20 exam-style MCQs on local anaesthesia, exodontia, trauma and anatomy. Pick an answer to see the explanation and the textbook page it comes from.
Written from standard OMFS textbooks; page numbers are printed book pages. The full bank is in progress.
Answer: B. Gow-Gates is a true mandibular (V3) block given high, at the condylar neck, about 10–25 mm above the mandibular occlusal plane with the mouth wide open. Option A is the conventional IANB target; option D describes the Vazirani–Akinosi closed-mouth block.
Malamed, Handbook of Local Anesthesia, 7th ed, ch 14, pp 251–252
Answer: A. Malamed gives 10–15% positive aspiration for the IANB, the highest of all intraoral techniques. Gow-Gates is about 2%, the PSA about 3% and the ASA under 1%. Always aspirate, in two planes for the IANB.
Malamed, 7th ed, ch 14, pp 241, 250; ch 13, pp 209, 214
Answer: C. The Vazirani–Akinosi block is given with the teeth gently together, so it works when opening is limited. The motor block comes on quickly, so the patient often starts to open wider. The IANB and Gow-Gates both need a wide-open mouth; a mental block does not reach the molar pulps.
Malamed, 7th ed, ch 14, pp 240, 251, 254–258
Answer: B. No bone contact means the needle is too far posterior, possibly in the parotid near the facial nerve. Withdraw, bring the barrel back over the molars and re-advance until you touch bone. If it happens, the palsy lasts as long as the soft-tissue anaesthesia: the patient can't close the eye, but the corneal reflex is intact.
Malamed, 7th ed, ch 14, pp 244–245; ch 17, pp 316–317
Answer: C. The PSA numbs the third, second and first molars, but the whole first molar in only about 72%. In about 28% the mesiobuccal root is supplied by the middle superior alveolar nerve, so a second (usually supraperiosteal) injection may be needed.
Malamed, 7th ed, ch 13, pp 207–208
Answer: A. The nasopalatine block numbs the anterior hard palate from canine to canine. To keep it comfortable: topical and pressure anaesthesia, insert beside (not into) the incisive papilla, no deeper than 5 mm, and deposit no more than 0.45 mL slowly.
Malamed, 7th ed, ch 13, pp 222–223
Answer: D. Peterson: mesioangular (about 45%) is the least difficult, vertical (40%) and horizontal (10%) are intermediate, and distoangular (5%) is the most difficult. More distal bone must come off, and the tooth tends to be elevated back into the ramus.
Peterson's Principles of OMS, 3rd ed, ch 5, pp 107, 110
Answer: B. Full bony impactions are always harder than soft-tissue ones, and of two impactions at the same depth, the one in the older patient is always harder. Peterson notes that angulation, ramus relationship and root morphology may have little influence on the time surgery takes.
Peterson's Principles of OMS, 3rd ed, ch 5, p 107
Answer: B. Position A is at or above the occlusal plane, B is between the occlusal plane and the second molar's cervical line, and C is below that cervical line. Option D is Class II of the ramus relationship, a separate part of the same classification.
Malik, Textbook of OMS, 5th ed, ch 20, p 314
Answer: B. The elevators (masseter, temporalis, medial pterygoid) pull the posterior fragment upwards. A line running downwards and backwards lets them do it, so it is unfavourable; downwards and forwards locks the fragment, so it is favourable. Option C describes a vertically favourable line (top view).
Rowe & Williams, Maxillofacial Injuries, vol 1, ch 1, pp 11–12; Malik, 5th ed, ch 33, p 608
Answer: B. At the angle the superior border is under tension and the inferior border under compression, so a monocortical miniplate on the superior border has the mechanical advantage. Champy (1978) described it; it is called functionally stable because it allows function, even with some interfragmentary motion.
Fonseca et al, Oral and Maxillofacial Trauma, 4th ed, ch 33, pp 812–813
Answer: A. The temporal branches cross the zygomatic arch, on average about 2 cm (0.8–3.5 cm) in front of the external auditory canal. Ellis and Zide advise incising the temporalis fascia and arch periosteum no more than 0.8 cm in front of the canal's anterior border.
Ellis & Zide, Surgical Approaches to the Facial Skeleton, 3rd ed, ch 12, p 194
Answer: C. Exploring a fresh suspected defect with an instrument can break down the clot and turn a communication into a fistula. Malik calls radiographs the best way to detect an OAC, and the gentle nose-blow test is useful when it isn't obvious.
Malik, Textbook of OMS, 5th ed, ch 41, pp 910–911; AOMSI textbook, ch 24, p 494
Answer: C. The buccal advancement (Rehrmann) flap is advanced over the defect after the periosteum is scored at its base. The price is a shallower vestibule, which can matter for a future denture.
Peterson's Principles of OMS, 3rd ed, ch 40, p 881; AOMSI textbook, ch 24, p 500
Answer: B. The internal carotid does not branch in the neck. Identify the ECA by its first two anterior branches and double-ligate between the superior thyroid and the lingual. Don't tie it at its root, where thrombus can spread into the ICA.
Kademani & Tiwana, Atlas of OMS, ch 61, p 656; Malik, 5th ed, p 1147
Answer: C. Three anterior branches (superior thyroid, lingual, facial), two posterior (occipital, posterior auricular), one medial (ascending pharyngeal) and two terminal (maxillary, superficial temporal). The ascending pharyngeal is small and arises low, near the bifurcation.
Fonseca et al, Oral and Maxillofacial Trauma, 4th ed, ch 10, pp 198–199
Answer: B. Grasp the anterior maxilla and move it while the other hand steadies the nasal bridge. In a Le Fort I the nasal bridge doesn't move. Movement at the nasofrontal suture means the fracture is higher: Le Fort II or III.
Peterson's Principles of OMS, 3rd ed, ch 20, pp 457–458; Rowe & Williams, vol 1, ch 4, pp 118–119
Answer: A. Guérin's sign is palatal bruising near the greater palatine foramen in a Le Fort I (Guérin) fracture. A Le Fort I alone doesn't involve the orbit, so it gives no circumorbital bruising.
Rowe & Williams, vol 1, ch 4, pp 108, 114; Malik, 5th ed, ch 31, p 567
Answer: B. The deep temporal fascia attaches to the upper border of the arch, while temporalis runs beneath the arch to the coronoid. The space between them leads straight under the arch. If the elevator stays superficial to the fascia it ends up lateral to the arch.
Peterson's Principles of OMS, 3rd ed, ch 21, p 470; Rowe & Williams, vol 1, ch 12, p 476
Answer: A. Children's elastic bone favours trapdoor fractures that snap back and trap tissue. They may show few of the usual signs, but nausea and vomiting are common and bradycardia suggests the oculocardiac reflex. Severe restriction that matches the CT is a true emergency.
Peterson's Principles of OMS, 3rd ed, ch 22, pp 501–502; ch 26, p 585
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