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ABOHNS Plastic Surgery Within the Head and Neck study materials
ABOHNS Plastic Surgery Within the Head and Neck study resources

ABOHNS Plastic Surgery Within the Head and Neck practice questions

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Question 1Facial Plastic and Reconstructive Surgery

A patient has a full-thickness defect of the upper eyelid involving 40% of its horizontal length with an intact lid margin laterally. Which reconstruction best restores the layered anatomy and avoids a second-stage procedure?

  1. Tarsoconjunctival advancement flap with skin graft
  2. Free tarsoconjunctival graft from the contralateral lid
  3. Full-thickness skin graft alone
  4. Primary layered closure with lateral canthotomy and cantholysis Correct answer.

Explanation

Defects up to roughly one-third to one-half of the lid margin can usually be closed directly after a lateral canthotomy and cantholysis to mobilize tissue. Layered closure restores tarsus, margin, and skin in a single stage. Larger defects generally require a sharing procedure or graft.

Question 2Facial Plastic and Reconstructive Surgery

Which suture material is most appropriate for closure of the anterior lamella of the eyelid to minimize tissue reaction and knot bulk near the margin?

  1. 2-0 polyglactin 910
  2. 6-0 nylon Correct answer.
  3. 6-0 fast-absorbing gut
  4. 5-0 silk

Explanation

Fine nonabsorbable monofilament such as 6-0 nylon provides precise approximation with minimal reactivity and is well tolerated near the lid margin. Heavier or braided sutures increase inflammation and granuloma risk.

Question 3Facial Plastic and Reconstructive Surgery

A patient presents with a dorsal nasal defect after Mohs surgery exposing bare cartilage but with an intact perichondrium. Which reconstructive approach is most reliable?

  1. Split-thickness skin graft placed directly on cartilage
  2. Full-thickness skin graft over the intact perichondrium Correct answer.
  3. Composite graft from the auricle
  4. Healing by secondary intention

Explanation

Skin grafts require a vascularized bed, and intact perichondrium provides that bed on the nasal dorsum. A full-thickness skin graft gives better color and contour match than a split-thickness graft at this site.

Question 4Facial Plastic and Reconstructive Surgery

The paramedian forehead flap is based on which vascular pedicle?

  1. Angular artery
  2. Supratrochlear artery Correct answer.
  3. Supraorbital artery
  4. Dorsal nasal artery

Explanation

The paramedian forehead flap is supplied by the supratrochlear artery, which reliably perfuses the axial flap. The pedicle is identified near the medial brow and allows a long arc of rotation to the nose.

Question 5Facial Plastic and Reconstructive Surgery

In a patient with a large full-thickness nasal alar defect, which option best restores both lining and external contour while avoiding a distant donor site?

  1. Turn-in hinge flap for lining with a paramedian forehead flap for cover Correct answer.
  2. Split-thickness skin graft
  3. Single full-thickness skin graft
  4. Nasolabial flap for cover only

Explanation

Full-thickness alar defects require both lining and cover. A turn-in hinge flap provides vascularized lining, and the paramedian forehead flap supplies robust cover with good color match.

Question 6Facial Plastic and Reconstructive Surgery

Which incision design is preferred for open reduction of a mandible angle fracture to minimize marginal mandibular nerve injury?

  1. Submental incision
  2. Preauricular incision
  3. Submandibular (Risdon) incision with nerve identification Correct answer.
  4. Retromandibular transparotid approach

Explanation

The submandibular approach allows direct visualization and protection of the marginal mandibular nerve, which runs near the inferior border. Careful dissection in the correct plane reduces injury risk.

Question 7Facial Plastic and Reconstructive Surgery

A patient with a zygomaticomaxillary complex fracture has persistent malar flattening and vertical dystopia after closed reduction. What is the most appropriate next step?

  1. Soft tissue filler injection
  2. Immediate orbital exenteration
  3. Open reduction and internal fixation Correct answer.
  4. Observation with follow-up imaging

Explanation

Persistent displacement after closed reduction indicates inadequate reduction, and open reduction with internal fixation restores orbital floor and malar projection. This addresses both functional and aesthetic deformity.

Question 8Facial Plastic and Reconstructive Surgery

Which nerve is at greatest risk during elevation of a subperiosteal flap over the anterior mandible near the mental foramen?

  1. Mental nerve Correct answer.
  2. Inferior alveolar nerve
  3. Lingual nerve
  4. Marginal mandibular nerve

Explanation

The mental nerve exits the mental foramen on the anterior mandible and is vulnerable during subperiosteal dissection in this region. Injury causes lower lip and chin numbness.

Question 9Facial Plastic and Reconstructive Surgery

A patient with a complete unilateral cleft lip undergoes repair at 3 months of age. Which maneuver best corrects the nasal deformity at the time of primary repair?

  1. Alar cartilage repositioning with rim incision and suturing Correct answer.
  2. Complete excision of the alar cartilage
  3. Nasal packing alone
  4. Delay of all nasal surgery until skeletal maturity

Explanation

Primary cleft lip repair often includes repositioning of the lower lateral cartilage through a rim incision to improve nasal symmetry. This addresses the alar buckling and vestibular web associated with the cleft.

Question 10Facial Plastic and Reconstructive Surgery

In cleft palate repair, which muscle is reconstructed to restore the levator sling?

  1. Palatopharyngeus
  2. Levator veli palatini Correct answer.
  3. Palatoglossus
  4. Tensor veli palatini

Explanation

The levator veli palatini muscles are abnormally inserted in cleft palate and must be repositioned to form a functional sling. This improves velopharyngeal closure and speech.

Question 11Facial Plastic and Reconstructive Surgery

A patient with a unilateral cleft lip has an orbicularis oris discontinuity. Which step is essential to restore lip function during repair?

  1. Leaving the muscle unrepaired
  2. Reapproximating the orbicularis oris muscle Correct answer.
  3. Suturing only the skin and mucosa
  4. Excising the prolabium

Explanation

Restoring orbicularis oris continuity is essential for sphincter function, symmetry, and a natural Cupid's bow. Muscle repair also provides a foundation for the overlying skin and vermilion.

Question 12Facial Plastic and Reconstructive Surgery

Which graft is most appropriate for augmentation of a small chin in a patient who desires a single-stage autologous reconstruction?

  1. Autologous bone graft from the iliac crest Correct answer.
  2. Fat injection alone
  3. Alloplastic silicone implant
  4. Autologous costal cartilage graft

Explanation

Autologous bone provides rigid structural support for genioplasty and is preferred when significant augmentation is needed. Iliac crest gives reliable volume and osteointegration.

Question 13Facial Plastic and Reconstructive Surgery

A patient undergoing rhinoplasty has a tension nose with a high dorsum and overprojected tip. Which maneuver addresses both the dorsal height and tip projection?

  1. Only alar base excision
  2. Dorsal hump reduction with caudal septal shortening Correct answer.
  3. Only tip graft augmentation
  4. Only columellar strut placement

Explanation

In a tension nose, the dorsum is high and the tip is overprojected due to a long caudal septum. Reducing the dorsal hump and shortening the caudal septum addresses both components.

Question 14Facial Plastic and Reconstructive Surgery

Which maneuver best prevents a Polly beak deformity after dorsal hump reduction in rhinoplasty?

  1. Overresection of the lower lateral cartilages
  2. Packing the nasal cavity for two weeks
  3. Aggressive supratip skin thinning
  4. Reconstruction of the middle vault with spreader grafts and meticulous supratip closure Correct answer.

Explanation

Polly beak results from dead space and inadequate middle vault support. Spreader grafts restore the keystone area and careful supratip closure eliminates dead space.

Question 15Facial Plastic and Reconstructive Surgery

Which artery is the dominant blood supply to the forehead flap used for nasal reconstruction?

  1. Facial artery
  2. Supratrochlear artery Correct answer.
  3. Superficial temporal artery
  4. Occipital artery

Explanation

The paramedian forehead flap is an axial flap based on the supratrochlear artery, a terminal branch of the ophthalmic artery. Preserving this pedicle is critical for flap survival.

Question 16Facial Plastic and Reconstructive Surgery

A patient has a full-thickness defect of the lower lip involving one-third of its width. What is the most appropriate reconstruction?

  1. Karapandzic flap
  2. Free fibula flap
  3. Wedge excision with primary closure in layers Correct answer.
  4. Radial forearm free flap

Explanation

Defects up to about one-third of the lower lip width can be closed primarily with a wedge excision and layered closure. This preserves sphincter function and oral competence.

Question 17Facial Plastic and Reconstructive Surgery

Which flap is best suited for reconstruction of a large lower lip defect with preservation of the commissure?

  1. Estlander flap
  2. Karapandzic flap
  3. Abbe flap
  4. Bernard-Burow advancement flap Correct answer.

Explanation

The Bernard-Burow advancement flap recruits cheek tissue to close large lower lip defects while preserving the commissure and oral competence. It is well suited to central or lateral defects.

Question 18Facial Plastic and Reconstructive Surgery

Which nerve is most commonly injured during superficial parotidectomy, resulting in brow asymmetry?

  1. Buccal branch
  2. Cervical branch
  3. Marginal mandibular branch
  4. Temporal branch of the facial nerve Correct answer.

Explanation

The temporal (frontal) branch of the facial nerve crosses the zygomatic arch superficially and is vulnerable during parotid surgery. Injury causes ipsilateral brow ptosis and asymmetry.

Question 19Facial Plastic and Reconstructive Surgery

A patient develops a salivary fistula after parotidectomy. Which initial measure is most appropriate?

  1. Pressure dressing and dietary modification with antisialagogues Correct answer.
  2. Radiation therapy
  3. Immediate reexploration and gland excision
  4. Observation alone without intervention

Explanation

Most salivary fistulas respond to conservative management with pressure dressings, reduced salivary stimulation, and antisialagogues. Reexploration is reserved for failure of conservative therapy.

Question 20Facial Plastic and Reconstructive Surgery

Which incision provides the best access for a parotid tumor while minimizing facial nerve injury?

  1. Submental incision
  2. Retroauricular incision alone
  3. Modified Blair (preauricular with cervical extension) incision Correct answer.
  4. Transoral incision

Explanation

The modified Blair incision provides wide exposure of the parotid and facial nerve branches while allowing cosmetic closure. It is the standard approach for parotidectomy.

Question 21Facial Plastic and Reconstructive Surgery

A patient with a large scalp defect down to bare calvaria requires coverage. Which option is most reliable when local flaps are unavailable?

  1. Split-thickness skin graft directly on bone
  2. Secondary intention
  3. Skin graft after burring to expose diploe
  4. Free tissue transfer Correct answer.

Explanation

Bare calvaria without periosteum cannot support a skin graft. Free tissue transfer provides well-vascularized coverage for large defects where local options are exhausted.

Question 22Facial Plastic and Reconstructive Surgery

Which technique best addresses a prominent ear with an underdeveloped antihelical fold?

  1. Ear splinting alone
  2. Mustarde suture technique Correct answer.
  3. Skin excision only
  4. Conchal excision alone

Explanation

The Mustarde technique uses mattress sutures to create an antihelical fold, correcting the most common cause of prominent ears. Conchal setback may be combined when the concha is also excessive.

Question 23Facial Plastic and Reconstructive Surgery

Which finding most strongly suggests a malignant rather than benign parotid neoplasm?

  1. Soft, mobile mass
  2. Slow growth over many years
  3. Bilateral symmetric enlargement
  4. Facial nerve palsy Correct answer.

Explanation

Facial nerve palsy in the setting of a parotid mass is highly concerning for malignancy because it implies perineural invasion. It warrants urgent evaluation and imaging.

Question 24Facial Plastic and Reconstructive Surgery

Which reconstructive option is preferred for a total upper lip defect after oncologic resection in a patient who desires single-stage reconstruction with adequate oral competence?

  1. Secondary intention
  2. Radial forearm free flap Correct answer.
  3. Local advancement flap
  4. Full-thickness skin graft

Explanation

Large total upper lip defects require composite reconstruction to restore sphincter function and oral competence. A radial forearm free flap provides thin, pliable tissue with reliable vascularity for single-stage reconstruction.

Question 25Facial Plastic and Reconstructive Surgery

Which graft material is preferred for dorsal nasal augmentation in a patient with thin skin to minimize visibility and resorption?

  1. Autologous rib cartilage
  2. Bovine collagen injection
  3. Autologous septal cartilage Correct answer.
  4. Alloplastic silicone

Explanation

Autologous septal cartilage is the preferred graft for dorsal augmentation in thin-skinned patients because it resists resorption and is less visible than rib or alloplast. It provides natural contour with low morbidity.

Question 26Facial Plastic and Reconstructive Surgery

A patient sustains a blow to the face and develops an isolated fracture of the orbital floor with entrapment of the inferior rectus muscle, producing restricted upward gaze. Which finding on forced duction testing confirms mechanical entrapment rather than inferior rectus paresis?

  1. Restriction of passive elevation of the globe Correct answer.
  2. Overelevation of the globe on forced duction
  3. Normal passive elevation with limited active elevation
  4. Downbeat nystagmus on upward gaze

Explanation

Forced duction testing distinguishes mechanical restriction from neuromuscular weakness. In entrapment, passive movement of the globe is mechanically limited in the direction of the entrapped muscle, so elevation is restricted. A paretic muscle shows free passive movement with limited active movement.

Question 27Facial Plastic and Reconstructive Surgery

A patient has a depressed comminuted nasal bone fracture with a stable septum and no other facial injuries. Which management approach is most appropriate when the patient presents 10 days after injury with persistent deformity?

  1. Immediate augmentation rhinoplasty
  2. Open reduction with osteotomies and splinting Correct answer.
  3. Observation with reassessment at 6 weeks
  4. Closed reduction under local anesthesia in the office

Explanation

Closed reduction is best performed within the first 7 to 10 days before fibrous union. Beyond this window, the fracture fragments are partially consolidated, and open reduction with osteotomies and stabilization is required to correct the deformity. Immediate augmentation is inappropriate in the acute setting.

Question 28Facial Plastic and Reconstructive Surgery

During harvest of a radial forearm free flap, the surgeon must preserve a structure that courses superficially in the distal forearm and is at risk with a volar harvest. Which structure is this?

  1. Superficial branch of the radial nerve Correct answer.
  2. Radial artery
  3. Palmaris longus tendon
  4. Median nerve

Explanation

The superficial branch of the radial nerve emerges from beneath the brachioradialis in the distal forearm and lies superficial, where it is vulnerable during volar harvest. Injury causes painful neuroma and sensory loss over the dorsoradial hand. The radial artery is the pedicle being harvested, not a structure to preserve.

Question 29Facial Plastic and Reconstructive Surgery

A patient undergoing face-lift develops a hematoma in the immediate postoperative period. Which initial step is most important to prevent skin flap necrosis?

  1. Application of a compressive dressing alone
  2. Evacuation of the hematoma and control of bleeding Correct answer.
  3. Initiation of therapeutic anticoagulation
  4. Massage of the flap

Explanation

An expanding hematoma causes tension that compromises flap perfusion and can lead to skin necrosis. Prompt evacuation with identification and control of the bleeding source relieves tension and restores perfusion. Compression alone does not relieve the underlying tension.

Question 30Facial Plastic and Reconstructive Surgery

A patient has a full-thickness nasal alar defect measuring 1.5 cm with intact underlying cartilage support. Which reconstructive option provides the best color match with the lowest donor-site morbidity for this defect?

  1. Nasolabial interpolation flap Correct answer.
  2. Forehead flap
  3. Full-thickness skin graft from the preauricular region
  4. Split-thickness skin graft from the thigh

Explanation

The nasolabial flap provides skin with a good color and texture match to the nose and allows a single-stage or two-stage reconstruction with concealed donor-site scar. It is well suited for alar defects of moderate size. Forehead flaps are reserved for larger or more complex defects.

Question 31Facial Plastic and Reconstructive Surgery

A patient with a large parotid pleomorphic adenoma undergoes superficial parotidectomy. Which structure should be identified early to protect facial nerve function?

  1. The tragal pointer and tympanomastoid suture line Correct answer.
  2. The external carotid artery
  3. The styloid process
  4. The posterior belly of the digastric muscle

Explanation

The main trunk of the facial nerve is reliably located using landmarks including the tragal pointer and the tympanomastoid suture line. Identifying the trunk early allows safe dissection of the nerve branches. The digastric muscle is a secondary landmark used after the trunk is found.

Question 32Facial Plastic and Reconstructive Surgery

A patient undergoing cleft lip repair has a wide alveolar cleft and nasal deformity. Which timing is generally preferred for alveolar bone grafting to optimize outcomes?

  1. Between 6 and 12 years of age Correct answer.
  2. After complete eruption of permanent dentition
  3. Before lip repair at 3 months
  4. At the time of lip repair

Explanation

Secondary alveolar bone grafting is typically performed between 6 and 12 years of age, before eruption of the permanent canine, to provide bone support for the erupting tooth and stabilize the alveolar arch. Earlier grafting can impair maxillary growth, and later grafting offers less benefit for tooth eruption.

Question 33Facial Plastic and Reconstructive Surgery

A patient presents with a rapidly enlarging, painful neck mass with fever and dysphagia after a recent dental infection. Which initial management step is most appropriate?

  1. Elective excision after imaging in 6 weeks
  2. Observation and outpatient antibiotics
  3. Radiation therapy
  4. Urgent airway assessment and intravenous antibiotics with drainage Correct answer.

Explanation

A deep neck space infection after dental infection is a surgical emergency because of the risk of airway compromise and spread to the mediastinum. Management includes urgent airway assessment, intravenous antibiotics, and prompt incision and drainage. Delay increases mortality.

Question 34Facial Plastic and Reconstructive Surgery

A patient with a large scalp defect down to bare calvaria is not a candidate for local flaps. Which reconstructive option is most reliable for coverage?

  1. Split-thickness skin graft
  2. Full-thickness skin graft
  3. Secondary intention healing
  4. Free tissue transfer Correct answer.

Explanation

Bare calvaria without periosteum cannot support a skin graft. Free tissue transfer, such as a latissimus or anterolateral thigh flap, provides reliable well-vascularized coverage when local flaps are unavailable. Secondary intention healing over bare bone risks desiccation and osteomyelitis.

Question 35Facial Plastic and Reconstructive Surgery

A patient with a small, well-defined basal cell carcinoma of the nasal tip undergoes Mohs micrographic surgery with clear margins. The resulting defect is 0.8 cm with intact cartilage. Which reconstructive option is most appropriate?

  1. Free tissue transfer
  2. Composite graft from the ear
  3. Forehead flap
  4. Full-thickness skin graft Correct answer.

Explanation

A small defect with intact cartilaginous support can be reconstructed with a full-thickness skin graft, which provides adequate coverage with minimal donor-site morbidity and good color match when taken from the preauricular or conchal region. Larger or composite defects require more complex options.

Question 36Facial Plastic and Reconstructive Surgery

A patient undergoes rhinoplasty and develops a saddle nose deformity years later. Which underlying process most commonly contributes to this late complication?

  1. Inadequate tip rotation
  2. Excessive dorsal augmentation
  3. Excessive columellar strut grafting
  4. Over-resection of the nasal dorsum with loss of structural support Correct answer.

Explanation

Saddle nose deformity results from loss of dorsal septal support, often from over-resection of the dorsum or septal cartilage. Structural grafting is required to restore support. Excessive augmentation does not cause saddle deformity.

Question 37Facial Plastic and Reconstructive Surgery

A patient with a unilateral cleft lip has a flattened nasal alar dome on the cleft side. Which maneuver during repair best restores nasal symmetry?

  1. Excision of the alar base
  2. Augmentation of the columella with a graft
  3. Repositioning of the lower lateral cartilage with suspension sutures Correct answer.
  4. Resection of the septal cartilage

Explanation

The cleft nasal deformity involves malposition of the lower lateral cartilage with a flattened alar dome. Repositioning and suspending the lower lateral cartilage restores the domal arch and improves symmetry. Excision or resection would worsen the deformity.

Question 38Facial Plastic and Reconstructive Surgery

A patient has a defect of the upper lip involving one-third of its width after Mohs surgery. Which reconstructive approach is most appropriate?

  1. Abbe flap
  2. Karapandzic flap
  3. Free tissue transfer
  4. Primary closure with layered repair Correct answer.

Explanation

Defects involving up to one-third of the upper lip width can typically be closed primarily in layers while preserving the commissure and oral competence. Larger defects require local flaps such as the Abbe or Karapandzic. Free tissue transfer is reserved for massive composite defects.

Question 39Facial Plastic and Reconstructive Surgery

A patient with a mandibular body fracture is treated with open reduction and internal fixation. Which complication is most specifically associated with injury to the inferior alveolar nerve during plating?

  1. Facial nerve weakness
  2. Loss of upper lip sensation
  3. Loss of lower lip sensation Correct answer.
  4. Loss of taste on the anterior tongue

Explanation

The inferior alveolar nerve supplies sensation to the lower lip and chin. Injury during plating of a mandibular body fracture produces numbness in the lower lip and chin on the affected side. Taste and upper lip sensation are mediated by other nerves.

Question 40Facial Plastic and Reconstructive Surgery

A patient undergoing brow lift via an endoscopic approach develops temporary forehead weakness. Which nerve is most likely injured?

  1. Marginal mandibular branch of the facial nerve
  2. Zygomatic branch of the facial nerve
  3. Temporal branch of the facial nerve Correct answer.
  4. Cervical branch of the facial nerve

Explanation

The temporal branch of the facial nerve crosses the zygomatic arch and supplies the frontalis and orbicularis oculi. It is at risk during endoscopic brow lift dissection in the temporal region. Injury produces forehead weakness and brow ptosis.

Question 41Head and Neck Reconstructive Surgery

Which pedicled flap is most commonly used for reconstruction of a large through-and-through cheek defect when microsurgery is unavailable?

  1. Temporoparietal fascial flap
  2. Deltopectoral flap
  3. Submental island flap
  4. Pectoralis major myocutaneous flap Correct answer.

Explanation

The pectoralis major myocutaneous flap provides a large skin paddle with reliable axial blood supply from the thoracoacromial artery and can reach the midface and oral cavity, making it a workhorse pedicled option for bulky composite defects. Deltopectoral and temporoparietal flaps are limited in volume and reach for full-thickness cheek defects.

Question 42Head and Neck Reconstructive Surgery

The blood supply of the radial forearm free flap is based on which vessel?

  1. Ulnar artery
  2. Posterior interosseous artery
  3. Brachial artery
  4. Radial artery Correct answer.

Explanation

The radial forearm fasciocutaneous free flap is perfused by the radial artery via septocutaneous perforators through the lateral intermuscular septum. The ulnar artery and interosseous arteries supply other forearm territories and are not the pedicle for this flap.

Question 43Head and Neck Reconstructive Surgery

Which reconstructive option is best suited for a small (<3 cm) full-thickness defect of the lower lip with adequate remaining vermilion?

  1. Karapandzic flap
  2. Gillies fan flap
  3. Abbe flap Correct answer.
  4. Free radial forearm flap

Explanation

The Abbe (lip-switch) flap transfers a full-thickness wedge from the upper lip on a labial artery pedicle, preserving sphincter function and restoring vermilion for moderate lower lip defects. It is generally reserved for defects up to about one-third of the lip where local tissue is insufficient.

Question 44Head and Neck Reconstructive Surgery

Which flap is the standard first choice for reconstruction of a total glossectomy defect?

  1. Anterolateral thigh free flap Correct answer.
  2. Radial forearm free flap
  3. Jejunal free flap
  4. Temporalis muscle flap

Explanation

The anterolateral thigh flap provides sufficient bulk to restore tongue volume, which is critical for swallowing and speech after total glossectomy, and has a long reliable pedicle. Thin fasciocutaneous flaps lack the volume needed for total tongue replacement.

Question 45Head and Neck Reconstructive Surgery

Which bone is most commonly used for mandibular reconstruction when a vascularized bone flap is chosen for a large segmental defect?

  1. Scapula
  2. Iliac crest
  3. Fibula Correct answer.
  4. Rib

Explanation

The free fibula flap is the most commonly used vascularized bone for mandibular reconstruction because of its length, reliable peroneal blood supply, and ability to accept dental implants. It allows multiple osteotomies to contour the neomandible.

Question 46Head and Neck Reconstructive Surgery

A patient undergoes a fibula free flap for mandibular reconstruction. Which preoperative assessment is essential to avoid a catastrophic donor-site complication?

  1. Assessment of pulmonary function
  2. Assessment of renal function
  3. Assessment of peroneal artery dominance with angiography or CT angiography Correct answer.
  4. Assessment of trigeminal nerve sensation

Explanation

The fibula flap depends on the peroneal artery; if the peroneal artery is dominant and supplies the foot (peronea magna), harvest can cause limb ischemia. Vascular imaging identifies peroneal artery dominance and variant anatomy before surgery.

Question 47Head and Neck Reconstructive Surgery

Which reconstructive goal is most important when planning closure of a palatal defect after maxillectomy?

  1. Preserving the orbital floor
  2. Restoring dental occlusion only
  3. Restoring an airtight separation between the oral and nasal cavities Correct answer.
  4. Achieving a bulky soft tissue contour

Explanation

The primary functional goal in palatal reconstruction is to separate the oral and nasal cavities to allow normal speech and swallowing without nasal regurgitation. Bulk and dental rehabilitation are secondary considerations after this seal is achieved.

Question 48Head and Neck Reconstructive Surgery

Which microvascular anastomotic configuration is generally preferred in head and neck free flap reconstruction to reduce the risk of flap congestion?

  1. Artery-to-artery and vein-to-vein end-to-end anastomoses Correct answer.
  2. Lymphaticovenous anastomosis
  3. Single arterial anastomosis without venous outflow
  4. Arteriovenous fistula creation

Explanation

Standard free tissue transfer requires arterial inflow and reliable venous outflow; end-to-end arterial and venous anastomoses to suitable neck vessels are the conventional configuration. Inadequate venous outflow is a leading cause of flap failure from congestion.

Question 49Head and Neck Reconstructive Surgery

A patient has a defect of the orbital floor and inferior orbital rim after resection of a maxillary sinus tumor. Which reconstructive approach best restores orbital support and facial contour?

  1. Fat graft alone
  2. Local mucosal advancement alone
  3. Vascularized bone flap or titanium mesh reconstruction of the orbital floor Correct answer.
  4. Split-thickness skin graft alone

Explanation

Restoration of the orbital floor requires rigid support to prevent enophthalmos and diplopia; vascularized bone or alloplastic mesh provides this structural support. Soft tissue alone cannot maintain orbital volume.

Question 50Head and Neck Reconstructive Surgery

Which factor most strongly predicts free flap failure in head and neck reconstruction?

  1. History of prior radiation to the neck Correct answer.
  2. Flap ischemia time greater than 4 hours
  3. Patient age over 70 years
  4. Use of a vein graft

Explanation

Prior radiation causes vessel fibrosis and atherosclerosis, increasing anastomotic complications and flap failure. Age alone is not a strong independent predictor when comorbidities are controlled.