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SU19.1-2,SU20.1-2,SU21.1-2 | Face, Mouth, Oropharynx and Salivary Glands — Practice Quiz
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A newborn boy has a visible gap in the upper lip on one side of the midline that extends into the floor of the nostril, together with a defect of the alveolus anterior to the incisive foramen, but the posterior palate is intact. Which embryological failure best explains this pattern of clefting?
Correct. The lip and primary palate (anterior to the incisive foramen) form from fusion of the maxillary process with the medial nasal process; failure here produces a cleft lip ± alveolus with an intact secondary palate.
The incisive foramen is the embryological landmark dividing primary from secondary palate and organises the whole cleft classification.
The incisive foramen divides primary (lip/alveolus, from maxillary + medial nasal process fusion) from secondary palate (palatine shelves). A defect anterior to the foramen with an intact posterior palate localises the failure to the primary palate fusion.
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A healthy infant with an isolated unilateral cleft lip is being scheduled for primary lip repair. According to the conventional 'rule of 10s' that signals the child is fit for surgery, which set of parameters should ideally be met?
Correct. The rule of 10s — about 10 weeks of age, about 10 lb in weight, and a haemoglobin of about 10 g/dL — marks fitness for primary lip repair, typically around 3 months.
Lip is repaired early (~3 months, by the rule of 10s) for appearance, feeding and bonding; the palate is repaired later (~6–12 months) to allow normal speech development.
The classic rule of 10s is ~10 weeks, ~10 lb, Hb ~10 g/dL, allowing lip repair around 3 months of age.
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When is the palate (secondary palate) ideally repaired in a child with cleft palate, and what is the principal reason for choosing that timing?
Correct. The palate is repaired around 6–12 months, before the child develops meaningful speech, so a competent palate is in place to allow normal speech and resonance.
The cleft timetable follows function: lip early for appearance/feeding, palate before speech.
Palate repair is timed to precede speech development (~6–12 months) so the velopharyngeal mechanism is functional when the child begins to speak.
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A 55-year-old man who has chewed tobacco and areca (betel) nut for thirty years has an ulcer on the lateral border of the tongue that has not healed for six weeks. Which statement about the most likely diagnosis is correct?
Correct. A non-healing oral ulcer beyond ~3 weeks is cancer until proven otherwise; >90% of oral/oropharyngeal cancers are squamous cell carcinoma, strongly linked to smokeless tobacco and areca nut.
Treat any oral ulcer unhealed at three weeks as cancer until proven otherwise; smokeless tobacco and areca nut dominate the aetiology in India.
Smokeless tobacco and areca nut are major carcinogens; >90% of oral cancers are SCC, and the three-week non-healing ulcer rule mandates suspicion of malignancy.
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During examination of a patient at risk of oral cancer, you note both a white mucosal patch and a red velvety patch. Which statement about these premalignant lesions is correct?
Correct. A red patch (erythroplakia) is more dangerous than a white one (leukoplakia) and has the higher rate of malignant transformation; both warrant biopsy.
Erythroplakia > leukoplakia for malignant potential; OSMF is an areca-nut-related premalignant condition.
Remember: RED (erythroplakia) is more dangerous than WHITE (leukoplakia). Oral submucous fibrosis is strongly linked to areca nut and is also premalignant.
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A suspected oral squamous cell carcinoma is being worked up. Which approach best reflects the principle of triple assessment used in this and other oncological diagnoses?
Correct. Triple assessment combines clinical examination, imaging and tissue diagnosis; for oral cancer this is supplemented by panendoscopy to detect synchronous tumours.
Triple assessment (clinical, imaging, tissue) underpins solid-tumour diagnosis; treatment is stage-directed and decided by a tumour board.
Triple assessment = clinical + imaging + tissue (histology). A definitive tissue diagnosis is mandatory before stage-directed, multidisciplinary treatment.
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A 45-year-old woman has a painless, rubbery, slowly growing lump in the parotid region with a completely intact facial nerve. Which surgical principle is most important when planning treatment of the most likely tumour?
Correct. The picture is a benign pleomorphic adenoma. It is never enucleated — its pseudopodia push through a false capsule, so superficial parotidectomy preserving the facial nerve is the operation.
Two rules of salivary surgery: never enucleate a pleomorphic adenoma, and preserve the facial nerve in parotid surgery.
Pleomorphic adenoma has microscopic pseudopodia through a false capsule; enucleation leaves tumour and recurs (with risk of malignant change). Superficial parotidectomy with facial nerve preservation is the rule.
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A 50-year-old man reports recurrent pain and swelling of a gland below the jaw that is worst at mealtimes and then settles. Which diagnosis and gland are most consistent with this history?
Correct. Painful swelling that peaks at mealtimes and then settles is classic obstructive sialadenitis from a stone; the submandibular gland is the commonest site for sialolithiasis.
Mealtime swelling = obstruction; submandibular gland is the commonest site for salivary calculi. Warthin's is a benign parotid tumour (often bilateral, in smokers).
Mealtime (prandial) pain and swelling that subsides indicates ductal obstruction by a calculus; the submandibular gland is most often affected because of its thick, mucinous secretion and uphill duct.
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