OMFS QUIZ 3

Which City is considered the most POLLUTED IN THE WORLD nowadays?

• Dhaka

• Lahore

• Delhi

• Hotan

 A 32-year-old man presents with fever, trismus, and a firm lateral pharyngeal wall bulge. CT shows an abscess tracking from a mandibular second molar into parapharyngeal space.

Which is the preferred site for surgical drainage of this abscess?

• Transcervical incision through the tonsillar fossa

• Transcervical incision along the anterior border of the sternocleidomastoid

• Submandibular incision at the angle of the mandible

• Percutaneous drainage via posterior cervical triangle

• Intraoral incision through the floor of mouth near the sublingual caruncle

Answer explanation

A patient presents with a rapidly spreading odontogenic infection that has progressed from a superficial dental abscess into deeper fascial spaces. The organism responsible is a facultative aerobe believed to initiate deep tissue spread by surviving in both oxygen-rich and oxygen-poor environments.

           Which organism is most likely involved?

• Bacteroides spp.

• Prevotella spp.

• Peptostreptococcus spp.

• Viridans streptococci

• Fusobacterium spp

    A 56-year-old man reports a 3-month history of persistent, dull pain in the right posterior mandible, which has recently worsened acutely. He also notes numbness of the lower lip. Imaging shows patchy radiolucency with sclerotic areas and small isolated bone fragments, minimal soft tissue swelling.

What is the most likely diagnosis?

• Acute submandibular abscess

• Ludwig’s angina

• Chronic suppurative osteomyelitis

• Osteoradionecrosis

• Masticator space infection

A patient with an untreated orbital infection develops fever, headache, periorbital edema, diplopia, and ophthalmoplegia. Fundoscopic examination reveals retinal venous congestion, including changes in the contralateral eye.

 Which cranial nerve is most likely to be affected first?

• Optic nerve

• Oculomotor nerve

• Trochlear nerve

• Abducent nerve

• Maxillary nerve

Answer explanation

In cavernous sinus thrombosis, the abducent nerve is affected first because it lies centrally within the cavernous sinus and is most vulnerable to compression.

  A 23-year-old man presents with trismus, mild drooling, pain behind the ear, and swelling along the posterior mandible after self-treating dental pain with herbal compresses. CT shows a collection between the mandible and medial pterygoid extending posteriorly into the parotid fascia.

Which fascial space best describes this infection?

• Submasseteric

• Lateral pharyngeal

• Pterygomandibular

• Parapharyngeal

• Retropharyngeal

Answer explanation

The pterygomandibular space is bounded:

·       Laterally: the mandible

·       Medially: the medial pterygoid muscle

   1.Submasseteric: Located between the masseter and mandible (lateral), not medial pterygoid.

2. Lateral pharyngeal / D. Parapharyngeal:

Deep neck spaces medial to the mandible

3.  Retropharyngeal: Lies posterior to the pharynx, between the buccopharyngeal fascia and alar fascia

SOLVE THIS: 5+ 5 x 5 =

• 50

• 30

• 25

• 10

A 45-year-old patient presents with facial pain over the maxilla, purulent nasal discharge, and a history of chronic dental infection in the posterior maxilla. Panoramic imaging shows opacification of the maxillary sinus with some air-fluid levels. There is no evidence of bony destruction.

Which of the following is the most likely diagnosis?

• Maxillary sinus carcinoma

• Acute odontogenic sinusitis

• Chronic osteomyelitis of the maxilla

• Mucormycosis of the maxilla

• Benign maxillary cyst

  A 55-year-old patient with a known cardiac condition requiring infective endocarditis prophylaxis undergoes a minimally invasive dental procedure without administering prophylactic antibiotics preoperatively. During the procedure, unexpected gingival bleeding occurs.

        What is the most appropriate management regarding infective endocarditis prophylaxis?

• No antibiotics are indicated because the procedure was minimally invasive

• Administer antibiotics only if signs of infection develop

• Administer prophylactic antibiotics within 4 hours

• Delay antibiotics until blood cultures confirm bacteremia

• Prescribe postoperative antibiotics for 5–7 day

  A 45-year-old woman presents with a painless, firm, mobile mass located at the angle of the mandible. She reports that the mass has been present for two years and has increased in size very slowly. FNA shows a biphasic epithelial–myxoid pattern.

What is the most appropriate management?

• Total parotidectomy

• Enucleation

• Superficial parotidectomy

• Core biopsy before surgery

• Radiotherapy