Ans:- 1. A.

Craniofacial Dysfunction

Exp.:-
Le Fort I Low level or Guerin fracture or Horizontal or Telescope
fracture
Le Fort II Pyramid or Infrazygomatic fracture
Le Fort III High level or suprazygomatic fracture
Extended Le Fort Cranio orbito maxillary fracture
fracture

Ans:- 2. D. Pupil Size

Exp.:- Glasgow coma scale is used to know the level of consciousness of patient by
meof ascertaining motor response, verbal performance and eye opening.

Ans:-3. C . Nasoethmoidal 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.

Ans:-4. D. Presence of Transferrin BETA

Exp.:- Le Fort II, III and NOE # (# of ethmoid m/c ) dueto a breakdown of the
dura & supporting structures of the skull base resulting in a connection
between the subarachnoid space & nose.
B1 transferrin is present in serum, nasal secretions, tears and saliva.

Ans:-5. D. None of the Above

Exp.:- Epiphora is seen in Le Fort II, Le Fort III and severe nasal complex injuries
due to partial or complete obstruction of epiphora and may devlop infected
mucocele, a condition termed as dacrocystitis.

Ans:- 6. A. Secure Airway

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

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Ans:-7. A . Enophthalmos

Exp.:- Enophthalmos are seen in zygomatic complex fracture, orbital fracture and
Le Fort III fractuere. It is caused either by escape of orbital contents like fat
of by an increase in the volume of the bony orbit.

Ans:-8. 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.

Ans:-9. 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.

Ans:- 10. A. Blow out fracture

Exp:- Orbital blow out fracture occurs when a rounded object struck the protruding
eyeball resulting in fracture of orbital floor.

Blow in fracture is due to inward of orbital floor. It usually occurs in

children and results from trauma to inferior orbital rim.

Ans:-11.B. Le Fort II Fractures

Exp.:- Panda facies is due to edema and ecchymosis around the eyes. Because of
this the patient develops black ciecles around the eyes (Raccoon eyes).

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Ans:- 12. D. Reduce Nasal Bone Fracture

Exp.:-
Instrument Use
Walsham/Asches forceps Used for reduction of nasal complex fractures.
Rowes disimpaction To reduces the toothe bearing portion of the upper jaw.
forceps
Bristows elevator To elevate fractured zygomatic bone.

Ans:-13. B. Ringer 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.

Ans:-14. A. Rowes

Exp.:- Rowes maxillary disimpaction forcep are available as right & left forceps.
They are used in pairs. There are 2 pronged forceps, where one prong fits
in to the nasal floor and another one on the hard palate.

Ans:-15. B . Zygomatico Maxillary

Exp.:- Most fractures of body of the zygomatic complex involve the infraorbital
nerve. The zygomatic nerve is also frequently damaged causing paresthesia
within the distribution of zygomatico facial & zygomatico temporal
branches.

Ans:-16. 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 II and Le Fort III
fractures when the fracture line passes above whitnalls tubercle.

Ans:-17. B. 6 Hours

Exp.:- Treatment of facial injury should not be delayed. It should be one in

maximum 6 to 8 hrs or sooner, wherever feasible. If possible facial
fractures should be treated at the time of the soft tissues repair.

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Ans:-18. B . A blow out fracture of orbit

Exp.:- Hanging drop sign is best seen in the waters projection of the face.

Ans:- 19. A . Le Fort III fracture

Exp.:- Le Fort III level ( High transverse / Suprazygomatic fracture /

craniofacial dysjuntion)

A fracture in which the facial bones separate from the cranial bones is
known as craniofacial dysjunction fracture. This is also known as Le Fort III
fracture.

# line runs from near the frontonasal suture transversely backwards parallel
with the base of the skull & involves the full depth of the ethmoid bone,
including the cribriform plate.

Within the orbit, the # passes below the optic foramen into posterior limit of
the inferior orbital fissure.

From the base of the inferior orbital fissure the # line extends in 2 directions.

- Backward across the pterygomaxillary fissure to # the roots of the

pterygoid laminae (upper 1/3rd region)
- Laterally across the lateral wall of orbit separating the zygomatic bone
from the frontal bone.

Ans:-20. D. Respiratory obstruction

Exp.:- Patient with severe facial injuries, respectory obstruction is immediate

danger so patient is carved in lateral position. This allows clearing of blood
& mucus from the mouth & nasopharynx & as cape of further secretion.

Ans:-21. A. Head Tilt Chin Tilt

Exp.:- Position of the patient supine with neck extended or head turned midways or
patient can be made prone with head down. So that the collection of saline
or blood in the mouth can be throughwn out instead of aspiration.

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Ans:- 22. D. Coronoid Process

Exp.:- Coronoid process is completely detached and caving limitation of the oral
opening after reduction that it should be excised through intraoral incision.

Ans:-23.A. Horizontal fracture of maxilla

Exp.:- Fracture line extends from the lower border in an upward & forward
fracture to meet the upper border. The posterior fragment will more in
upward direction due to unopposed action of the nasseter & medial up
terygoid muscle. So this results in true open bite.

Ans:-24. B. They may need to be reduced for a FEW Week

Exp.:- Walshams forceps & Asches forceps are used for reduction of
fractured segments. These fractures should be repaired within 7-10days.

Ans:-25. D. A & B are correct

Exp.:- Treatment consists of surgical explanation of orbital floor and

reconstruction of the orbital floor by silastic sheet or bone graft wherever
necessary. Otherwise balloon support or ribbon gauze packing can be used
in the maxillary sinus.

Ans:-26. A. Le Fort I or Guerin fracture

Exp.:- The term floting maxilla is due to movement of maxillary complex as a

single unit at the frontonasal area.

Ans:-27. D . Ability to open eye

Exp.:- Ability to open eye will reveal that whether the injury is due to intracranial
injury or hacmorrhagic or nerogenic shock .

Ans:-28. B. Stertoreous breathing

Exp.:- The important sign of absolution of air in conscious patients are

- Stertoreous breating
- Prenounced retraction of intracoastal and supra councilor spaces.
- Hands ever throat
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Ans:-29. B . Le Fort II & III fractures

Exp.:- Patients 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.

Ans:-30. C. Bleeding from bone.

Exp.:-It consists of a number of aromatic resins, which slavery border down to

produce benzoic acid which is a polent antiseptic.

Ans:-31.A. Enophthalmos

Ans:-32. A. 100 mmol

Exp.:- A patient with maxillofacial trauma requires 100 mmol amounts of daily
Sodium
- A patient with maxillofacial trauma requires 60 mmol amount of the
daily potassium.

Ans:- 33. Open reduction of zygomatic fracture

Exp.:- GILLES apparoach is done method of reduction of zygomatic fracture. In

this approach, a2cm incision is made in the hairline, between the
bifurcation of the superficial temporal vessels. The temporalis passed down
beneath the zygomatic bone which is then gently lifted back into position.

The structure of anatomical significance in Gilles approach is superficial

temporal artery.

Ans:-34. C. Infraorbital nerve

Exp.:- Most fractures of the body of the zygomatic complex involve the
infraorbital nerve leading to rather a neuropraxia or neurotmesis. The
zygomatic nerve is also frequently damaged causing anaesthesia and
parasthesia with in the distribution of the zygomaticofacial may, therefore,
exhibit anaesthesia of the temple, cheek, one side of the upper lip and side
of the nose.

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Ans:- 35. 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 sheath.

Ans:-36. E. None of the above.

Exp.:- Fractures of Le Fort III fracture are:

- Crock pet sound on tapping teeth
- CSF rhino rhea
- Fracture at frontozygomatic suture
- Whole face is mobility
- Moon face
- Traumatic telecanthus

Ans:-36.