DEPARTMENT OF ORAL AND

MAXILLOFACIAL SURGERY
GOVERMENT DENTAL COLLEGE &
HOSPITAL, AHMEDABAD.

Mandibular Fracture

Presented by :- Naziya Shaikh

Jigna Patel
Intern Batch :- 2014 15.
1

Que.:- 1. Fracture of mandible all are true except.

A.
B.
C.
D.

Fractures of the mandible are common at the angle of the mandible

Fractures of the mandible are effected by the muscle pull
Fractures of the mandible are usually characterized by sublingual hematoma
C.S.F. rhinorrhea is a common finding

Ans.:- D. C.S.F. rhinorrhea is a common finding

Exp.:- CSF rhinorhea is seen in Le Fort II, III and in cases of severe
nasoethmoidal fractures.
Ref.:- Vinod Kapoor, 2nd edition, Page No. 290, 291.
Que:- 2. The ideal treatment for fracture of the angle of mandible is
A.
B.
C.
D.

Transosseous wiring
Intermaxillary fixation
Plating on the lateral side of the body of the mandible
Plating at the inferior border of the mandible.

Ans:- D. Plating at the inferior border of the mandible.

Exp.:- Compression plates are used at inferior border of mandible below the
inferior dental canal. If there is opening of the upper border, it is necessary
to apply a tension band in the form of arch bar or miniplates at the upper
border.
Ref. :- Neelima Malik, 1st Edition, Page No. 321, 364.

Que:-3. A 7-year-old boy presented with fracture of left sub condylar region
with occlusion undisturbed, the treatment would be.
A.
B.
C.
D.

Immobilization for 7 days

Immobilization for 14 days with intermittent active opening
No immobilization with restricted mouth opening for 10 days
No immobilization and active treatment

Ans:- D . No immobilization and active treatment

Exp:- In case of subcondylar fracture in children below 10 years No immobilization and active treatment is required if the occlusion is
undisturbed.
If the occlusion is grossly deranged, IMF is indicated for 7-10 days with
intermittent active mouth openings.
Ref.:- Killeys Mand # 4th Edition, Page No. 100 / Vinod Kapoor, 2nd edition,
Page No. 281.
Que:- 4. A fracture mandible should be immobilized for an average of
A.
B.
C.
D.

3 Weeks
6 Weeks
9 Weeks
12 Weeks

Ans:- B. 6 Weeks
Exp.:- Period of immobilization for fractures of tooth-bearing areas of mandible.
a. Young adult with fracture of the angle receiving early treatment in which
tooth removed from fracture line 3 weeks
b. If tooth retained in fracture line 1 week is added. ( 3+1=4 weeks )
c. If fracture occurs at the symphysis 1 week is added. ( 4+1 = 5 weeks )
d. If the patient age is 40 years and over 1 or 2weeks are added.
e. If fracture occurs in children and adolescents Subtract 1 week.
Ref.:- Killeys Mand # 4th Edition, Page No. 45 / Vinod Kapoor, 2nd edition,
Page No. 253.
3

Que:-5. Most common complication of condylar injuries in children

A.
B.
C.
D.

Pain
Ankylosis
Osteoarthritis
Fracture of glenoid fossa

Ans :- B . Ankylosis
Exp:- To avoid this, early mobilization is indicated in cases of young children.
Ref.:- Killeys Mand # 4th Edition, Page No. 98 / Vinod Kapoor, 2nd edition,
Page No. 279.
Que:-6. In case of sub condylar fracture, the condylar move in
A.
B.
C.
D.

Anterior lateral direction

Posterior medial direction
Posterior lateral direction
Anterior medial direction

Ans:- D . Anterior medial direction

Exp.:- The condyle is moved in anterio medial direction under the influence of
lateral pterygoid or external pterygoid muscle.
Ref.:- Killeys Mand # 4th Edition, Page No. 14 / Vinod Kapoor, 2nd edition,
Page No. 250.
Que:-7 . A patient with unfavourable fracture of the angle of mandible is best
treated by:
A.
B.
C.
D.

Closed reductionwith intermaxillary fixation

Closed reduction with cap splints
Open reduction with interosseous wiring
Open reduction with rigid bone fixation

Ans:- D . Open reduction with rigid bone fixation

Ref.:- Killeys Mand # 4th Edition, Page No. 50, 54 / Vinod Kapoor, 2nd edition,
Page No. 252.
4

Que:- 8 . The fracture of the tooth bearing segment of the mandible is

A.
B.
C.
D.

Simple
Complex
Compound
Comminuted

Ans:- C . Compound
Exp.: Simple fracture includes liner # of condyle, coronoid ramus and edentulous
body of mandible.
Compound fracture include fractures of tooth bearing portions of mandible.
Green stick fracture is a rare type of simple # and is found is found
exclusively in children.
Comminuted fracture are due to direct violence to mandible from
penetrating sharp objects and missiles.
Ref.:- Killeys Mand # 4th Edition, Page No. 4 / Vinod Kapoor, 2nd edition,
Page No. 243.
Que:-9. The proximal segmental of mandibular angle fracture usually displaced in
which direction
A.
B.
C.
D.

Anterior and superior

Posterior and interior
Interior only
Posterior and superior

Ans:- A. Anterior and superior

Exp.:- Fracture of angle of mandible are influenced by the pull of medial
pterygoid, masseter and temporalis muscles, which displace the ramus in
superior and anterior direction. This is a horizontally unfavorable fracture.
Ref.:- Killeys Mand # 4th Edition, Page No. 12 / Vinod Kapoor, 2nd edition,
Page No. 244,245.

Que:-10. Displaced mandibular fracture in a child should be managed by.

A.
B.
C.
D.

Circum mandibular wiring

Early mobilization
Intermaxillary fixation
Transosseous wiring

Ans:- B . Early mobilization

Ref.:- Killeys Mand # 4th Edition, Page No. 107 / Vinod Kapoor, 2nd edition,
Page No. 278.
Que:-11. A fracture of the mandible in the canine region in a 6 year old child
should be managed by.
A.
B.
C.
D.

Cap splint fixation

Intermaxillary fixation
Risdon wiring
Transosseous wiring

Ans:- A . Cap splint fixation

Exp.:- The use of acrylic cap splint with circumferential wiring is the best method
to treat mandibular fractures in children.
Ref.:- Killeys Mand # 4th Edition, Page No. 108 / Vinod Kapoor, 2nd edition,
Page No. 278.
Que:-12. The most common site of fracture of the mandible is the:
A.
B.
C.
D.

Body
Angle
Symphysis
Condyle

Ans:- B. Angle
Exp.:- Because of sudden change in angulation, angle is considered as weakest
part of mandible.
6

Ref.:- Vinod Kapoor, 2nd edition, Page No. 278.

Que:-13. Bucket handle type of fractures are seen in
A.
B.
C.
D.

Children
Soldiers
Edentulous persons
Young adults

Ans:- C . Edentulous persons

Exp.:- In edentulous mandible, the molar areas are weakened following alveolar
resorption and become the site for bilateral fracture of edentulous mandible.
There is downward and backward movement of anterior part of mandible
under the influence of digastrics and mylohyoid muscles.
Ref.:- Killeys Mand # 4th Edition, Page No. 16.
Que:- 14. A fracture mandibular condyle is displaced forward and medially
by the action of the following muscle:
A.
B.
C.
D.

Temporalis
External pterygoid
Internal pterygoid
Masseter

Ans:- B . External pterygoid

Ref.:- Killeys Mand # 4th Edition, Page No. 14 / Vinod Kapoor, 2nd edition,
Page No. 248.
Que:- 15. Compression osteosynthesis heals fracture mandible by:
A.
B.
C.
D.

Primary union with out callus formation

Secondary union with out callus formation
Compression union
All of the above.

Ans:- A . Primary union with out callus formation

Ref.:- Killeys Mand # 4th Edition, Page No. 46.
7

Que:- 16. Primary healing of a mandibular fracture is seen following fixation

with:
A.
B.
C.
D.

Gunning splints
Compression plates
Trans-osseous wires
Clampy plates

Ans:- B . Compression plates

Exp.:- Bone plating is of three types- simple, non-compression plates, mini plates
and compression plates.
Ref.:- Killeys Mand # 4th Edition, Page No. 46 / Vinod Kapoor, 2nd edition,
Page No. 267.
Que:-17. Eburnation is seen in
A.
B.
C.
D.

Malunion
Non union
Osteomyelitis
Osteoradionecrosis

Ans:- B. Non union

Exp.:- Eburnation is seen in the case of non-union of # and the radiographs show
rounding off and sclerosis of bone ends.
Ref.:- Killeys Mand # 4th Edition, Page No. 125.
Que:-18. Green stick fractures are most common with:
A. Older people
B. Adult
C. Children
D. Soldiers
Ans:- C . Children
Exp.:- Green stick fracture is a variant of simple # and is found exclusively in
children.
8

Ref.:- Killeys Mand # 4th Edition, Page No. 4.

Que:-19. Lower lip paresthesia occurs in
A.
B.
C.
D.

Body fracture
Symphysis fracture
Coronoid fracture
Condyle fracture

Ans:- A. Body fracture

Exp.: Damage to the interior alveolar nerve after fracture, results in the
paraesthesia or anesthesia of the lower lip on the affected side.
Although changes in sensation in the lower lip and chin may be related to
chin and lip lacerations and blunt trauma, numbness in the distribution of
inferior alveolar nerve after trauma is almost pathognomic of a fracture
distal to the mandibular foramen.
Ref.:- Neelima Malik 1st Edition, Page No.350/ Textbook of oral and maxillofacial
trauma by Raymond J Fonseca 3rd Edition vol 1 498,571.
Que:-20. The treatment for a mandibular fracture between the incisors is:
A.
B.
C.
D.

Risdon wiring
Essig wiring
Cap splint with circum-mandibular wiring
Transosseous wiring

Ans:- A . Risdon wiring

Exp.:- Risdon wiring is indicated for symphysis # when all the teeth are present in
the arch.
Ref.:- Vinod Kapoor, 2nd edition, Page No. 267.

Que:-21. Open reduction & fixation of fracture of mandibular condyle is

indicated when.
A.
B.
C.
D.

Shortening of ramal height is more than 5 mm

Superior 5 mm condyle is fractured
Green stick fracture in children
Condylar fracture which is not dislocated

Ans:- A . Shortening of ramal height is more than 5 mm

Exp.:- Greatly displaced and dislocated fractures ( separation of fragments
exceeding 5mm and displacements exceeding 30 degrees ) increasingly, a
functional conservative treatment is worth considering in less severely
dislocated fractures.
Ref.:- Peter Ward Booth Maxillofacial Surgery, 2nd Edition, Vol. 1 82.
Que:-22. The most common pathognomonic sign of mandibular fracture is:
A.
B.
C.
D.

Malocclusion
Sublingual hematoma
Deviation of the jaw on opening
Paraesthesia of the mental nerve

Ans:- A. Malocclusion
Exp.:-Sublingual hematomas followed by malocclusion, both are considered as
pathognomonic signs of mandibular fracture.
Ref.:- Killeys Mand # 4th Edition, Page No. 31 / Vinod Kapoor, 2nd edition,
Page No. 250.

10

Que:- 23. Direct inter dental wiring is also known as:

A.
B.
C.
D.

Risdons wiring
Gilmers wiring
Eyelet wiring
Col. Stouts wiring

Ans:- B . Gilmers wiring

Exp.:- In presence of sufficient numbers of teeth, simple fractures of tooth-bearing
part of the mandible is adequately immobilized by IMF alone. Gilmers
direct method of wiring is simplest and rapid method of immobilizing the
jaws. In this method, the wires are directly attached to the teeth. It is
therefore difficult to release the intermaxillary connection without stripping
off all the fixation.
Ref.:- Vinod Kapoor, 2nd edition, Page No. 254.
Que:-24. An adult patient sustained a subcondylar fracture on the left side.
Clinically it is seen that there is:
A.
B.
C.
D.

Moderate intraoral bleeding

Trismus and bilateral crepitus
Deviation of the mandible to the right on protrusion
Inability to deviate the mandible to the right

Ans:- D . Inability to deviate the mandible to the right

Exp.:- In case of unilateral condylar #, the mandible deviates towards the side of
fracture, the patient cannot deviate the mandible to the opposite side
because of ineffective action of lateral pterygoid on the fractured side.
Ref.:- Killeys Mand # 4th Edition, Page No. 28.

11

Que:-25. The weakest point of the mandible where fracture occurs is

A.
B.
C.
D.

Neck of the mandible

Angle of the mandible
Symphysis menti
Oblique ridge near mental foramen

Ans:- B . Angle of the mandible

Ref.:- Vinod Kapoor, 2nd edition, Page No. 240.
Que:-26. Direct impact on the bone will produce a:
A.
B.
C.
D.

Transverse fracture
Oblique fracture
Spiral fracture
Comminuted fracture

Ans:- A. Transverse fracture

Exp.: A direct blow usually causes a transverse fracture and damage to overlying
skin
Crushing is more likely to cause a comminuted fracture.
Twisting causes spiral fracture.
Compression causes a short oblique fracture.
Bending results in fracture with a triangular butterfly fragment.
Ref.:- Apleys System of orthopedics and fractures 8th , Edition 539/ Check
Explanation Below .

12

Que:- 27. A deviation of mandible to right side may suggest

A.
B.
C.
D.

Fracture of Le fort condyle

Hyperplasia of right condyle
Hypoplasia of left condyle
Fracture of right condyle

Ans:- D . Fracture of right condyle

Ref.:- Killeys Mand # 4th Edition, Page No. 28 / Vinod Kapoor, 2nd edition,
Page No. 249.
Que:-28. If fracture of mandible occurs distal to lost tooth, the treatment of
choice:
A.
B.
C.
D.

Closed reduction with IMF

Open reduction with bone plating
Open reduction with interosseous wiring
Closed reduction with cap splint

Ans:- B . Open reduction with bone plating

Ref.:- Killeys Mand # 4th Edition, Page No. 50,54 / Vinod Kapoor, 2nd edition,
Page No. 252.
Que:- 29. Following bilateral mandibular fracture in the canine region, the
following muscles will tend to pull the mandible back:
A.
B.
C.
D.

Genioglossus and anterior belly of digastrics

Genioglossus and mylohyoid
Genioglossus and thyrohyoid
Genioglossus and masseter

Ans:- A . Genioglossus and anterior belly of digastrics

Exp.:- This type of fracture results in removal of tongue attachment to the
mandible and allows the tongue to fall back and obstruct the oropharynx.
13

Ref.:- Killeys Mand # 4th Edition, Page No. 50,54 / Vinod Kapoor, 2nd edition,
Page No. 252.
Que:-30. Treatment of choice to manage symphyseal fracture in a 8-year-old
child is:
A.
B.
C.
D.

Intermaxillary fixation
Cap splint with circumferential wiring
Open reduction
No treatment indicated

Ans:- B. Cap splint with circumferential wiring

Exp.:- Symphysis fracture in adult patient is usually treated by Risdon wiring.
Mandibular fractures in children with mixed dentition is treated by acrylic
cap splints with circumferential wiring.
Ref.:- Killeys Mand # 4th Edition, Page No. 108.
Que:-31. Fracture of body of mandible with full arch of teeth ( undisplaced ) is
treated by:
A.
B.
C.
D.

IMF
Open reduction and internal fixation
Close reduction and internal fixation
External pin fixation

Ans:- A . IMF
Exp.:- Dental wiring is used when the patient has a complete or almost complete
set of teeth.
Arch bars are useful when the patienthas an insufficient number of suitably
shaped teeth to enable effective interdenatal eyelet wiring.
Ref.:- Killeys Mand # 4th Edition, Page No. 58 / Vinod Kapoor, 2nd edition,
Page No. 254.

14

Que:-32. In osteosynthesis all are used except:

A.
B.
C.
D.

Lag screw
Wires
Clampy bone plate
Eyelet wiring

Ans:- D . Eyelet wiring

Exp.:- Bonded brackets, dental wiring, arch bars and cap aplints, all come under
IMF without osteosynthesis .
a. Osteosynthesis without IMF:
1.
2.
3.
4.

Non-compression small plates

Compression plates
Miniplates
Lag screws

b. Intermaxillary fixation:
1. Bonded brackets
2. Dental wiring
Direct
Eyelet
3. Arch bars
4. Cap splints
c. IMF with osteosynthesis:
1.
2.
3.
4.
5.

Transosseous wiring
Circumferential wiring
External pin fixation
Bone clamps
Transfixation with Kirschner wires

Ref.:- Killeys Mand # 4th Edition, Page No. 46.

15

Que:-33. Fracture of mandible not involving dental arch is treated by:

A.
B.
C.
D.

Open reduction
Closed reduction
No treatment required
None of the above

Ans:- A. Open reduction

Exp.:- Reduction methe restoration of afunctional alignment of bone fragments.
Fracture of mandible not involving dental arch is treated by open reduction.
Fracture of dentate mandible is treated by closed reduction since the
presence of teeth provides an accurate guide for closed reduction.
Ref.:- Killeys Mand # 4th Edition, Page No. 41 / Vinod Kapoor, 2nd edition,
Page No. 252.
Que:-34. Treatment of choice of a linear non-displaced fracture of the body of
the mandible, with full compliment of teeth is
A.
B.
C.
D.

Kirschner wire
Circumferential wiring
External pin fixation
Inter dental fixation

Ans:- D . Inter dental fixation

Exp.:- The interdental eyelet wiring is treatment of choice of a linear fracture with
full compliment of teeth. About five eyelets are applied in upper arch and
five in the lower arch and then the eyelets are connected with tie wires.
Ref.:- Killeys Mand # 4th Edition, Page No. 60 / Vinod Kapoor, 2nd edition,
Page No. 254.

16

Que:-35.Which of the following condition is associated with anterior open

bite
A.
B.
C.
D.

Unilateral condylar #
Bilateral condylar #
Maxillary fractures
Coronoid fracture

Ans:- B . Bilateral condylar #

Exp.:- Open bite is seen bilateral condylar fracture and horizontal fracture of
maxilla.
Ref.:- Killeys Mand # 4th Edition, Page No. 28 / Vinod Kapoor, 2nd edition,
Page No. 281.
Que:- 36. When subcondylar fractures on protrusion of mandible it deviates
to
A.
B.
C.
D.

Same side
Opposite side
Does not move
Retrudes

Ans:- A. Same side

Ref.:- Killeys Mand # 4th Edition, Page No. 28.
Que:- 37. Battles sign is:
A.
B.
C.
D.

Sub-conjuctival ecchymosis.
Sub-lingual ecchymosis
Palatal ecchymosis
Ecchymosis in the mastoid region.

Ans:- D . Ecchymosis in the mastoid region.

17

Ref.:- Killeys Mand # 4th Edition, Page No. 28 / Vinod Kapoor, 2nd edition,
Page No. 281.
Que:-38. Risdon wiring is indicated for
A.
B.
C.
D.

Body fracture
Angle fracture
Symphysis fracture
Subcondylar fracture

Ans:- C . Symphysis fracture

Ref.:- Vinod Kapoor, 2nd edition, Page No. 257.
Que:- 39. The optimum length of screw, for fixation of plate in mandible is
A.
B.
C.
D.

2 mm
3 mm
4 mm
6 mm

Ans:- C . 3 mm
Exp.:- Usually the thickness of buccal cortex is around 3.5 mm. A 4 mm length
screw is adequate for proper screw-bone contact.
Que:- 40. A displaced, unfavorable fracture in the mandibular angle region is
a potentially difficult fracture to treat because of
A.
B.
C.
D.

Injury to neurovascular bundle

Malocclusion secondary to injury
Distraction of fracture segments by muscle pull
Increased density of bone in this region of mandible

Ans:- C . Distraction of fracture segments by muscle pull

Exp.:- In case ofunfavourable fracture, the posterior fragment is pulled lingually
under the influence of medial pterygoid muscle. The treatment consists of
open reduction of the fragments followed by rigid fixation with bone
plating.
18

Ref.:- Killeys Mand # 4th Edition, Page No. 12 / Vinod Kapoor, 2nd edition,
Page No. 247, 248.
Que:-41.The splint which is most commonly used in dentulous mandibular
fracture is
A.
B.
C.
D.

Gunning splint
Cap splint
Ribbon splint
All of these

Ans:- B . Cap splint

Exp.:- Indications for silver cap splints:
Patient with extensive and advanced periodontal disease. A cap splint in this
situation will splint all the loose teeth together and allow the application of
IMF.
When a portion of the body of mandible is missing together with substantial
tissue loss, a cap splint will allow the remaining tooth-bearing segments to
be maintained in their correct relationship.
To provide prolonged fixation on the mandibular teeth in a patient with
fracture of condylar neck.
Ref.:- Killeys Mand # 4th Edition, Page No. 66,108 / Vinod Kapoor, 2nd edition,
Page No. 259.
Que:-42. Gunning splints are used when the patient is:
A.
B.
C.
D.

Dentulous
Edentulous
Children
Young adults

Ans:- B. Edentulous
Exp.:- Rarely in very young children ( option C) with unerupted or very few
deciduous teeth, Gunning type splints are used. But option B is more
appropriate.
19

Ref.:- Killeys Mand # 4th Edition, Page No. 87.

Que:-43. Which of the following is used for Figure of eight wiring for
stabilization of subluxated teeth in alveolar injuries:
A.
B.
C.
D.

0.23 mm stainless steel wire

0.35 mm stainless steel wire
0.45 mm stainless steel wire
0.55 mm stainless steel wire

Ans:- B . 0.35 mm stainless steel wire

Ref.:- Rowe & Williams 2nd Edition, Page no. 383.
Que:- 44. The radiographic view of choice for diagnosing horizontally
favorable and unfavorable # is:
A.
B.
C.
D.

OPG
Occlusal
Lateral oblique view
Transpharyngeal

Ans:- C . Lateral oblique view

Exp.:- To decide whether the # is horizontally favourable or unfavourable the
mandible should be viewed from the horizontal plane or studied by taking
oblique lateral radiographic view.
Ref.:- Neelima Malik 2nd Edition, Page no. 383.

20

Que:- 45. In lingual splaying of guardsman fracture with ORIF, which is the
clinical feature?
A.
B.
C.
D.

Increased intercanthal distance

Increased interpupillary distance
Increased gonion gnathion distance
Increased interangular distance

Ans:- D . Increased interangular distance

Exp.:- The type of mandibular fracture more prone for complication is
symphyseal fracture associated with condylar fractures and poor dentition.
In this type of fractures muscle pull from the tongue and suprahyoids can
cause lateral flaring of the mandibular angles and lingual tipping of the
buccal segments. The buccal fracture line at the symphysis remains intact,
but the lingual cortex is separated.
Ref.:- Oral and Maxillofacial trauma Raymond Fonseca, Robert V. Walker, 3rd
Edition, vo. 1 516.
Que:-46. Incondylar fracture with greater than 5 mm overlapping & greater
than 37 degree angulation with fracture segment, what is the line of
treatment?
A.
B.
C.
D.

Closed reduction and IMF

ORIF
Soft diet
No treatment

Ans:- B . ORIF
Exp.:- Greatly displaced and dislocated fractures (separation of fragments
exceeding 5mm and displacements exceeding 30 degrees) increasingly are
being treated surgically. A functional conservative treatment is worth
considering in less severely dislocated fractures.
21

Ref.:-Peter Ward Booth Maxillofacial Surgical, 2nd Edition, Vol. 1 81.

Que:-47. In fracture of atrophic mandible with bone loss, what is the best
treatment modility?
A.
B.
C.
D.

Bone grafting and load bearing

Bone grafting and sharing
Semi-rigid fixation
IMF with open reduction

Ans:- A. Bone grafting and load bearing

Exp.:- When the mandible is severely atrophic, it is possible thet healing will not
occur even if ORIF principles are properly applied. In some circumstances,
treatment consists of bone graft reconstruction at the time of fracture
repaire.
As the mandible is severely atrophic, load bearing is better as compared to
load shearing.
Ref.:- Peter Ward Booth maxillofacial trauma and esthetic facial and
reconstructive surgery 296.
Que:-48. A patient with condylar fracture, the occlusion is normal with
normal mouth opening. The best treatment is?
A. IMF for 3 weeks.
B. IMF for 5-6 weeks.
C. Conservative treatment, close observation and soft diet and return to normal
function as soon as possible.
D. Open reduction and bone plating.
Ans:- C . Conservative treatment, close observation and soft diet and return to
normal function as soon as possible.
Ref.:- Neelima Malik, 2nd Edition, Page no. 409.

22

Que:-49. Fracture passing through mental foramen in mandible with less than
10 mm of bone can be best managed by
A.
B.
C.
D.

Reconstruction plate
MMF
Lag screws
3-D plate

Ans:- A . Reconstruction plate

Exp.:- Fractures of the atrophic mandible
An atrophic mandible shows resorption of the alveolar process.atrophic
edentulous mandible can be extremely thin the muscular forces acting up on
the bone are incomparable to forces acting upon dentate mandible.
In fractures of the edentulous and atrophic mandible functional load must be
transmitted by using a stable fixation device.
Ref.:- Manual of internal fixation in craniofacial skeleton by J. Prein 1998 yr,
Edition 86-87
Que:-50. Champys plates are?
A.
B.
C.
D.

Semirigid fixation with monocortical screws

Semirigid fixation with bicortical screws
Rigid fixation with bicortical screws
Rigid fixation with monocortical screws

Ans:-A. Semirigid fixation with monocortical screws

Exp.:- Champhy et al elaborated on michelets work with the intraoral application
of the monocortical miniplate for the treatment of mandibular angle
fracture.
Ref.:- Neelima Malik, 1st Edition, Page no. 320 & Oral & Maxillofacial Trauma by
23

Raymond J. Fonseca 3rd Edition, Vol. 2 1147.

Que:-51. In case of fracture of mandible; alveolar border experiences which

force.
A.
B.
C.
D.

Tension
Compression
Torsion
Rotation

Ans:- A. Tension
Exp.:- Masticatory force produce tensional force I the alveolar region or at the
upper border & compression forces at the lower border. This explains the
cause of distraction of fracture segments in the upper border, and
compression in the lower border.
Ref.:- Textbook of oral & Maxillofacial surgery by S.M. Balaji, 1st Edition,
Page no. 581.
Que:-52. In mandibular angle fracture, which is most appropriate treatment?
A.
B.
C.
D.

1 mini plate on oblique ridge

2 mini plates on lateral surface of mandible
Compression plates
Reconstruction plates

Ans:- A. 1 mini plate on oblique ridge

Exp.:- An ideal osteosynthesis lines for the mandibular body corresponds to the
course of line of tension at the base of the alveolar process. In this region, a
plate can be fixed with monocortical self tapping screws.
Ref.:- Neelima Malik 1st Edition 321, 364/ Internal fixation of mandibular angle
fracture with the Champy technique Operative Techniques in
Otolaryngology Head and Neck Surgery, Volume 19, Issue 2,
Pages 123-127.
24

Que:- 53. Most Difficult fracture to treat

A.
B.
C.
D.

Body fracture
Angle fracture
Condylar fracture
Symphyseal fracture

Ans:- C > B
Exp.:- Condylar region of the mandible is the most vulnerable site. Although the
rate of postoperative complications is higher in the treatment of angle
fractures, the difficulties of reduction and fixation are more frequent in the
treatment of condylar fracture, due to less visibility in the operative field, a
difficult hemostasia and the possibility of facial nerve injury.
Ref.:- Manual of internal fixation in craniofacial skeleton by J. Prein 1998 yr 83.
Que:-54.Submental intubation is an alternative to tracheostomy in which type
of fractures?
A.
B.
C.
D.

Mandibular fracture.
Nasal fracture.
Panafacial fracture.
Styloid process fracture.

Ans:- C. Panafacial fracture.

Exp.: Nasal endotracheal intubation is often contraindicated in the presence of
fracture of base of skull and in presence of midface fractures, Especially
those involving cibriform plate.
comminuted midfacial fractures causes physical obstruction to the passage
of nasotracheal tube.

25

Ref.:- www. Blackwell-synergy.com

Que:-55. Use of an acrylated arch bars for closed reduction of mandible was
described by
A.
B.
C.
D.

Schuchardt (1956)
Risdon (1929)
Stanstout (1943)
Leonard (1977)

Ans:- A. Schuchardt (1956)

Exp.:- Schuchardt (1956) and Schuchardt and metz (1966) first described the use
of acrylated arch bar.
Ref.:- Rowe & Williams 2nd Edition, Vol I 302.
Que:-56. Mandibular fracture managed by adapting mini plates is a type of
A.
B.
C.
D.

Load bearing osteosynthesis

Load sharing
Non rigid osteosynthesis
Rigid osteosynthesis

Ans:- B. Load sharing

Exp.: Champy and Lodde developed and popularized an osteosynthesis system
comprising smaller plates inserted along the lines of tension.
Animal studies showed that micromovement, using semirigid or biological
fixation, encouraged prompt healing.
Ref.:- Peter Ward Booth Maxillofacial Surgery 2nd Edition, Vol 1 55.

26

Que:-57. A patient with a history of fall after hypoglycemic episode presents

with pain in bilateral preauricular region and deviation of the
mandible to right side on mouth opening, probable diagnosis will be.
A.
B.
C.
D.

Fracture of right condyle

Fracture of left condyle
Dislocation of left condyle
Dislocation of both condyles

Ans:- A. Fracture of right condyle

Exp.:- Diagnostic findings of condylar fractures
Evidence of facial trauma, especially in the area of mandible and symphysis.
Localized pain and swwlling in the region of the TMJ.
Limitation in opening
Ref.:- Neelima Malik 1st Edition, Page no. 373.
Que:-58. The most common site of mandible fracture is
A.
B.
C.
D.

Condylar head
Condylar neck
Coronoid head
Coronoid neck

Ans:- B. Condylar neck

Exp.:-The slender neck of the mandibular condyle renders it particularly liable to
fracture as a result of direct violence applied to chin. This anatomical
weakness actually acts as safety mechanism, as a fracture of the neck of the
condyle prevents injury to the middle cranial fossa.

27

Ref.:- Neelima Malik 1st Edition, Page no. 298.

Que:-59. High velocity gunshot injury with periosteal denudation &

comminuted fracture is best treated as
A.
B.
C.
D.

Bag of bones & IMF

Reconstruction plates & closure of fracture
Immediate reconstruction & grafting
Initially debridement is done, than load bearing reconstruction plates, and
grafting in secondary procedure.

Ans:- D. Bag of bones & IMF

Exp.:- High velocity bullets:
Small wound of entry and large, ragged wounds of exit. Fragmentation of
teeth, bone may serve as secondary missiles, causing extensive internal
trauma.
If usual wound care is not sufficient, then after primary treatment, extensive
reconstructive surgery is needed to restore the facial contour.
Ref.:- Neelima Malik 1st Edition, Page no. 298.
Que:-60. In which of the following conditions does internal derangement cause
mandibular deviation to the same side?
A.
B.
C.
D.

Bilateral TM Joint dislocation

TM Joint ankylosis
Unilateral TM Joint dislocation
Unilateral disk placement anteriorly without reduction

Ans:- D. Unilateral disk placement anteriorly without reduction

Exp.:- Anterior disc displacement witout reduction:
28

 Here there is a closed lock form, where the disc interferes with condylar
translation.
Patient will not be able to open the mouth further, pain in the affected joint
will be exhibited and deviation of the mandibile towards the painful side will
be noticed.
Ref.:- Neelima Malik 1st Edition, Page no. 226.
Que:-61. Most stable in closed reduction is
A.
B.
C.
D.

Screws
Arch bar
Direct wiring
None of the above

Ans:- B. Arch bar

Exp.:- As Arch Bar involves all the teeth during reduction as comparedto other
methods of reduction so it is most stable in closed reduction as compared to
other methods.
Ref.:- Check Explanation Below
Que:-62. In fracture of the body of mandible the miniplate is given
A.
B.
C.
D.

Upper border
Lower border
Between upper and lower border
One at the upper and lower border

Ans:- C. Between upper and lower border

Exp.: When a miniplates is used for fixation of a mandibular angle fracture,
placement should be at the superior aspect of the mandible extending on to
the broad surface of the external oblique ridge.

29

 In the resion between the two mental foramina, two plates are
recommended: one in the subapical region of the symphysis and the second
at the inferior border.
In the body of the mandible, one plate is recommended just below the apices
of teeth but above the inferior alveolar nerve canal.
Ref.:- Textbook of oral and maxillofacial trauma by Raymond J Fonseca, 3rd
Edition, Vol 2 1148.

Que:-63. Medial dislocation of fracturescondyle in subcondylar fracture is

caused by
A.
B.
C.
D.

Lateral pterygoid
Medial pterygoid
Masseter
Temporalis

Ans:-A. Lateral pterygoid

Exp.:- Condylar fracture is most common site of mandibular fracture ( approx.
2/3rd of all mandible fracture). The condylar fragment may be undisplaced
or frequently displaced in anteromedial direction due to pull of external
pterygoid muscle, which is attached to anteromedial aspect of condylar
head.
Ref.:- Fractures of Mandible Ranjit Sen, 1st Edition, Page no.149.
Que:-64. Le Fort III fracture is the same as
A.
B.
C.
D.

Craniofacial dysjuction
Guerrins fracture
Pyramidal fracture
None of the above

Ans:- A . Craniofacial dysjuction

Exp.:30

Le Fort I
Le Fort II
Le Fort III
Extended Le Fort
fracture

Low level or Guerin fracture or Horizontal or Telescopic

fracture
Infrazygomatic or Pyramidal fracture
High level or suprazygomatic fracture
Carnio-orbito maxillary fracture

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.13.

Que:-65. Which of the following is not included in the Glassgow coma scale
A.
B.
C.
D.

Eye opening
Motor response
Verbal response
Pupil size

Ans:- D . Pupil size

Exp.:- Glasgow coma scale is used to know the level of consciousness of
patientsby meof ascerting motor response, verbal performance and eye
opening.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.22.
Que:-66. CSF rhinorrhea is found in:
A.
B.
C.
D.

Frontal bone structure

Zygomaticmaxillary fracture
Naso ethmoidal fracture
Condylar fracture

Ans:- C. Naso ethmoidal fracture

Exp.:- CSF rhinorrhea is seen in nasoethmoidal, Le Fort II and Le Fort III
fractures, associated with comminuted cibriform plate of ethmoid. Tramline
effect and halo on pillow effect are diagnostic signs of CSF rhinorrhea.
31

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.49, Vinod Kapoor 2nd Edition,
Page no. 291.

Que:-67. After fracture of middle cranial foramen there is epiphora this is due
to damage of:
A.
B.
C.
D.

Ciliary ganglion
Greater palatine nerve
Infraorbital nerve
None of the above

Ans:- D. None of the above

Exp.:- Epiphora is seen in Le Fort III and severe nasal complex injuries due to
partial or complete obstruction of nasolacrimal duct. The patient complains
of epiphora and may develop infected mucocele, a condition termed as
dacrocystitis.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.9,101.
Que:-68. The first step in management of head injury is:
A.
B.
C.
D.

Secure airway
I.V. mannitol
I.V. dexamethasone
Blood transfusion

Ans:- A. Secure airway

Exp.:- If the patients is unconscious, the should be carried in lateral position. This
allows the clearing of blood and mucus from the mouth and nasopharynx
32

and escape of fracture secretions.

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.17, Vinod Kapoor 2nd Edition,
Page no. 225.

Que:-69. Which of the following is not a feature of Le Fort II fracture :

A. Enophthalmos
B. Malocclusion
C. Paraesthesia
D. CSF rhinorrhea
Ans:-A. Enophthalmos
Exp.:- Enophthalmos are seen in zygomatic complex fracture, orbital fracture and
Le Fort III fracture. It is caused either by escape of orbital contents like fat
or by an increase in the volume of the bony orbit.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no. 39.
Que:-70. Gillis approach for reduction of zygomatic fractures is done through
A.
B.
C.
D.

Temporal fossa
Intra temporal fossa
Infra orbital fossa
All of the above

Ans:- A. Temporal fossa

Exp.:- The displaced zygomatic complex can be reduced by
Gillies extraoral temporal approach.
Intraoral approach through an incision in the buccal sulcus or Keens
technique.
Extraoral approach through a stab incision in the cheek.
33

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.17, Vinod Kapoor 2nd Edition,
Page no. 225.
Que:-71. Forceps used for maxillary fracture disimpaction
A.
B.
C.
D.

Rowes
Bristows
Asha
Walshams

Ans:- A . Rowes
Ref.:- Killeys Mid 3rd # 5th Edition, Page no. 77.
Que:-72.Guerin fracture is:
A.
B.
C.
D.

Maxillary fracture
Maxillary and zygomatic fracture
Maxillary and nasal bone fracture
Nasal bone fracture only

Ans:- A. Maxillary fracture

Exp.: Guerin fracture is other name for Le Fort I or low level fracture.
Le Fort II involves maxilla, nasal, lacrimal bones.
Le Fort III involves maxilla, lacrimal, nasal and ethmoidal bones
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.13, Vinod Kapoor 2nd Edition,
Page no. 288.
Que:-73. A fracture of eye by a ping pong boll is:
A.
B.
C.
D.

Blow out fracture

Orbital fracture
Blow in fracture
Compound fracture

Ans:- A. Blow out fracture

34

Exp.:- Orbital blow out fracture occurs when a rounded object struck the
protruding eyeball resulting in fracture of orbital floor .
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.45, Vinod Kapoor 2nd Edition,
Page no. 296.

Que:- 74. Panda facies is commonly seen after

A.
B.
C.
D.

Le Fort I fractures
Le Fort II fractures
Mandible fractures
None of the above

Ans:- B. Le Fort II fractures

Exp.:- Pandafacies is due to edema and ecchymosis around the eyes. Because of
this the patient develop black circles around the eyes ( Raccoon eyes).
Ref.:- Neelima Malik 1st Edition, Page no. 356.
Que:- 75. Walshams forceps are used to:
A.
B.
C.
D.

Remove teeth
Remove root
Clamp blood vessels
Reduce nasal bone fractures

Ans:- D. Reduce nasal bone fractures

Exp.:Instrument

Use
35

Walsham / Asches forceps

Rowes disimpaction
forceps
Bristows elevator

Used for reduction of nasal complex fractures.

To reduce the tooth bearing portion of the upper
jaw.
To elevate fractured zygomatic bone.

Ref.:- Vinod Kapoor, 2nd Edition, Page no. 305.

Que:- 76. A patient is in shock with gross comminuted fracture, immediate

treatment is to give?
A.
B.
C.
D.

Normal saline
Ringers lactate solution
Whole blood
Plasma expanders

Ans:- B . Ringers lactate solution

Exp.:- Usually after trauma, hypovolemic shock is developed due to severe blood
loss. Ringer lactate solution because of its high osmotic value maintains the
fluid in vascular compartment.
Ref.:- Vinod Kapoor, 2nd Edition, Page no. 608.
Que:-77. Parasthesia is seen with which of the following types of fractures:
A.
B.
C.
D.

Subcondylar
Zygomatico maxillary
Coronoid process
Symphyseal

Ans:- B. Zygomatico maxillary

Ref.:- Killeys Mid 3rd # 5th Edition, Page no. 37, 54.
36

Que:- 78. Diplopia is most common with:

A.
B.
C.
D.

Mandibular fracture
Craniofacial dysjunction
Nasal fractures
Zygomatico maxillary complex

Ans:- D. Zygomatico maxillary complex

Exp.:-Diplopia is due to interference with activity of ocular muscles. It is seen
following fractures of zygomatic complex, Le Fort III fractures when the
line passes above whitnalls tubercle. The degree of diplopia in maxillofacial
trauma can accurately recorded by Hess Chart.
Ref.:- Vinod Kapoor, 2nd Edition, Page no. 608.
Que:-79. Suturing in facial wound injuries should be done within:
A.
B.
C.
D.

2 hours
6 hours
4 hours
8 hours

Ans:- B. 6 hours
Ref.:- Neelima Malik 1st Edition, Page no. 318.
Que:-80. The hanging drop appearance in the maxillary sinus radiograph
indicates:
A.
B.
C.
D.

A nasal polyp
A below out # of the orbit
A radiograph artifact
An antrolith

Ans:- B . A below out # of the orbit

Exp.:- Hanging drop sign is best seen in the waters projection of the face.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no. 47.
Que:-81.Which is the immediate danger to a patient with severe facial injuries
37

A.
B.
C.
D.

Bleeding
Associated fracture spine
Infection
Respiratory obstruction

Ans:- D . Respiratory obstruction

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.17, Vinod Kapoor 2nd Edition,
Page no. 224.

Que:- 82. The safest initial approach to open airway of patient with
maxillofacial trauma is:
A.
B.
C.
D.

Head tilt-chin tilt

Jaw thrust technique
Head lift-neck lift
Heimlich procedure

Ans:- A. Head tilt-chin tilt

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.17.
Que:-83. In depressed zygomatic arch fracture, difficulty in opening the
mouth is caused by impingement of:
A.
B.
C.
D.

Condyles
Ramus
Petrous temporal
Coronoid process

Ans:- D. Coronoid process

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.43, Vinod Kapoor 2nd Edition,
Page no. 294.
Que:- 84. True open bite is caused by:
38

A.
B.
C.
D.

Horizontal fracture of the maxilla

Unilateral fracture of mandibular angle
Fracture of the coronoid process of left side of mandible
Fracture of mandibular symphysis

Ans:- A. Horizontal fracture of the maxilla

Ref.:- Vinod Kapoor 2nd Edition, Page no. 294.

Que:-85. All of the following statements of nasal fractures are true except:
A. Even if minor, they may be followed by bilateral ecchymossis and facial
oedema
B. They may need to be reduced for a few weeks
C. They need not be complicated by traumatic telecanthus
D. They may lead to the telescoping of the nasal complex into the frontal sinus
Ans:- B. They may need to be reduced for a few weeks
Exp.:- Walshams forceps & Asches forceps are used for reduction of
fractured segments. These fractures should be repaired within 7-10 days.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.48, 49.
Que:-86. Fixation may lead to the telescoping of the nasal complex into the
frontal sinus
A.
B.
C.
D.

To support comminuted fracture of the body of zygomatic complex

To support and reconstitute comminuted orbital floor fracture
To protect mucosal covering of maxillary sinus
(A) and (B) are correct

Ans:- D. (A) and (B) are correct

A. To support comminuted fracture of the body of zygomatic complex
B. To support and reconstitute comminuted orbital floor fracture
39

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.65, Vinod Kapoor 2nd Edition,
Page no. 307, 311.
Que:-87. In a patient of head injury which is more important to note first:
A.
B.
C.
D.

Papillary light reflex

Papillary size
Corneal reflex
Ability to open eye

Ans:- D. Ability to open eye

Ref.:- Vinod Kapoor 2nd Edition, Page no. 227.
Que:- 88. Floating maxilla is typically found in:
A.
B.
C.
D.

Le Fort I or Guerin fractures

Le Fort II or pyramidal fractures
Craniomandibular dysjunction
All of the above

Ans:- A. Le Fort I or Guerin fractures

Exp.:- The term floating maxilla is due to movement of maxillary complex as a
single unit at the frontonasal area.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.53, Vinod Kapoor 2nd Edition,
Page no. 288.
Que:-89. Which of the following always indicates obstruction to the airway?
A.
B.
C.
D.

Slow pounding pulse

Strenuous breathing
Increase in pulse rate
Decrease in blood pressure

Ans:- B. Strenuous breathing

Ref.:- Refer Synopsis.
40

Que:- 90. Moon face appearance is seen in

A.
B.
C.
D.

Isolated Le Fort I fracture.

Le Fort II and Le Fort III fractures.
Mandibular fractures.
Unilateral zygomatic complex fractures.

Ans:- B. Le Fort II and Le Fort III fractures.

Exp.:- Patient with Le Fort II & III fractures have gross edema of the soft tissues
overlying the middle third of the facial skeleton, giving rise to the
characteristic moon face appearance. This ballooning of the features is not
seen in isolated Le Fort I fractures.
Ref.:- Killeys fractures of the middle 3rd of facial skeleton 5th Edition, Page no.51.
Que:-91. Whiteheads varnish in gauze is used to arrest bleeding from
A.
B.
C.
D.

Gingival crest
Bleeding from pulp
Bleeding from bone
Bleeding from capillaries

Ans:- C . Bleeding from bone

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.66.
Que:- 92. In blow out fractures which of the following is seen
A.
B.
C.
D.

Enophthalmos
Exophtholmos
Bulbar hemorrhage
None

Ans:- A. Enophthalmos
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.69, Vinod Kapoor 2nd Edition,
Page no. 311.
Que:-93. An average patient with maxillofacial trauma requires how much of
daily sodium?
41

A.
B.
C.
D.

100 mmol
50-60 mmol
10 mmol
1000 mmol

Ans:- A. 100 mmol

Exp.: A patient with maxillofacial trauma requires 100 mmol amount of daily
sodium
A patient with maxillofacial trauma requires 60 mmol amount of daily
potassium
Que:- 94. Diplopia after fracture results from entrapment of
A.
B.
C.
D.

Inferior rectus
Inferior oblique
Lateral rectus
Superior oblique

Ans:- A. Inferior rectus

Exp.:- Diplopia is due to interference with the action of extraocular muscles,
mainly the inferior rectus and inferior oblique muscles that are in same
fascial aheath.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.45, Vinod Kapoor 2nd Edition,
Page no. 294.
Que:- 95. In Le Fort III fracture all are seen except
A.
B.
C.
D.
E.

Crack pot sound on tapping teeth

CSF rhinorrhea
Fracture at frontozygomatic suture
Whole face is mobile
None of the above

Ans:- E . None of the above

42

Ref.:- Killeys Mid 3rd # 5th Edition, Page no.55, 56, Vinod Kapoor 2nd Edition,
Page no. 290.
Que:-96. The muscle that aids in displacement of maxillary fractures are
A.
B.
C.
D.

Masseter
Temporalis
Orbicularis oculi and orbicularis oris
None of the above

Ans:- D. None of the above

Que:- 97. Hooding of eyes is seen in which fracture:

A.
B.
C.
D.

Le Fort 1
Le Fort 2
Le Fort 3
Nasal bone

Ans:- C . Le Fort 3
Exp.:- If the fracture line passes above the Whitnalls tubercle, it removes the
support given to eye by lockwoods suspensory ligament and the upper
eyelid follows the globe down producing hooding of eyes.
Ref.:- Killeys Mid 3rd # 5th Edition, Page no.56.
Que:-98. The intercanthal distance suggestive of traumatic telecanthus is:
A.
B.
C.
D.

30 mm
32 mm
25 mm
40 mm

Ans:- D. 40 mm
Exp.:- Normal intercanthal distance is 25 mm. in traumatic telecanthus the
43

intercanthal distance is increased to 35-40 mm.

Ref.:- Rowe & Williams 2nd, Edition, Vol-2, Page no. 615, 616.

Que:-99. Le Fort I fracture is characterized by

A.
B.
C.
D.

Bleeding from ear

40 mm
CSF rhinorrhoea
All of the above

Ans:- B . 40 mm
Exp.:- In Le Fort I fracture, there is hemorrhage in to maxillary sinuses. When
antral cavities become full blood starts leaking through the nose. The nasal
passages may get blocked with this clotted blood.
Ref.:- Vinod Kapoor 2nd Edition, Page no. 289.
Que:-100. The subconjuctival hemorrhage remains bright red in color for a
long time because?
A.
B.
C.
D.

Permeability of conjunctiva to the oxygen

Natural color of the blood
Lack of drainage of the pooled blood
None

Ans:- A. Permeability of conjunctiva to the oxygen

44

Exp.:- Subconjunctive hemorrhage redness under the conjunctiva is due to blood

trickling in this place on account of fractures. The blood remains red here
because oxygenation of hemoglobin can take place through the thin
conjunctiva.
Ref.:- Vinod Kapoor 2nd Edition, Page no. 287.

=======*********=======

45