Dental Oral Surgery and Anesthesia — MCQ ও উত্তর

ডেন্টাল ভর্তি · । এই অধ্যায়ে মোট 113টি প্রশ্ন আছে। নিচে প্রথম 10টি প্রশ্ন ও সঠিক উত্তর দেওয়া হলো।

এই অধ্যায়ে সব প্রশ্নে অনুশীলন করুন

1. In the surgical management of Ludwig's angina, the incision should be extended deeply up to which anatomical layer?

   1. Mucous membrane of the floor of the mouth
   2. Subcutaneous tissue above the mylohyoid muscle
   3. Muscle fibers of the mylohyoid muscle
   4. Periosteum of the mandible

   সঠিক উত্তর: Mucous membrane of the floor of the mouth

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A In the surgical management of Ludwig's angina, the incision must be extended deeply up to the mucous membrane of the floor of the mouth to ensure adequate drainage of the submandibular and sublingual spaces. This approach allows direct access to the infected fascial planes beneath the mylohyoid muscle, which is commonly involved in Ludwig's angina. Incising only superficial layers risks incomplete drainage and persistence of infection. Extending the incision to the mucous membrane provides a pathway for thorough evacuation of pus and decompression, preventing airway compromise. Hence, deep extension to the mucous membrane is crucial for effective management. Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

2. Why do infections in the masticator space typically not spread into the neck region?

   1. The fascia is tightly adherent to the periosteum at the inferior border of the mandible
   2. The presence of a dense lymphatic barrier between masticator space and neck
   3. The masticator space lacks any communication with neck fascial spaces
   4. The mandibular nerve blocks the downward spread of infection

   সঠিক উত্তর: The fascia is tightly adherent to the periosteum at the inferior border of the mandible

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Infections in the masticator space rarely spread into the neck because the deep cervical fascia is firmly adherent to the periosteum along the inferior border of the mandible. This anatomical fusion acts as a natural barrier preventing downward extension of infection from the masticator space into the neck spaces. As a result, infections tend to remain confined within the masticator compartment rather than spreading inferiorly. Understanding this fascial adherence is crucial in surgical planning and infection management in maxillofacial regions.Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

3. Which of the following is a hallmark clinical feature of an infection involving the masticator space?

   1. Trismus
   2. Dysphagia
   3. Facial nerve palsy
   4. Lower lip anesthesia

   সঠিক উত্তর: Trismus

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Infection of the masticator space commonly causes trismus due to inflammation and spasm of the muscles of mastication, particularly the masseter and pterygoid muscles, which are contained within this space. This limits mouth opening and is a hallmark clinical feature. Other symptoms like dysphagia, facial nerve palsy, or lower lip anesthesia are not characteristic findings for masticator space infections but may suggest involvement of different anatomical structures or spaces. Identifying trismus helps in localizing the infection to the masticator space.Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

4. Both masticator space and lateral pharyngeal space infections present with swelling in similar regions. What feature distinguishes a masticator space infection from a lateral pharyngeal space infection?

   1. The swelling in masticator space infection does not displace towards the midline
   2. Masticator space infection causes deviation of the uvula to the opposite side
   3. Masticator space infection shows trismus more commonly than lateral pharyngeal space infection
   4. Masticator space infection typically causes medial displacement of the carotid artery

   সঠিক উত্তর: The swelling in masticator space infection does not displace towards the midline

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Masticator space infections cause swelling that typically does not cross or displace towards the midline because the space is enclosed by rigid fascial boundaries, limiting medial expansion. In contrast, lateral pharyngeal space infections tend to produce medial displacement of the pharyngeal wall and swelling towards the midline, often leading to uvular deviation and airway compromise. Moreover, trismus is common in masticator space infections due to involvement of the muscles of mastication. However, the key distinguishing feature is the lack of medial displacement of swelling in masticator space infections, helping clinicians differentiate between these two deep neck space infections. Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

5. Infections originating in the masticator space can spread to all of the following anatomical spaces except:

   1. Parapharyngeal space
   2. Infratemporal fossa
   3. Submandibular space
   4. Orbit

   সঠিক উত্তর: Submandibular space

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option C Infections originating in the masticator space can spread to the parapharyngeal space and infratemporal fossa due to their direct anatomical communication. However, the submandibular space is separated from the masticator space by the mandibular body and associated fascial barriers, preventing direct spread. The orbit can be involved via extensions through the infratemporal fossa or fractures that communicate with the orbital floor. Therefore, infections do not directly spread from the masticator to the submandibular space without involvement of intermediate spaces.Reference: Neelima Anil Malik, Textbook of Oral & Maxillofacial Surgery, 6th ed. (2025).

6. What is the preferred approach for incision and drainage of an abscess in the masticator space?

   1. Intraorally through the posterior buccal mucosa
   2. Extraorally via a subangular incision
   3. Through a transnasal endoscopic approach
   4. Intraorally through the retromolar trigone

   সঠিক উত্তর: Extraorally via a subangular incision

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B The preferred approach for incision and drainage of a masticator space abscess is extraorally via a subangular incision because this provides direct and adequate access to the deep masticator space. Intraoral approaches are limited by restricted exposure and risk of inadequate drainage due to the complex anatomy and depth of the space. The extraoral subangular incision allows for better visualization, complete evacuation of pus, and thorough debridement while minimizing neurovascular injury. This approach also facilitates placement of drains to prevent recurrence and promotes proper healing. Thus, it is the safest and most effective method for managing deep masticator space abscesses.Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

7. Which fascial space is most commonly involved in infections originating from the mandibular first molar?

   1. Pterygomandibular space
   2. Sublingual space
   3. Submandibular space
   4. Buccal space

   সঠিক উত্তর: Sublingual space

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B Infections from the mandibular first molar most commonly involve the sublingual space because the root apices of this tooth lie above the mylohyoid muscle attachment. When the infection breaks through the lingual cortical plate above this muscle, it spreads into the sublingual space. This is critical for surgical drainage as the sublingual space lies above the mylohyoid, unlike the submandibular space which is beneath it. Proper identification of the involved space determines the appropriate intraoral or extraoral surgical approach to effectively manage the infection and prevent its spread.Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

8. A patient develops ophthalmoplegia along with meningeal irritation signs following extraction of an upper central incisor. What is the most likely diagnosis?

   1. Subdural empyema
   2. Cavernous sinus thrombosis
   3. Orbital cellulitis
   4. Brain abscess

   সঠিক উত্তর: Cavernous sinus thrombosis

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B The development of ophthalmoplegia and meningeal irritation signs after extraction of an upper central incisor strongly suggests cavernous sinus thrombosis. This is due to the venous drainage of the facial region through veins that connect directly to the cavernous sinus without valves, allowing for rapid spread of infection. The involvement of cranial nerves III, IV, and VI causes ophthalmoplegia, while meningeal signs result from intracranial extension. Early recognition and aggressive management are crucial to prevent fatal complications. Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).

9. Which diagnostic approach did Eagelton emphasize for confirming cavernous sinus thrombosis?

   1. Identify the site of infection
   2. Perform lumbar puncture to assess CSF pressure
   3. Evaluate pupillary light reflex abnormalities
   4. Check for unilateral facial muscle weakness

   সঠিক উত্তর: Identify the site of infection

   ব্যাখ্যা: সমাধান সঠিক উত্তর: Option A Eagelton emphasized the importance of identifying the site of infection as the primary diagnostic approach in cavernous sinus thrombosis. This is crucial because the infection often originates from contiguous areas such as the face, orbit, or paranasal sinuses. Recognizing the initial source allows for targeted management to control the spread of infection and prevent further complications. Accurate identification guides appropriate surgical drainage and antibiotic therapy, which are essential for patient recovery. Therefore, locating the primary infection site is fundamental to confirming the diagnosis and planning effective treatment.Reference: Bailey & Love’s Short Practice of Surgery, 27th ed. (2018).

10. When does a dissecting subperiosteal abscess typically develop following extraction of the third molar?

    1. Within 24 hours at the site of extraction
    2. Several weeks later, distant from the third molar extraction site
    3. Immediately after surgery with localized swelling
    4. Within 3-5 days confined to the extraction socket

    সঠিক উত্তর: Several weeks later, distant from the third molar extraction site

    ব্যাখ্যা: সমাধান সঠিক উত্তর: Option B A dissecting subperiosteal abscess typically develops several weeks after third molar extraction due to secondary infection spreading beneath the periosteum, often distant from the original extraction site. This delayed presentation contrasts with immediate post-operative infections that are confined to the socket or adjacent tissues. The abscess forms as bacterial invasion tracks along fascial planes, leading to a localized collection under the periosteum, which is anatomically separate from the extraction wound. This characteristic timing and location are key in diagnosis and surgical management.Reference: Miloro M et al., Peterson’s Principles of Oral & Maxillofacial Surgery, 4th ed. (2024).