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

ABPS Plastic Surgery Within the Head and Neck practice questions

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Question 1Head and Neck Anatomy and Wound Healing

Which cranial nerve provides motor innervation to the muscles of facial expression?

  1. Facial nerve (CN VII) Correct answer.
  2. Trigeminal nerve (CN V)
  3. Hypoglossal nerve (CN XII)
  4. Glossopharyngeal nerve (CN IX)

Explanation

The facial nerve supplies the muscles of facial expression through its five peripheral branches after exiting the stylomastoid foramen. The trigeminal nerve is primarily sensory to the face and motor to the muscles of mastication.

Question 2Head and Neck Anatomy and Wound Healing

The blood supply to the central forehead is derived primarily from which vessel?

  1. Transverse facial artery
  2. Posterior auricular artery
  3. Supratrochlear artery Correct answer.
  4. Superficial temporal artery

Explanation

The supratrochlear artery arises from the ophthalmic artery and supplies the central forehead and glabella region. The superficial temporal artery supplies the lateral scalp and temple.

Question 3Head and Neck Anatomy and Wound Healing

Which layer of the scalp contains the major blood vessels and requires careful hemostasis during dissection?

  1. Dermis
  2. Subcutaneous connective tissue Correct answer.
  3. Galea aponeurotica
  4. Loose areolar tissue

Explanation

The dense subcutaneous connective tissue layer contains the rich vascular and nerve supply of the scalp, and vessels here retract when cut, causing significant bleeding. The galea is avascular aponeurosis and the loose areolar layer is the danger space.

Question 4Head and Neck Anatomy and Wound Healing

Sensation to the lower lip and chin is provided by which nerve?

  1. Infraorbital nerve
  2. Auriculotemporal nerve
  3. Mental nerve Correct answer.
  4. Long buccal nerve

Explanation

The mental nerve, a terminal branch of the inferior alveolar nerve from V3, exits the mental foramen to supply the lower lip and chin. The infraorbital nerve supplies the midface and upper lip.

Question 5Head and Neck Anatomy and Wound Healing

Which collagen type predominates in the mature dermal extracellular matrix of a healed wound?

  1. Type V
  2. Type IV
  3. Type I Correct answer.
  4. Type III

Explanation

Mature scar and normal dermis are composed predominantly of type I collagen, which replaces the early type III collagen deposited during granulation. Type III is abundant early in healing but is progressively remodeled.

Question 6Head and Neck Anatomy and Wound Healing

Which phase of wound healing is characterized by fibroblast proliferation and new capillary formation?

  1. Inflammation
  2. Proliferation Correct answer.
  3. Hemostasis
  4. Remodeling

Explanation

The proliferative phase features fibroblast migration, angiogenesis, and deposition of granulation tissue. Remodeling later balances collagen synthesis and degradation to increase tensile strength.

Question 7Head and Neck Anatomy and Wound Healing

A 45-year-old sustains a full-thickness laceration of the mid-cheek. Which facial nerve branch is most at risk when the dissection approaches the anterior border of the parotid gland?

  1. Temporal branch
  2. Buccal branch Correct answer.
  3. Zygomatic branch
  4. Cervical branch

Explanation

The buccal branch crosses the mid-cheek superficial to the masseter and is vulnerable in mid-face lacerations near the parotid's anterior border. The temporal and cervical branches lie at the superior and inferior extremes of the facial nerve distribution.

Question 8Head and Neck Anatomy and Wound Healing

During elevation of a forehead flap, the plane of dissection deep to the frontalis muscle is chosen primarily to protect which structure?

  1. The supraorbital neurovascular bundle within the muscle Correct answer.
  2. The facial nerve branches, which lie deep to the muscle
  3. The galea aponeurosis
  4. The superficial temporal fascia

Explanation

The supraorbital and supratrochlear neurovascular bundles travel within or just deep to the frontalis, so dissection in a subgaleal or subperiosteal plane helps preserve them. This plane also reduces bleeding and protects the pedicle.

Question 9Head and Neck Anatomy and Wound Healing

A patient has a deep laceration over the eyebrow. Which structural rule best guides repair to prevent a visible contour deformity?

  1. Excise the brow margin for a straight-line scar
  2. Repair in layers with accurate reapproximation of the brow margin Correct answer.
  3. Delay closure until granulation tissue forms
  4. Close with a single layer of fine absorbable suture

Explanation

The eyebrow is an aesthetic landmark that must be reapproximated precisely at its margin to avoid a step-off or notch. Layered closure restores the deeper tissue and aligns the hair-bearing margin.

Question 10Head and Neck Anatomy and Wound Healing

The blood supply to the platysma and overlying neck skin is most reliably based on which vessel system?

  1. Facial artery and submental branches Correct answer.
  2. Occipital artery
  3. Posterior auricular artery
  4. Supratrochlear artery

Explanation

The facial artery and its submental branch provide robust axial supply to the upper neck and platysma region, which supports platysma-based flaps. The occipital and posterior auricular arteries supply the posterior scalp and periauricular region.

Question 11Head and Neck Anatomy and Wound Healing

Which suture characteristic makes a monofilament absorbable suture preferable for closure of oral mucosa?

  1. High tensile strength retained indefinitely
  2. Permanent non-absorbable nature
  3. Low tissue drag and predictable absorption Correct answer.
  4. Multifilament braiding that resists bacterial colonization

Explanation

Monofilament absorbable sutures slide smoothly through mucosa and resorb predictably, avoiding a second procedure for removal. Braided multifilament material tends to harbor bacteria in the contaminated oral cavity.

Question 12Head and Neck Anatomy and Wound Healing

A patient with a history of keloid formation undergoes a planned excision on the anterior chest. Which adjunct most reduces recurrence risk?

  1. Intralesional corticosteroid injection and pressure therapy Correct answer.
  2. Wide undermining with tension closure
  3. Topical antibiotic ointment alone
  4. Early suture removal at 3 days

Explanation

Keloid recurrence is reduced by combining tension-free closure with intralesional corticosteroids and pressure therapy, which suppress fibroblast activity. High-tension closure and early suture removal increase recurrence.

Question 13Head and Neck Anatomy and Wound Healing

The danger space of the scalp is located in which layer, and why is it clinically important?

  1. Galea aponeurotica, which resists infection spread
  2. Pericranium, which adheres tightly to bone
  3. Loose areolar layer, allowing spread of infection to the intracranial compartment Correct answer.
  4. Subcutaneous layer, where vessels retract and bleed

Explanation

The loose areolar layer contains emissary veins connecting to the intracranial venous sinuses, so infection can spread intracranially. This makes scalp infections in this plane a serious concern.

Question 14Head and Neck Anatomy and Wound Healing

A patient develops a hematoma under a forehead flap. Which anatomic feature best explains the rapid expansion of the collection?

  1. The pericranium is highly vascular and resorbs blood quickly
  2. The loose areolar plane permits fluid to spread widely Correct answer.
  3. The galea firmly confines fluid to a small area
  4. The subcutaneous layer is avascular

Explanation

The loose areolar layer offers little resistance, allowing blood to spread across the scalp and expand rapidly. This is why drains and careful hemostasis are used in subgaleal dissections.

Question 15Head and Neck Anatomy and Wound Healing

Which nerve is most likely injured during a deep dissection at the angle of the mandible?

  1. Supratrochlear nerve
  2. Temporal branch of the facial nerve
  3. Infraorbital nerve
  4. Marginal mandibular branch of the facial nerve Correct answer.

Explanation

The marginal mandibular branch runs near the inferior border of the mandible and is at risk in dissections at the mandibular angle, causing lower lip depressor weakness. The temporal branch is far superior and the infraorbital and supratrochlear nerves are midface and forehead structures.

Question 16Head and Neck Anatomy and Wound Healing

Which factor most impairs wound healing by reducing collagen synthesis and tissue perfusion?

  1. Tobacco smoking Correct answer.
  2. Mild anemia
  3. Moderate sun exposure
  4. Topical moisturizer use

Explanation

Smoking causes vasoconstriction, carbon monoxide-mediated hypoxia, and impaired fibroblast function, all of which reduce collagen synthesis and perfusion. Smoking cessation before elective surgery improves outcomes.

Question 17Head and Neck Anatomy and Wound Healing

A patient with poorly controlled diabetes has a surgical wound. Which mechanism best explains delayed healing in this setting?

  1. Increased collagen cross-linking
  2. Enhanced macrophage phagocytosis
  3. Impaired neutrophil function and microvascular disease Correct answer.
  4. Excessive angiogenesis

Explanation

Hyperglycemia impairs leukocyte function and is associated with microangiopathy that reduces tissue perfusion and oxygen delivery. Both factors slow the inflammatory and proliferative phases of healing.

Question 18Head and Neck Anatomy and Wound Healing

Which statement best describes the biomechanical rationale for placing deep sutures in a high-tension facial wound?

  1. They redistribute tension to the deep plane, reducing dermal stress and scar widening Correct answer.
  2. They replace the need for hemostasis
  3. They eliminate the need for epidermal reapproximation
  4. They increase dermal tension to stimulate collagen

Explanation

Deep sutures bear tension in the subcutaneous and fascial plane, offloading the dermis so the epidermal closure is not under stress. This reduces scar widening and hypertrophy.

Question 19Head and Neck Anatomy and Wound Healing

A patient requires reconstruction of a full-thickness cheek defect. Which principle best guides choice of a local flap over a skin graft?

  1. Local flaps provide better color and texture match and restore contour Correct answer.
  2. Skin grafts provide superior vascularity to the recipient bed
  3. Local flaps are always less likely to fail than grafts
  4. Skin grafts better restore underlying soft tissue volume

Explanation

Local flaps recruit adjacent tissue with similar color, texture, and thickness, and they can restore contour and volume better than a graft. Grafts depend on recipient bed vascularity and do not add bulk.

Question 20Head and Neck Anatomy and Wound Healing

During a parotidectomy, injury to which nerve would produce weakness of the lower lip depressors?

  1. Buccal branch
  2. Marginal mandibular branch Correct answer.
  3. Zygomatic branch
  4. Cervical branch

Explanation

The marginal mandibular branch supplies the depressor anguli oris, depressor labii inferioris, and mentalis, so injury causes lower lip asymmetry. The cervical branch supplies the platysma and does not depress the lower lip.

Question 21Facial Trauma and Reconstruction

A patient has a zygomaticomaxillary complex fracture with a completely immobile zygoma on examination. Which fracture classification term best describes this finding?

  1. Comminuted fracture
  2. Impacted fracture Correct answer.
  3. Greenstick fracture
  4. Displaced fracture

Explanation

An impacted fracture occurs when fracture fragments are driven into one another and become wedged, producing clinical immobility. Comminution refers to multiple small fragments, and displacement refers to loss of normal alignment rather than interlocking. Greenstick fractures are incomplete fractures seen in pliable bone.

Question 22Facial Trauma and Reconstruction

Which nerve is most commonly injured during a subcondylar mandibular fracture, producing loss of sensation to the lower lip and chin?

  1. Auriculotemporal nerve
  2. Inferior alveolar nerve Correct answer.
  3. Lingual nerve
  4. Long buccal nerve

Explanation

The inferior alveolar nerve courses through the mandibular canal below the tooth roots and is vulnerable in fractures of the body, angle, and subcondylar region. Injury produces ipsilateral lower lip and chin paresthesia. The lingual, buccal, and auriculotemporal nerves supply other territories.

Question 23Facial Trauma and Reconstruction

In a patient with a suspected Le Fort fracture, the Le Fort I level corresponds to which anatomic plane?

  1. Pyramidal separation through the maxilla and nasal bones
  2. Frontomaxillary suture through the nasal bridge
  3. Low transverse separation of the maxilla above the tooth apices Correct answer.
  4. Horizontal separation through the orbital floors and nasal septum

Explanation

Le Fort I is a low transverse (Guérin) fracture separating the tooth-bearing maxilla from the upper midface above the dental apices. Le Fort II is pyramidal and passes through the nasal bones and medial orbital walls, and Le Fort III is craniofacial disjunction at the frontomaxillary and zygomaticofrontal levels.

Question 24Facial Trauma and Reconstruction

What is the primary goal of rigid internal fixation in facial fracture repair?

  1. Restore anatomic occlusion and facial contour with stable three-dimensional position Correct answer.
  2. Prevent the development of plate infection
  3. Allow immediate return to a normal diet
  4. Eliminate the need for postoperative antibiotics

Explanation

Rigid fixation restores and maintains the three-dimensional anatomic position of fracture segments so that occlusion and facial projection are reestablished and bone heals in the correct relationship. It does not eliminate antibiotic needs or guarantee infection avoidance, and diet is advanced gradually.

Question 25Facial Trauma and Reconstruction

Which imaging study is generally preferred for initial evaluation of suspected facial fractures because it displays bone detail in multiple planes?

  1. Panoramic radiograph
  2. Lateral cephalometric radiograph
  3. Magnetic resonance imaging
  4. Computed tomography with thin axial slices and coronal reformats Correct answer.

Explanation

Computed tomography provides detailed multiplanar bony anatomy and is the standard for evaluating complex facial fractures. Panoramic and cephalometric films are limited to specific views, and MRI is less sensitive for cortical bone detail.

Question 26Facial Trauma and Reconstruction

A patient presents with a unilateral orbital floor blowout fracture and restricted upward gaze. Which structure is most likely entrapped?

  1. Superior oblique muscle
  2. Levator palpebrae superioris
  3. Medial rectus muscle
  4. Inferior rectus muscle Correct answer.

Explanation

The inferior rectus lies directly above the orbital floor and is the muscle most often entrapped in a floor blowout fracture, limiting upward gaze and producing diplopia. The medial rectus relates to the medial wall, and the superior oblique and levator are superior structures.

Question 27Facial Trauma and Reconstruction

Which clinical sign most reliably indicates a true orbital floor blowout fracture rather than an isolated rim fracture?

  1. Restricted vertical eye movement with diplopia Correct answer.
  2. Lid edema
  3. Periorbital ecchymosis
  4. Subconjunctival hemorrhage

Explanation

Restricted vertical motility with diplopia suggests entrapment or tethering of the inferior rectus and periorbital tissues through the floor defect. Ecchymosis, subconjunctival hemorrhage, and edema are nonspecific soft-tissue signs that can accompany any periorbital trauma.

Question 28Facial Trauma and Reconstruction

Which approach is most appropriate for a non-displaced, minimally symptomatic nasal bone fracture seen within 24 hours of injury?

  1. Immediate closed reduction under general anesthesia
  2. Immediate bone grafting of the nasal dorsum
  3. Open reduction with internal fixation
  4. Observation with reassessment for functional or aesthetic deformity Correct answer.

Explanation

Non-displaced nasal fractures without airway compromise or cosmetic deformity can be managed with observation and reassessment. Closed reduction is reserved for displaced fractures, usually within 7 to 10 days before callus forms. Open reduction and grafting are not indicated acutely for minimal injuries.

Question 29Facial Trauma and Reconstruction

A patient sustains a mandibular angle fracture. Which biomechanical factor most strongly predisposes this region to fracture?

  1. Attachment of the masseter muscle
  2. Presence of the mandibular canal
  3. Thin cortical bone at the angle combined with a third molar Correct answer.
  4. Curvature of the condylar neck

Explanation

The angle is a transition zone between the horizontal body and vertical ramus, and the presence of an impacted third molar creates a stress riser with reduced bone volume. This makes the angle one of the most commonly fractured mandibular sites. The canal, masseter attachment, and condylar curvature do not by themselves create the same weakening effect.

Question 30Facial Trauma and Reconstruction

A patient with a unilateral subcondylar fracture shows premature contact of the ipsilateral posterior teeth and an anterior open bite tendency. What is the best explanation for this finding?

  1. Upward pull of the masseter on the fractured segment
  2. Posterior displacement of the fractured condyle by the lateral pterygoid Correct answer.
  3. Loss of the occlusal stop from a missing molar
  4. Medial displacement of the fractured condyle by the medial pterygoid

Explanation

The lateral pterygoid pulls the condylar head anteromedially and, in many fractures, the ramus shortens and rotates, producing premature ipsilateral contact and a contralateral open bite. The masseter elevates the ramus rather than displacing the condyle posteriorly, and missing teeth or medial pterygoid action do not explain this pattern.

Question 31Facial Trauma and Reconstruction

Which finding on examination most strongly suggests a Le Fort II fracture rather than a Le Fort I fracture?

  1. Cerebrospinal fluid rhinorrhea
  2. Mobility of the maxilla with the nasal complex Correct answer.
  3. Mobility limited to the palate and dental arch
  4. Anterior open bite

Explanation

Le Fort II is a pyramidal fracture that includes the nasal bones and medial orbital rims, so the maxilla moves together with the nasal complex. Le Fort I mobility is confined to the lower maxilla. CSF rhinorrhea and open bite can occur at multiple levels and are not specific to Le Fort II.

Question 32Facial Trauma and Reconstruction

A patient has a zygomaticomaxillary complex fracture with significant enophthalmos and a large orbital floor defect. Which management step is most important to prevent persistent enophthalmos?

  1. Orbital floor reconstruction with restoration of orbital volume Correct answer.
  2. Observation with serial imaging
  3. Nasal packing for 48 hours
  4. Isolated fixation of the zygomaticofrontal suture

Explanation

Persistent enophthalmos after zygomaticomaxillary complex fracture results from increased orbital volume, often from a large floor defect. Reconstructing the floor and restoring orbital volume are essential. Observation, isolated suture fixation, and nasal packing do not correct the volume deficit.

Question 33Facial Trauma and Reconstruction

Which suture is most important to reduce first to restore facial width and projection in a panfacial fracture?

  1. Zygomaticofrontal suture Correct answer.
  2. Nasofrontal suture
  3. Piriform aperture
  4. Inferior orbital rim

Explanation

In panfacial reconstruction, reestablishing facial width begins with the zygomaticofrontal suture, which restores the lateral projection of the zygomatic arch and midface. The nasofrontal and orbital rim sutures restore anterior projection and vertical height after width is set. The piriform aperture is used for anterior projection and nasal base support.

Question 34Facial Trauma and Reconstruction

What is the primary indication for open reduction and internal fixation of a mandibular angle fracture?

  1. Presence of a single non-displaced fracture line
  2. Age over 40 years
  3. Any angle fracture regardless of displacement
  4. Significant displacement, malocclusion, or instability after closed reduction Correct answer.

Explanation

Open reduction and internal fixation is indicated for displaced angle fractures, malocclusion, or instability after attempted closed management, because these features predict poor healing and functional deficit. Non-displaced fractures can often be managed closed, and age alone is not an indication.

Question 35Facial Trauma and Reconstruction

Which plate configuration is generally preferred for fixation of an unfavorable mandibular angle fracture to resist torsional and tensile forces?

  1. Two monocortical miniplates or a single reconstruction plate Correct answer.
  2. Single monocortical miniplate along the superior border
  3. Single monocortical miniplate along the inferior border
  4. Wire osteosynthesis alone

Explanation

Unfavorable angle fractures experience tensile and torsional forces that a single miniplate may not resist adequately. Two monocortical miniplates or a load-bearing reconstruction plate provide more stable fixation. Wire osteosynthesis lacks the rigidity needed for early function.

Question 36Facial Trauma and Reconstruction

A patient has a frontal sinus fracture with posterior table displacement and persistent CSF rhinorrhea. What is the most appropriate management?

  1. Antibiotics alone without surgical intervention
  2. Observation with serial CT scans
  3. Nasal packing and discharge
  4. Endoscopic or open repair of the dural tear with sinus obliteration or cranialization Correct answer.

Explanation

Posterior table frontal sinus fractures with CSF leak imply dural injury and carry a risk of meningitis, requiring neurosurgical or combined repair of the dural defect and management of the sinus (obliteration or cranialization). Observation or antibiotics alone do not address the dural defect.

Question 37Facial Trauma and Reconstruction

Which clinical feature most reliably distinguishes a tripod (zygomaticomaxillary complex) fracture from an isolated orbital rim fracture?

  1. Periorbital swelling
  2. Malar depression with lateral canthal dystopia Correct answer.
  3. Lid laceration
  4. Subconjunctival hemorrhage

Explanation

A zygomaticomaxillary complex fracture disrupts the malar eminence and the lateral canthal attachment, producing malar flattening and lateral canthal dystopia. Swelling, subconjunctival hemorrhage, and lid lacerations are nonspecific findings that can accompany either injury.

Question 38Facial Trauma and Reconstruction

What is the main advantage of using a coronal approach for repair of complex frontal and naso-orbitoethmoid fractures?

  1. Elimination of the risk of CSF leak
  2. Direct visualization of the entire upper facial skeleton with a hidden scar Correct answer.
  3. Shorter operative time than local approaches
  4. Avoidance of any need for fixation

Explanation

The coronal approach exposes the frontal bone, orbital roofs, nasal root, and zygomatic arches through a scalp incision hidden in the hairline. It does not eliminate the need for fixation or the risk of CSF leak, and it is generally more extensive than limited local approaches.

Question 39Facial Trauma and Reconstruction

A patient with a naso-orbitoethmoid fracture has traumatic telecanthus. Which structure is most directly responsible for the increased intercanthal distance?

  1. Fracture of the orbital floor
  2. Displacement of the nasal septum
  3. Fracture of the zygomatic arch
  4. Detachment of the medial canthal ligament from the lacrimal crest Correct answer.

Explanation

Traumatic telecanthus after a naso-orbitoethmoid fracture results from avulsion or displacement of the medial canthal ligament from its insertion at the medial orbital wall. Zygomatic arch, septal, and floor fractures do not directly increase the intercanthal distance.

Question 40Facial Trauma and Reconstruction

Which reconstructive option is preferred for a large full-thickness scalp defect with exposed calvaria after trauma when local tissue is unavailable?

  1. Free tissue transfer such as a latissimus dorsi or anterolateral thigh flap Correct answer.
  2. Full-thickness skin graft on periosteum
  3. Split-thickness skin graft directly on bone
  4. Secondary intention healing

Explanation

Exposed calvaria without periosteum cannot support a skin graft, so vascularized tissue is required. Free tissue transfer is preferred for large defects when local flaps are unavailable. Skin grafts and secondary intention healing fail over bare bone.

Question 41Facial Trauma and Reconstruction

A patient has a comminuted anterior table frontal sinus fracture without nasofrontal duct injury or displacement. Which management is most appropriate?

  1. Observation with follow-up imaging Correct answer.
  2. Cranialization of the sinus
  3. Sinus obliteration with fat
  4. Endoscopic sinus surgery

Explanation

Non-displaced or minimally displaced anterior table fractures without nasofrontal duct involvement or cosmetic deformity can be managed with observation and follow-up. Cranialization and obliteration are reserved for posterior table or duct injuries or severe displacement.

Question 42Facial Trauma and Reconstruction

In a patient with a gunshot wound to the face causing a through-and-through mandibular defect, what is the most important initial priority in management?

  1. Immediate bone grafting of the defect
  2. Immediate dental rehabilitation
  3. Airway control and hemorrhage management Correct answer.
  4. Immediate definitive plate fixation

Explanation

Advanced trauma life support principles prioritize airway, breathing, and circulation before definitive facial reconstruction. Hemorrhage control and airway protection take precedence over bone grafting, fixation, and dental rehabilitation, which are addressed in later phases.

Question 43Facial Trauma and Reconstruction

A patient has a unilateral condylar fracture with a stable occlusion and minimal displacement. Which management is generally preferred?

  1. Immediate condylectomy
  2. Open reduction with internal fixation
  3. Closed management with soft diet and analgesia Correct answer.
  4. Mandibular reconstruction with a free fibula flap

Explanation

Minimally displaced condylar fractures with a stable occlusion and no functional impairment are typically managed closed with a soft diet, analgesia, and physiotherapy. Open reduction is reserved for significant displacement, occlusal disturbance, or inability to restore function.

Question 44Facial Trauma and Reconstruction

A patient with a severe midface crush injury develops progressive visual loss and a tense globe after facial fracture repair. What is the most likely diagnosis and immediate management?

  1. Orbital cellulitis requiring antibiotics
  2. Corneal abrasion requiring patching
  3. Optic neuritis requiring steroids
  4. Retrobulbar hematoma requiring emergent decompression Correct answer.

Explanation

A tense globe with progressive visual loss after orbital or midface surgery suggests retrobulbar hematoma with orbital compartment syndrome. Emergent decompression, including lateral canthotomy and cantholysis, is required to preserve vision. Steroids, antibiotics, or patching do not address the compartment syndrome.

Question 45Facial Trauma and Reconstruction

Which factor most strongly predicts the need for bone grafting in delayed reconstruction of a mandibular continuity defect?

  1. Presence of a single nondisplaced fracture
  2. Defect size greater than 5 to 6 cm with loss of continuity Correct answer.
  3. Use of monocortical screws
  4. Patient age under 30 years

Explanation

Continuity defects larger than approximately 5 to 6 cm generally cannot heal spontaneously and require bone grafting or a vascularized flap. Smaller defects may heal with rigid fixation alone. Age, a non-displaced fracture, and screw type are not the primary determinants of grafting need.

Question 46Facial Trauma and Reconstruction

Which imaging modality is considered the standard for diagnosing facial fractures?

  1. Computed tomography (CT) scan Correct answer.
  2. Magnetic resonance imaging (MRI)
  3. Ultrasound
  4. Plain radiography

Explanation

CT scanning provides detailed three-dimensional evaluation of bone and is the gold standard for facial trauma imaging. It allows accurate assessment of fracture displacement and involvement of vital structures.

Question 47Facial Trauma and Reconstruction

A patient presents with a zygomatic arch fracture. Which clinical finding is most characteristic?

  1. Flattening of the malar prominence Correct answer.
  2. Diplopia
  3. Trismus
  4. Anesthesia in the infraorbital nerve distribution

Explanation

Zygomatic arch fractures typically cause a depression over the arch, leading to a flattened malar prominence. This is a hallmark sign due to displacement of the arch.

Question 48Facial Trauma and Reconstruction

A 30-year-old patient sustains a mandibular parasymphysis fracture. Which factor most strongly influences the choice between closed and open reduction?

  1. Time since injury
  2. Presence of a single fracture line
  3. Patient's age
  4. Degree of displacement and presence of malocclusion Correct answer.

Explanation

The decision for open reduction is primarily based on the degree of displacement and whether a functional malocclusion is present. Minimally displaced fractures with normal occlusion can often be managed closed, while significant displacement or malocclusion typically requires open reduction and internal fixation.

Question 49Facial Trauma and Reconstruction

Which nerve is most at risk during open reduction and internal fixation of a mandibular angle fracture via a transoral approach?

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

Explanation

The lingual nerve runs close to the medial aspect of the mandible in the retromolar region and is at risk during transoral dissection and plate placement for angle fractures. Careful retraction and knowledge of anatomy help prevent injury.

Question 50Facial Trauma and Reconstruction

A patient with a panfacial fracture undergoes surgical repair. Which sequence of reduction is generally recommended to restore facial width and projection?

  1. Mandible first, then midface, then upper face Correct answer.
  2. Upper face first, then midface, then mandible
  3. Midface first, then mandible, then upper face
  4. Mandible and midface simultaneously, then upper face

Explanation

The mandible serves as a foundation for the lower facial third, and reducing it first helps re-establish the vertical dimension and facial width. The midface is then reduced to the mandible, followed by the upper face, ensuring proper projection and contour.