Cheilitis granulomatosa, facial paralysis and scrotal tongue is seen in:

 # Cheilitis granulomatosa, facial paralysis and scrotal tongue is seen in:

A. Miescher syndrome

B. Melkersson-Rosenthal syndrome

C. Apert syndrome

D. Peutz-Jeghers syndrome

The correct answer is B. Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome is a rare condition consisting of a triad of persistent or recurring lip or facial swelling, intermittent seventh (facial) nerve paralysis (Bell’s palsy), and a fissured tongue.

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Farmer’s lip is also known as:

 # Farmer’s lip is also known as:

A. Actinic cheilitis

B. Cheilitis granularis

C. Oral submucous fibrosis

D. Noma

Actinic cheilitis, sometimes known as "farmer's lip" or "sailor's lip," is a precancerous condition related to cumulative lifetime sun exposure. The lower lip is most often affected. Individuals with actinic cheilitis often complain of persistent dryness and cracking of the lips.

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Dry socket commonly occurs after:

 # Dry socket commonly occurs after:

A. 24 hours

B. 2 days

C. 3-4 days

D. 10-15 days

The correct answer is: C. 3-4 days.

Dry socket or alveolar osteitis is delayed healing but is not associated with an infection. This postoperative complication causes moderate to severe pain but is without the usual signs and symptoms of infection such as fever, swelling, and erythema. The term dry socket describes the appearance of the tooth extraction socket when the pain begins. In the usual clinical course, pain develops on the third or fourth day after removal of the tooth. Almost all dry sockets occur after the removal of lower molars.

The occurrence of a dry socket after a routine tooth extraction is rare (2% of extractions), but it is frequent after the removal of impacted mandibular third molars and other lower molars (20% of extractions in some series).

The treatment of alveolar osteitis is dictated by the single therapeutic goal of relieving the patient’s pain during the period of healing. If the patient receives no treatment, no sequela other than continued pain exists (treatment does not hasten healing).

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The recurrent ranula is best treated by:

 # The recurrent ranula is best treated by:

A. Electrosurgery

B. Cryosurgery

C. Marsupialization

D. Sublingual gland excision

The correct answer is D. Sublingual gland excision.

The usual treatment of a ranula is marsupialization, in which a portion of the oral mucosa of the floor of the mouth is excised, along with the superior wall of the ranula. Subsequently, the ranula wall is sutured to the oral mucosa of the floor of the mouth and allowed to heal by secondary intention with cicatrix formation and a decreased likelihood of recurrence. The preferred treatment for recurrent or persistent ranulas is excision of the ranula as well as the sublingual gland via an intraoral approach to the anterior floor of mouth; several recent studies have indicated that this might be appropriate for initial therapy since the recurrence rate with marsupialization may be unacceptably high. 

Hupp, 6th Edition page 410

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In unilateral TMJ ankylosis, the chin is deviated to:

 # In unilateral TMJ ankylosis, the chin is deviated to:

A. The contralateral side

B. The affected side

C. No deviation seen

D. Side where growth is occurring

The correct answer is B. The affected side.

In unilateral ankylosis occurring at an early age, the chin is displaced laterally and backward on the affected side because of a failure of development of the mandible. When an attempt is made to open the mouth, the chin deviates toward, the ankylosed side, if any motion is present. Bilateral ankylosis occurring in childhood results in underdevelopment of the lower face; a receding chin and micrognathia. The maxillary incisors often manifest overjet due to failure of this mandibular growth.

Ref: Shafer's Textbook of Oral Pathology, 7th Edition, Page No. 742

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Ideal time for repair of a cleft lip is:

 # The ideal time for repair of a cleft lip is:

A. Immediately after birth

B. 3 weeks to 3 months

C. 3 months to 3 years

D. After puberty

The correct answer is B. 3 weeks to 3 months.

Variations occur in timing of the first lip surgery; however, the most usual time occurs at approximately three months of age. Pediatricians used to strictly follow a rule of ‘three 10s’ as a necessary requirement for identifying the child’s status as suitable for surgery (i.e. 10 lb, 10 mg/L of hemoglobin, and age 10 weeks). Although pediatricians are presently much more flexible, and some surgeons may well justify a neonatal lip closure, the rule of three 10s is still very useful.

Ref: Shafer's Textbook of Oral pathology, 7th Edition, Page no. 21

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Severe pain in an extraction socket after 3 days of extraction

 # A patient comes with severe pain in an extraction socket after 3 days of extraction. Which of the following drugs would you prescribe?

A. Amoxicillin

B. Metronidazole

C. Diclofenac

D. Tramadol

The correct answer is B. Metronidazole.

Dry socket or alveolar osteitis is delayed healing but is not associated with an infection. This postoperative complication causes moderate to severe pain but is without the usual signs and symptoms of infection such as fever, swelling, and erythema. The term dry socket describes the appearance of the tooth extraction socket when the pain begins. In the usual clinical course, pain develops on the third or fourth day after removal of the tooth. Almost all dry sockets occur after the removal of lower molars.

The occurrence of a dry socket after a routine tooth extraction is rare (2% of extractions), but it is frequent after the removal of impacted mandibular third molars and other lower molars (20% of extractions in some series).

The treatment of alveolar osteitis is dictated by the single therapeutic goal of relieving the patient’s pain during the period of healing. If the patient receives no treatment, no sequela other than continued pain exists (treatment does not hasten healing). Both Tramadol and Diclofenac can be used for pain but as this is a single response type of question, B. Metronidazole should be the correct answer.

Treatment consists of irrigation of the socket and placement of an obtundent dressing. This may be supplemented with metronidazole 200–400 mg three times a day for 3 days to eradicate any secondary anaerobic infection that is present.

Ref: An Introduction to Oral and Maxillofacial Surgery David A. Mitchell,   SECOND EDITION Page 137

The goal of treatment of dry socket is to relieve the patient’s pain during the delayed healing process. This is usually accomplished by irrigation of the involved socket, gentle mechanical débridement, and placement of an obtundent dressing, which usually contains eugenol. The dressing may need to be changed on a daily basis for several days and then less frequently after that. The pain syndrome usually resolves within 3 to 5 days, although it may take as long as 10 to 14 days in some patients. There is some evidence that topical antibiotics such as metronidazole may hasten resolution of the dry socket.

Ref: Peterson's 3rd edition, page 115

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