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MAXILLOFACIAL SURGERY
GOVERMENT DENTAL COLLEGE &
HOSPITAL, AHMEDABAD.
Mandibular Fracture
Transosseous wiring
Intermaxillary fixation
Plating on the lateral side of the body of the mandible
Plating at the inferior border of the mandible.
Que:-3. A 7-year-old boy presented with fracture of left sub condylar region
with occlusion undisturbed, the treatment would be.
A.
B.
C.
D.
3 Weeks
6 Weeks
9 Weeks
12 Weeks
Ans:- B. 6 Weeks
Exp.:- Period of immobilization for fractures of tooth-bearing areas of mandible.
a. Young adult with fracture of the angle receiving early treatment in which
tooth removed from fracture line 3 weeks
b. If tooth retained in fracture line 1 week is added. ( 3+1=4 weeks )
c. If fracture occurs at the symphysis 1 week is added. ( 4+1 = 5 weeks )
d. If the patient age is 40 years and over 1 or 2weeks are added.
e. If fracture occurs in children and adolescents Subtract 1 week.
Ref.:- Killeys Mand # 4th Edition, Page No. 45 / Vinod Kapoor, 2nd edition,
Page No. 253.
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Pain
Ankylosis
Osteoarthritis
Fracture of glenoid fossa
Ans :- B . Ankylosis
Exp:- To avoid this, early mobilization is indicated in cases of young children.
Ref.:- Killeys Mand # 4th Edition, Page No. 98 / Vinod Kapoor, 2nd edition,
Page No. 279.
Que:-6. In case of sub condylar fracture, the condylar move in
A.
B.
C.
D.
Simple
Complex
Compound
Comminuted
Ans:- C . Compound
Exp.: Simple fracture includes liner # of condyle, coronoid ramus and edentulous
body of mandible.
Compound fracture include fractures of tooth bearing portions of mandible.
Green stick fracture is a rare type of simple # and is found is found
exclusively in children.
Comminuted fracture are due to direct violence to mandible from
penetrating sharp objects and missiles.
Ref.:- Killeys Mand # 4th Edition, Page No. 4 / Vinod Kapoor, 2nd edition,
Page No. 243.
Que:-9. The proximal segmental of mandibular angle fracture usually displaced in
which direction
A.
B.
C.
D.
Body
Angle
Symphysis
Condyle
Ans:- B. Angle
Exp.:- Because of sudden change in angulation, angle is considered as weakest
part of mandible.
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Children
Soldiers
Edentulous persons
Young adults
Temporalis
External pterygoid
Internal pterygoid
Masseter
Gunning splints
Compression plates
Trans-osseous wires
Clampy plates
Malunion
Non union
Osteomyelitis
Osteoradionecrosis
Body fracture
Symphysis fracture
Coronoid fracture
Condyle fracture
Risdon wiring
Essig wiring
Cap splint with circum-mandibular wiring
Transosseous wiring
Malocclusion
Sublingual hematoma
Deviation of the jaw on opening
Paraesthesia of the mental nerve
Ans:- A. Malocclusion
Exp.:-Sublingual hematomas followed by malocclusion, both are considered as
pathognomonic signs of mandibular fracture.
Ref.:- Killeys Mand # 4th Edition, Page No. 31 / Vinod Kapoor, 2nd edition,
Page No. 250.
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Risdons wiring
Gilmers wiring
Eyelet wiring
Col. Stouts wiring
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Transverse fracture
Oblique fracture
Spiral fracture
Comminuted fracture
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Ref.:- Killeys Mand # 4th Edition, Page No. 50,54 / Vinod Kapoor, 2nd edition,
Page No. 252.
Que:-30. Treatment of choice to manage symphyseal fracture in a 8-year-old
child is:
A.
B.
C.
D.
Intermaxillary fixation
Cap splint with circumferential wiring
Open reduction
No treatment indicated
IMF
Open reduction and internal fixation
Close reduction and internal fixation
External pin fixation
Ans:- A . IMF
Exp.:- Dental wiring is used when the patient has a complete or almost complete
set of teeth.
Arch bars are useful when the patienthas an insufficient number of suitably
shaped teeth to enable effective interdenatal eyelet wiring.
Ref.:- Killeys Mand # 4th Edition, Page No. 58 / Vinod Kapoor, 2nd edition,
Page No. 254.
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Lag screw
Wires
Clampy bone plate
Eyelet wiring
b. Intermaxillary fixation:
1. Bonded brackets
2. Dental wiring
Direct
Eyelet
3. Arch bars
4. Cap splints
c. IMF with osteosynthesis:
1.
2.
3.
4.
5.
Transosseous wiring
Circumferential wiring
External pin fixation
Bone clamps
Transfixation with Kirschner wires
Open reduction
Closed reduction
No treatment required
None of the above
Kirschner wire
Circumferential wiring
External pin fixation
Inter dental fixation
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Unilateral condylar #
Bilateral condylar #
Maxillary fractures
Coronoid fracture
Same side
Opposite side
Does not move
Retrudes
Sub-conjuctival ecchymosis.
Sub-lingual ecchymosis
Palatal ecchymosis
Ecchymosis in the mastoid region.
Ref.:- Killeys Mand # 4th Edition, Page No. 28 / Vinod Kapoor, 2nd edition,
Page No. 281.
Que:-38. Risdon wiring is indicated for
A.
B.
C.
D.
Body fracture
Angle fracture
Symphysis fracture
Subcondylar fracture
2 mm
3 mm
4 mm
6 mm
Ans:- C . 3 mm
Exp.:- Usually the thickness of buccal cortex is around 3.5 mm. A 4 mm length
screw is adequate for proper screw-bone contact.
Que:- 40. A displaced, unfavorable fracture in the mandibular angle region is
a potentially difficult fracture to treat because of
A.
B.
C.
D.
Ref.:- Killeys Mand # 4th Edition, Page No. 12 / Vinod Kapoor, 2nd edition,
Page No. 247, 248.
Que:-41.The splint which is most commonly used in dentulous mandibular
fracture is
A.
B.
C.
D.
Gunning splint
Cap splint
Ribbon splint
All of these
Dentulous
Edentulous
Children
Young adults
Ans:- B. Edentulous
Exp.:- Rarely in very young children ( option C) with unerupted or very few
deciduous teeth, Gunning type splints are used. But option B is more
appropriate.
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OPG
Occlusal
Lateral oblique view
Transpharyngeal
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Que:- 45. In lingual splaying of guardsman fracture with ORIF, which is the
clinical feature?
A.
B.
C.
D.
Ans:- B . ORIF
Exp.:- Greatly displaced and dislocated fractures (separation of fragments
exceeding 5mm and displacements exceeding 30 degrees) increasingly are
being treated surgically. A functional conservative treatment is worth
considering in less severely dislocated fractures.
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Que:-47. In fracture of atrophic mandible with bone loss, what is the best
treatment modility?
A.
B.
C.
D.
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Que:-49. Fracture passing through mental foramen in mandible with less than
10 mm of bone can be best managed by
A.
B.
C.
D.
Reconstruction plate
MMF
Lag screws
3-D plate
Tension
Compression
Torsion
Rotation
Ans:- A. Tension
Exp.:- Masticatory force produce tensional force I the alveolar region or at the
upper border & compression forces at the lower border. This explains the
cause of distraction of fracture segments in the upper border, and
compression in the lower border.
Ref.:- Textbook of oral & Maxillofacial surgery by S.M. Balaji, 1st Edition,
Page no. 581.
Que:-52. In mandibular angle fracture, which is most appropriate treatment?
A.
B.
C.
D.
Body fracture
Angle fracture
Condylar fracture
Symphyseal fracture
Ans:- C > B
Exp.:- Condylar region of the mandible is the most vulnerable site. Although the
rate of postoperative complications is higher in the treatment of angle
fractures, the difficulties of reduction and fixation are more frequent in the
treatment of condylar fracture, due to less visibility in the operative field, a
difficult hemostasia and the possibility of facial nerve injury.
Ref.:- Manual of internal fixation in craniofacial skeleton by J. Prein 1998 yr 83.
Que:-54.Submental intubation is an alternative to tracheostomy in which type
of fractures?
A.
B.
C.
D.
Mandibular fracture.
Nasal fracture.
Panafacial fracture.
Styloid process fracture.
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Que:-55. Use of an acrylated arch bars for closed reduction of mandible was
described by
A.
B.
C.
D.
Schuchardt (1956)
Risdon (1929)
Stanstout (1943)
Leonard (1977)
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Condylar head
Condylar neck
Coronoid head
Coronoid neck
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Here there is a closed lock form, where the disc interferes with condylar
translation.
Patient will not be able to open the mouth further, pain in the affected joint
will be exhibited and deviation of the mandibile towards the painful side will
be noticed.
Ref.:- Neelima Malik 1st Edition, Page no. 226.
Que:-61. Most stable in closed reduction is
A.
B.
C.
D.
Screws
Arch bar
Direct wiring
None of the above
Upper border
Lower border
Between upper and lower border
One at the upper and lower border
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In the resion between the two mental foramina, two plates are
recommended: one in the subapical region of the symphysis and the second
at the inferior border.
In the body of the mandible, one plate is recommended just below the apices
of teeth but above the inferior alveolar nerve canal.
Ref.:- Textbook of oral and maxillofacial trauma by Raymond J Fonseca, 3rd
Edition, Vol 2 1148.
Lateral pterygoid
Medial pterygoid
Masseter
Temporalis
Craniofacial dysjuction
Guerrins fracture
Pyramidal fracture
None of the above
Le Fort I
Le Fort II
Le Fort III
Extended Le Fort
fracture
Que:-65. Which of the following is not included in the Glassgow coma scale
A.
B.
C.
D.
Eye opening
Motor response
Verbal response
Pupil size
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.49, Vinod Kapoor 2nd Edition,
Page no. 291.
Que:-67. After fracture of middle cranial foramen there is epiphora this is due
to damage of:
A.
B.
C.
D.
Ciliary ganglion
Greater palatine nerve
Infraorbital nerve
None of the above
Secure airway
I.V. mannitol
I.V. dexamethasone
Blood transfusion
Temporal fossa
Intra temporal fossa
Infra orbital fossa
All of the above
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.17, Vinod Kapoor 2nd Edition,
Page no. 225.
Que:-71. Forceps used for maxillary fracture disimpaction
A.
B.
C.
D.
Rowes
Bristows
Asha
Walshams
Ans:- A . Rowes
Ref.:- Killeys Mid 3rd # 5th Edition, Page no. 77.
Que:-72.Guerin fracture is:
A.
B.
C.
D.
Maxillary fracture
Maxillary and zygomatic fracture
Maxillary and nasal bone fracture
Nasal bone fracture only
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Exp.:- Orbital blow out fracture occurs when a rounded object struck the
protruding eyeball resulting in fracture of orbital floor .
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.45, Vinod Kapoor 2nd Edition,
Page no. 296.
Le Fort I fractures
Le Fort II fractures
Mandible fractures
None of the above
Remove teeth
Remove root
Clamp blood vessels
Reduce nasal bone fractures
Use
35
Normal saline
Ringers lactate solution
Whole blood
Plasma expanders
Subcondylar
Zygomatico maxillary
Coronoid process
Symphyseal
Mandibular fracture
Craniofacial dysjunction
Nasal fractures
Zygomatico maxillary complex
2 hours
6 hours
4 hours
8 hours
Ans:- B. 6 hours
Ref.:- Neelima Malik 1st Edition, Page no. 318.
Que:-80. The hanging drop appearance in the maxillary sinus radiograph
indicates:
A.
B.
C.
D.
A nasal polyp
A below out # of the orbit
A radiograph artifact
An antrolith
A.
B.
C.
D.
Bleeding
Associated fracture spine
Infection
Respiratory obstruction
Que:- 82. The safest initial approach to open airway of patient with
maxillofacial trauma is:
A.
B.
C.
D.
Condyles
Ramus
Petrous temporal
Coronoid process
A.
B.
C.
D.
Que:-85. All of the following statements of nasal fractures are true except:
A. Even if minor, they may be followed by bilateral ecchymossis and facial
oedema
B. They may need to be reduced for a few weeks
C. They need not be complicated by traumatic telecanthus
D. They may lead to the telescoping of the nasal complex into the frontal sinus
Ans:- B. They may need to be reduced for a few weeks
Exp.:- Walshams forceps & Asches forceps are used for reduction of
fractured segments. These fractures should be repaired within 7-10 days.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.48, 49.
Que:-86. Fixation may lead to the telescoping of the nasal complex into the
frontal sinus
A.
B.
C.
D.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.65, Vinod Kapoor 2nd Edition,
Page no. 307, 311.
Que:-87. In a patient of head injury which is more important to note first:
A.
B.
C.
D.
Gingival crest
Bleeding from pulp
Bleeding from bone
Bleeding from capillaries
Enophthalmos
Exophtholmos
Bulbar hemorrhage
None
Ans:- A. Enophthalmos
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.69, Vinod Kapoor 2nd Edition,
Page no. 311.
Que:-93. An average patient with maxillofacial trauma requires how much of
daily sodium?
41
A.
B.
C.
D.
100 mmol
50-60 mmol
10 mmol
1000 mmol
Inferior rectus
Inferior oblique
Lateral rectus
Superior oblique
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.55, 56, Vinod Kapoor 2nd Edition,
Page no. 290.
Que:-96. The muscle that aids in displacement of maxillary fractures are
A.
B.
C.
D.
Masseter
Temporalis
Orbicularis oculi and orbicularis oris
None of the above
Le Fort 1
Le Fort 2
Le Fort 3
Nasal bone
Ans:- C . Le Fort 3
Exp.:- If the fracture line passes above the Whitnalls tubercle, it removes the
support given to eye by lockwoods suspensory ligament and the upper
eyelid follows the globe down producing hooding of eyes.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.56.
Que:-98. The intercanthal distance suggestive of traumatic telecanthus is:
A.
B.
C.
D.
30 mm
32 mm
25 mm
40 mm
Ans:- D. 40 mm
Exp.:- Normal intercanthal distance is 25 mm. in traumatic telecanthus the
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Ans:- B . 40 mm
Exp.:- In Le Fort I fracture, there is hemorrhage in to maxillary sinuses. When
antral cavities become full blood starts leaking through the nose. The nasal
passages may get blocked with this clotted blood.
Ref.:- Vinod Kapoor 2nd Edition, Page no. 289.
Que:-100. The subconjuctival hemorrhage remains bright red in color for a
long time because?
A.
B.
C.
D.
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