Cortical bone or cancellous bonewhich among the two
contains more BMP?
Ans. Demineralized cortical bone has been shown to contain more
BMP than demineralized cancellous bone.
121. What is platelet-rich plasma?
Ans. Platelet-rich plasma is an autologous source of platelet
derived growth factor (PDGF) and insulin like growth factor (IGF)
and transforming growth factor beta 1 and 2 (TGF beta 1 and TGF
beta 2). These factors have been shown to increase bone graft
maturation rates and bone density.
Miscellaneous 323
122. What are the seven anatomical structures that attach to the
anterior iliac crest?
Ans. i. Fascia latae
ii. Inguinal ligament
iii. Tensor fascia latae
iv. Sartorius
v. Iliacus
vi. Internal abdominal oblique muscle
vii. External abdominal oblique muscle.
123. Why is the mandibular defect that crosses the midline the
most difficult?
Ans. In this area there is need for hard tissue support for the
chins soft tissue as well as suspension of the extrinsic tongue
musculature.
124. What are the major considerations in repair of large
mandibular defects?
Ans. i. Soft tissue coverage
ii. Amount of bone replacement
iii. Stabilization of the graft
iv. Occlusal rehabilitation.
125. What are the advantages and disadvantages of cancellous
bone graft?
Ans. Advantages:
i. Cancellous bone grafts provide an immediate reserve
population of viable bone forming cells as well as a
population of progenitor cell that are capable of differen
tiating into osteoblasts
ii. The porous microstructure of cancellous graft allows
in the growth of endothelial buds and provides a large
surface area for osteoblastic/osteoclastic activity.
Disadvantage:
i. It does not have any macroscopic structural integrity.
126. What are the advantages and disadvantages of cortical

bone grafts?
Ans. Advantages:
i. Its rigid lamellar architecture does not deform with
compression or tension allowing rigid fixation of the graft
and its use in load bearing or structural applications.
ii. Cortical bone also has a higher concentration of BMP and
cortical chips.
Disadvantages:
i. Cortical bone does not carry a large population of
osteocompetent cells
ii. Lamellar bone provides little surface area for remodelling
activity
iii. Lamellar bone makes the graft more susceptible to
infection.
127. What are the objectives of facelift rhytidectomy?
Ans. Rhytidectomy removes the lax and redundant skin of the
face and neck including prominent nasolabial folds and submental
region that contribute to the aged appearance of the face.
128. What are the complications of rhytidectomy?
Ans. Sequelae of rhytidectomy includes:
i. Swelling
ii. Discomfort
iii. Hematoma
iv. Paresthesia
v. Ecchymosis
vi. Sloughing of the flap
vii. Facial nerve injury
viii. Unfavorable scarring
ix. Earlobe deformities
129. What are the advantages and disadvantages of open
rhinoplasty operation?
Ans. Advantage:
Miscellaneous 325
i. Direct visualization of the structure clearly demonstrates

the effect of surgical technique like, nasal deformity and
cleft lip.
Disadvantages:
i. Unfavorable scarring occurs
ii. Prolonged edema
iii. Paresthesia of nasal tip
iv. Skin loss or slough.
(i) Syndrome; (ii) Malformation; (iii) Deformation
(iv) Disruption
Ans. i. Syndrome: A syndrome is a set of symptoms that occur
together. A particular syndrome may have three, four
or ten manisfestations but a key sequence of symptoms
leads to the diagnosis of particular syndrome
ii. Malformation: A malformation is a morphologic defect of
an organ, part of an organ or larger region of the body.
For example, cleft lip or palate (embryonic occurrence)
iii. Deformation: Abnormal form or position of part of a
body caused by nondisruptive mechanical forces (fetal
occurrence)
iv. Disruption: Morphological defect of an organ, part of an
organ or larger region of the body resulting from the
breakdown of or an interference with an originally normal
developmental process.
131. List the peculiarities of mobius syndrome.
Ans. i. Mobius syndrome affects 6 cranial nerves:
III cranial nerve (oculomotor)
V cranial nerve (trigeminal)
VI cranial nerve (abducent)
VII cranial nerve (facial)
IX cranial nerve (glossopharyngeal)
XII cranial nerve (hypoglossal)
ii. The most commonly affected muscle is the lateral rectus

muscle by paralysis with defect of the abducent cranial
nerve (VI CN)
iii. The cardinal clinical complications are:
Mask-like faces due to paralysis of lateral rectus
muscle. So the patient cannot cry or smile
Drooping of angles of the mouth
Inefficient sucking and swallowing and speech
impairment
Mild mental retardation
High and broad nasal bridge with hypoplastic
mandible.
132. Which syndrome is referred as to hysterical dysphagia?
Ans. Plummer Vinson syndrome. Its features are:
i. Seen in 4th and 5th decades of life
ii. Most commonly seen in women
iii. Manifestation of iron deficiency anemia:
Cracks at commissures
Lemon-tinted skin color
Red and smooth painful tongue
Dysphagia from esophageal stricture.
133. What is coloboma and with which syndrome is it associated?
Ans. Coloboma is a notch on the lower eyelid. It is present in 75%
Treacher-Collins syndrome.
134. Which are the syndromes associated with the mandibular
prognathism?
Ans. i. Basal cell nevus syndrome (Gorlin syndrome)
ii. Klinefelters syndrome
iii. Marfans syndrome
iv. Osteogenic imperfecta
v. Waardenburg syndrome.
135. What are the malformation syndromes associated with the
midface deficiency?
Ans. i. Achondroplasia
ii. Aperts syndrome
Miscellaneous 327
iii. Cleidocranial dysplasia

iv. Crouzons syndrome
v. Marshalls syndrome
vi. Pfeiffer syndrome
vii. Stickler syndrome.
136. In which diseases is the caf au lait spot seen?
Ans. i. Neurofibromatosis orvon Recklinghausens disease
ii. McCune-Albright syndrome.
137. What is alloplast?
Ans. The term alloplast is synonymous with the synthetic
produced from inorganic sources and contains no animal or human
components.
138. What are the indications of polymethyl methacrylate
(PMMA)?
Ans. The PMMA is most often used in:
i. Forehead contouring
ii. Cranioplasty procedure for full thickness defects of skull.
(i) Snoring; (ii) Apnea; and (iii) Hyponea
Ans. i. Snoring: Snoring is a partial airway and pharyngeal
flow obstruction that does not awaken an individual.
Movement of air through an obstructed airway creates
the snoring sound
ii. Apnea: Apnea is the cessation of airflow lasting for more
than 10 seconds
iii. Hyponea: It refers to a greater than 2/3rd decrease in tidal
volume. Apnea and hyponea show a decrease in oxygen
saturation of atleast 2%.
140. A patient is on periodic renal dialysis. When should the
minor oral surgical procedure be undertaken?
Ans. One day after dialysis.
141. What is venepuncture?
Ans. This technique is used to obtain blood sample for either
hematological or biochemical examination and to give IV injection
in emergencies. The preferred site is within the elbow, where the

veins are easily visible.
142. What are the clinical applications of epinephrine (adrena
line)?
Ans. i. For the management of acute allergic reaction
ii. For the management of bronchospasm
iii. For the management of cardiac arrest
iv. As a vasoconstrictor for hemostasis
v. To increase the depth of anesthesia.
143. Name of the other vasoconstrictor which can be used in
dentistry other than vasoconstrictor?
Ans. Levonordefrin, but it is still not available in market.
144. What are the conditions that may cause trismus in case of
trauma, infection and neurogenic condition?
Ans. i. Trauma
Unfavorable angle fracture of the mandible
Displaced subcondylar fracture of mandible
Zygomatic arch fracture
ii. Infection
Pericoronitis (third molar region)
Masticatory spaces infection, e.g. pterygomandibular
space infection, infratemporal space infection,
masseteric space infection
TMJ ankylosis (mainly fibrous)
TMJ arthritis
TMJ dislocation
Dentoalveolar abscess (acute alveolar abscess)
iii. Neurogenic condition.
Tetanus (Bacterial infection)
Tetany (Hypocalcemia).
145. What is the method of describing any instrument?
Ans. Any instrument should be described in the following way:
i. Name of the instrument [e.g. tooth extraction forcep]
ii. Material of the instrument [stainless steel]
Miscellaneous 329
iii. Parts of the instrument [beak, hinge and handle]

iv. Indications of the instrument [removal of the maxillary
anterior teeth].
146. After the extraction of tooth, one encounters bleeding due
to hemangioma. What is the first step in the treatment?
Ans. Replacing the tooth in the socket should be the first step to
control the bleeding.
147. List the key points about hemophilia.
Ans. i. Hemophilia is sex-linked congenital hereditary disorder
of the clotting mechanism
ii. Males are affected and females act as the carriers
iii. It is mainly due to the deficiency of blood clotting factor
VIII antihemophilic globulin (AHG)
iv. It is characterized by a prolonged coagulation time (CT
increases) but bleeding time (BT) is normal with bleeding
tendency
v. In hemophilic patient, intraligamentous injection of the
local anesthetic agent is indicated to avoid bleeding.
Nerve block is absolutely contraindicated.
148. Which is the common site of the metastasis from mandible?
Ans. Lungs are the common site.
149. What do you understand by primary, secondary and
reactionary hemorrhage?
Ans. Hemorrhage means escape of blood from the blood vessels
due to any cause that may rupture the vessels.
i. Primary hemorrhage: It occurs as a part of surgery or from
laceration
ii. Reactionary or intermediate hemorrhage: Hemorrhage
which occurs within 24 hours postoperatively
iii. Secondary hemorrhage: This occurs during postoperative
phase after the initial 24 hours. Generally, it occurs due
to the breakdown of clot due to infection.
150. What are the indications (therapeutic and prophylactic) of

the antibiotic therapy?
Ans. It can be summarized as follows:
i. Acute cellulitis of dental origin
ii. Acute pericoronitis with elevated temperature and trismus
iii. Deep fascial space infection
iv. Open (compound) fracture of the mandible, maxilla and
other facial bones
v. Extensive, deep or old (more than 6 hours) orofacial
lacerations
vi. Dental infection or dental surgery
vii. Prophylaxis for dental surgery in a cardiac patient.
151. List the various diagnostic tests conducted in the following
conditions:
(i) Cavernous sinus thrombosis; (ii) CSF rhinorrhea; (iii) Facial
paralysis; (iv) Diplopia; and (v) Freys syndrome.
Ans. i. Cavernous sinus thrombosis: Tobey Ayer test
ii. CSF rhinorrhea: Handkerchief test (Tramline pattern)
iii. Facial paralysis: Conduction test
iv. Diplopia: Forced duction test
v. Freys syndrome: Iodine dust test
152. List the radiographic features of the following lesions:
(i) Osteosarcoma; (ii) Chronic osteomyelitis; and (iii)
Ameloblastoma.
Ans. i. Osteosarcoma: Sunburst appearance or Sunrays
appearance
ii. Chronic osteomyelitis: Sequestra formation or moth-eaten
appearance
iii. Ameloblastoma: Honeycomb appearance or soap
bubbles-like appearance.
153. What is the importance of the rule of the three S in the
evaluation of a patient with head injury?
Ans. A precise approach is necessary in the evaluation of the patient
with head injury. One should adhere to the rule of the three S:
Miscellaneous 331
i. Simple: To facilitate triage, the examination should be

simple to perform
ii. Systemic: An accurate and reliable format will ensure that
all the organs are assessed and the treatment is started
in a timely fashion
iii. Standardized: The examination should be easily recorded
and standardized so that multiple examinations may
be performed and recorded. Along with that the
neurological changes should be examined and noted.
(i) Concussion of the brain; (ii) Compression of the brain;
and (iii) Contusion or laceration of brain.
Ans. i. Concussion of the brain: Unconsciousness immediately
after injury is a sign of concussion of the brain. The patient
regains consciousness after some time depending on the
type of injury (e.g. mild, moderate and severe)
ii. Compression of the brain: When the patient is conscious
following trauma, then after some time he starts going
into the unconsious state. It is a sign of compression
of the brain. There is a rupture of the vessel, mainly
the middle meningeal artery, resulting in intradural or
extradural hemorrhage. Blood starts collecting in the
skull, resulting in the compression of the brain.
iii. Contusion or laceration of the brain: It is the hemorrhage
in the brain tissue. Laceration is the tearing of the brain
tissue. The tissue will lose its sensation or function
depending upon the injury to the nerve cell.
155. In case of maxillofacial trauma, what are the primary and
secondary surveys?
Ans. The primary survey includes:
i. A = Patency of airway
ii. B = Breathing
iii. C = Assessment for circulation
iv. D = Disability in terms of neurological evaluation is
assessed
v. E = Environment control to save the patient from further

injury.
The secondary survey includes:
i. Proving patency of airway
ii. Control of bleeding
iii. Management of cranial injuries and insult to brain, CSF
leak, injuries of cervical spine and chest, any diplopia
iv. Status of dentition/denture and drug consumed.
v. Status of eyes and ears
vi. Fracture of bones
vii. Coma with history of events
viii. Infection control.
156. What are the surgical procedures which may cause damage
to the nerve, vein and artery?
Ans. i. Nerve:
Lingual nerve: Removal of the impacted mandibular
third molar
Auriculotemporal nerve: TMJ surgery
Facial nerve: Parotid gland surgery
Inferior alveolar nerve/mental nerve: Removal of the
impacted mandibular third molar
Infraorbital nerve (infraorbital nerve block): Orbital
fracture
ii. Vein:
Pterygoid venous plexus: Posterior superior alveolar
nerve block, Le Fort I osteotomy
Facial vein: Submandibular gland surgery
iii. Artery:
Superficial temporal artery: TMJ surgery (preauricular
incision)
Facial artery: Fracture of the body of the mandible,
mandibular impacted third molar surgery, sub-
mandibular gland surgery
Internal maxillary artery: TMJ ankylosis, maxillary sinus
surgery (posterior wall)
Miscellaneous 333
d. Lingual artery: Glossectomy, floor of the mouth surgery

e. Retromolar artery: Surgery in the retromolar area.
157. What do the following signs signify:
(i) Guerins sign; (ii) Colemans sign; (iii) Murphys sign;
(iv) Virells sign; (v) Battles sign; (vi) Raccoon sign (vii) Bells
sign (viii) Levine sign (ix) Tinels sign; (x) Chvosteks sign;
and (xi) Trousseaus sign.
Ans. i. Guerins sign: Ecchymosis at the greater palatine foramen
in Le Fort I fracture
ii. Colemans sign: Ecchymosis in the lingual sulcus, patho
gnomic of the mandibular fracture (fracture in the
symphysis region of mandible)
iii. Murphys sign: Seen in cholecystitis
iv. Virells sign: The following three symptoms are seen:
50% eyelid ptosis
Blurring of vision
Slurring of speech indicating the correct level after
diazepam sedation
v. Battles sign: This gives rise to the ecchymosis of skin just
below the mastoid process on the same side in case of
the fracture of the base of the skull and condyle
vi. Raccoon sign: It is seen in case of Le Fort II and III fracture of
maxilla. Bilateral circumorbital or periorbital ecchymosis
and gross edema occur giving an appearance of Raccoon
eyes
vii. Bells sign: It can be defined as an idiopathic paresis or
paralysis of the facial nerve. In an attempt to close the
eyelid, the eyeball rolls upwards so that the pupil is
covered and only the white sclera is visible
viii. Levine sign: It is one of the symptoms of myocardial
infarction. It is characterized by the patient as fist
clenched over the sternum describing the discomfort
ix. Tinels sign: It is seen during the starting of the nerve
regeneration. It is elicited by percussion over the divided
nerve that results in the tingling sensation in the part

supplied by the peripheral section
x. Chvosteks sign: It is twitching of the facial muscle as
a result of the tapping over the facial nerve in the
preauricular area
xi. Trousseaus sign: It is carpopedal spasm due to the
occlusion of the brachial artery when a blood pressure
cuff is applied above the systolic pressure for three
minutes.
158. Nerve injury caused by different incision approaches:
(i) Denkers operation; (ii) Mylohyoid ridge removal; (iii)
Transoral sialolithotomy of the submandibular; (iv) Surgical
removal of the parotid gland; (v) Submandibular or Risdons
incision; and (vi) Preauricular incision.
Ans. i. Denkers operation: Anterior superior alveolar nerve
ii. Mylohyoid ridge removal: Lingual nerve
iii. Transoral sialolithotomy of the submandibular duct:
Lingual nerve
iv. Surgical removal of the parotid gland: Facial nerve
v. Submandibular or Risdons incision: Marginal mandibular
branch of facial nerve
vi. Preauricular incision: If the incision is downward behind
the attachment of pinnafacial nerve
If the upper incision is curved anteriorly it may otherwise
cause damage to the auriculotemporal nerve.
159. Explain the following techniques of tooth extraction:
(i) Stobis technique; (ii) Wilkinsons technique; (iii) Postage
stamp technique; and (iv) Open window technique.
Ans. i. Stobis technique: Extraction of six mandibular anterior
teeth in a single setting
ii. Wilkinsons technique: Extraction of the first molar to
create space for eruption of third molars is called as
Wilkinsons extraction or extraction is done to permit an
eruption of third molars in proper position
Miscellaneous 335
iii. Postage stamp technique: A method of bone removal in

transalveolar extraction
iv. Open-window technique: Modification of open technique
with the help of bur, removing the bone overlying the
apex of the tooth and exposing the fragment, and the
tooth is displaced from the socket with the help of an
elevator.
160. What is the rule of 5 anatomic limitation of bone
harvesting in the symphyseal region (bone grafting)?
Ans. 5 mm of bone should be left from the following:
i. Mental foramen
ii. Apex of the root
iii. Lower border of the mandible

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Form of Key Points 1

8. Perfect suturing can increase 40% success rate and surgeon

cause Antibioma. The strength of antibiotic therapy depends

Second dayNo fomentation

42. In hypertension, if the patient had taken antihypertensive and

60. The level of reduced hemoglobin at which a patient becomes

83. If a normal patient loses 1000 cc of blood due to surgery, it

93. Lateral pterygoid muscle is only one of the principal muscles of

mask the head injury symptom and arrests the respiratory

3. Define the following terms:

6. When does the development of mandible takes place?

17. What are the anomalies (developmental) related to middle

22. What are the two peculiarities of lateral pterygoid muscle,

3 unpaired, which are: Thyroid (one)

32. From where do the branches of trigeminal nerve pass

41. Lingual artery is the branch of which artery?

54. Which tissue has less tendency to regenerate tendon or

iv. Medial wall: Composed of 4 bonesethmoidal bone

67. What are the contents of the carotid sheath?

72. What are the surface anatomy landmarks for tracheostomy?

77. What are the indications for prophylactic antibiotics?

85. What is the common side effect of NSAIDs drug?

94. Which is the broad spectrum antibioticpenicillin or

v. Vagus (cranial nerve X), glossopharyngeal nerve (cranial

105. In reference to the bleeding time and clotting time, what

107. In which condition does the lymph node become rubbery

108. In which system is the lymphatic drainage not present?

114. What is the rate of lymph flow?

Supraclavicular (subclavian) triangle. It is also known as

ii. Dyspnea: It is difficult or belaboured breathing

128. Which are the principal muscles of mastication?

iv. Larynx: The larynx is the organ for the production of

iii. They consist of two types of cells:

Basic Oral Surgery 3

Shock: It is an acute generalized inadequate perfusion of critical

10. What is the difference between allergy and idiosyncrasy?

23. Which is the most commonly detected organism in the

35. What is the purpose of a hand scrub?

45. Which muscles are present on the floor of the mouth?

54. Which suture material elicits more tissue reaction among

63. How is gut suture material absorbed?

71. How does pupil look in the patients of syncope?

78. When does the hypovolemic shock develop?

95. What are the common causes of postoperative hypotension?

iv. Malformation syndrome: It may be defined as two or more

103. Why are chromic catgut sutures packed in isopropyl

115. There is a case of patient with the history of chest pain

123. Give five cardinal principles of antibiotic therapy.

ii. Place the incision in an aesthetically acceptable area and

iii. Abscess is a localized collection of pus in a cavity formed

135. What is WHO standardized grading scale to measure the

139. What are the anatomic radiopacities of jaws?

144. How will you differentiate between the bleedings from

Arterial Venous Capillary

145. List the rule of 1 mm/2 mm/3 mm and 5 mm for suturing.

v. Sodium chloride (isotonic solution) = 6 mg

v. Vagus (cranial nerve X), glossopharyngeal nerve (cranial

Supraclavicular (subclavian) triangle. It is also known as