Question 11#

A 37-year-old woman is undergoing evaluation because of intermittent locking of the right temporomandibular joint (TMJ). She has no pain or crepitus of the joint. Interincisal opening is 40mm. MRI shows a non-reducing articular disk within the right TMJ. Which of the following is the most appropriate management?

A. Observation

Observation.

References:

1. Bays RA. Surgery for internal derangement. In: Oral and maxillofacial surgery, 4th ed. Bays RA, Quinn PD, Eds. Philadelphia, USA: Saunders, 2000: 275-300.
2. Feinberg S, Larsen P. Reconstruction of the temporomandibular joint with pedicled temporalis muscle flaps. In: Modern practice in orthognathic and reconstructive surgery. Bell WH, Ed. Philadelphia, USA: Saunders, 1992: 733.

Question 12#

Maxillary sinus tumours:

A. Some tumours may be accessed using a Webster-Fergusohn incision

The wider and higher the defect the greater the likelihood that a free flap will be required for reconstruction. The wider and higher the defect the greater the likelihood that a free flap will be needed. A Weber-Fergusson incision may be used for access. Involvement of the orbital floor would normally necessitate an exenteration for adequate tumour clearance. A free flap is indeed indicated in the wide and high defects and a DCIA flap allows for dental rehabilitation.

Question 13#

The following are risk factors associated with the malignant transformation of leukoplakia except:

A. Long duration

Location on the buccal mucosa (as opposed to the floor of the mouth or tongue). The risk factors for malignant transformation include all those mentioned except the buccal mucosa. The floor of the mouth and tongue are high risk. Additional high-risk factors include the presence of epithelial dysplasia as well as non-homogeneous leukoplakia (combined red and white lesions). Mimics of leukoplakia include Candidiasis, discoid lupus, lichen planus, papillary hyperplasia secondary to ill-fitting dentures and white sponge naevi.

References:
1. Gnepp DR. Diagnostic surgical pathology of the head and neck, 2nd ed. SaundersElsevier, 2009: 9.

Question 14#

A 24-year-old woman undergoes a LeFort I osteotomy with maxillary impaction and bilateral sagittal split osteotomy with mandibular advancement. Following release of intermaxillary fixation 6 weeks later, the patient has an anterior open bite. Which of the following is the most likely cause of this finding? 

A. Improper intra-operative seating of the condyles in the glenoid fossae

Improper intra-operative seating of the condyles in the glenoid fossae

References:

1. Mason ME, Schendel SA. Revision orthognathic surgery. In: Maxillofacial surgery. Booth PW, Schendel SA, Hausamen JE, Eds. New York, USA: Churchill Livingstone, 1999: 1321-34.
2. McCarthy JG, Kawamoto HK, Grayson BH, Colen SR, Coccaro PJ. Surgery of the jaws. In: Plastic surgery. McCarthy JG, Ed. Philadelphia, USA: Saunders, 1990: 1188-474. 

Question 15#

A patient has an infection at the surgical site 1 week after undergoing open reduction and internal fixation of a fracture of the mandibular body using an inferior border reconstruction plate and a tension band. Occlusion is normal. The infection site is surgically drained; intra-operative exploration shows that the plates and screws are stable with no evidence of loosening. Which of the following is the most appropriate management of the hardware?

A. Removal of all plates and immediate application of intermaxillary fixation

Removal of all plates and immediate application of intermaxillary fixation.

References:

1. Jacques B, Richter M, Arza A. Treatment of mandibular fractures with rigid osteosynthesis: using the AO system. J Oral Maxillofac Surg 1997; 55(12): 1402-6.
2. Koury ME, Perrott DH, Kaban LBN. The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis. J Oral Maxillofac Surg 1994; 52(11): 1114-9.