The stomatodeum or primitive mouth is formed by the ectoderm at the head end of the embryo on the third week, and when the oropharyngeal membrane disappears, a icon

The stomatodeum or primitive mouth is formed by the ectoderm at the head end of the embryo on the third week, and when the oropharyngeal membrane disappears, a





НазваниеThe stomatodeum or primitive mouth is formed by the ectoderm at the head end of the embryo on the third week, and when the oropharyngeal membrane disappears, a
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Oral and maxillofacial surgery

Explanations





  1. (B) Most common is the fracture of the condylar process (36%), followed by: angle (20%), line of the canines+premolars (21%), symphysis (14%), ramus (3%), muscular process (2%).

  2. (A) Order of frequency: Le Fort II (23%), zygomatic bone (22%), Le Fort I, Le Fort III.

  3. (B) Occlusal difference is a certain sign, the others are uncertain ones.

  4. (C) Haematoma is not a certain sign of fracture. The other three are certain signs.

  5. (E) The items on the list are the classification of fractures according to type.

  6. (D) A Gunning-splint is used in the case of an edentulous jaw. The upper acrylic plate (or denture) is fixed to the maxilla with a transosseal wire through the alveolar process of the maxilla, the lower one with a circumferential wire to the mandible.

  7. (D) Neuner’s fixation is done with a wire suture; the others are types of plate osteosynthesis.

  8. (A) A Blow-out fracture is the fracture of the base of the orbit, it is a lateral fracture of the midface, and the others are central fractures.

  9. (C) Pyramidal, or Le Fort II. fracture is a central; the other three are lateral midface fractures.

  10. (D) Matas’s method serves to elevate the zygomatic arch; the others are used to reposition the zygomatic bone.

  11. (B) Fibroma, lipoma and haemangioma are of mesenchymal origin, ameloblastoma is odontogenic, and papilloma is of epithelial origin.

  12. (E) All those listed are benign odontogenic tumours.

  13. (C) There is fibrous connective tissue among fat cells. Statements in the other four points are characteristic of a lipoma.

  14. (B) Proliferating angioendotheliomatosis is malignant lesion, the others are benign.

  15. (C) Its typical occurrence is in the mandible (molars, angle, ramus). It can be solid or cystous, uni- or multilocular, it can become malignant (0.5%). It origin: dental lamina, Malassez’s epithelial tissue.

  16. (A) It most often occurs in the middle third of the edge of the tongue, rarely on the back of the tongue. The other statements are characteristic of lingual carcinoma.

  17. (D) Any of the malignant tumours listed may give a metastasis to the jaws – mainly to the mandible – but a metastasis of the breast or the prostate is most common.

  18. (E) The list gives the base and border of neck dissection correctly except for the posterior border. The posterior border is the anterior edge of the trapezius muscle.

  19. (A) A functional neck dissection differs from a radical in as much as it spares important anatomic structures (sternocleidomastoid muscle, internal jugular vein).

  20. (E) A temporary grafting of the mandible is possible with all the listed materials.

  21. (D) Philtrum will deviate to the healthy side. The other characteristics are true.

  22. (C) Palatoschisis may be associated with unilateral or bilateral cheiloschisis, but it can occur on its own as well. In the latter case it always involves the secondary palate and is in the midline. An isolated one may be a complete cleft of the palate or the soft palate. A bifid uvula also belongs to this group.

  23. (C) Various institutes and cleft centres suggest various dates, but out of the times listed the 4th month is the most appropriate one. Immediately after birth it is too early, after the age of one year it is too late.

  24. (D) Rosenthal’s flap is a pedicled palatinal one, the other methods are bridge flaps.

  25. (C) All the methods listed– except for Köle’s – close the palatoschisis with a bridge flap plasty. Köle’s name has become known for his nasal plasty.

  26. (A) Osteotomy is performed according to Schuchardt. Köle’s operation is an anterior segment osteotomy.

  27. (B) Out of the methods listed Obwegeser’s method as modified by Dal Pont is a sagittal osteotomy, the others are angled osteotomies, Trauner’s is an inverse ’L’ shaped osteotomy.

  28. (B) There is no transverse reduction. Out of the ones listed vertical augmentation belongs to this group of operations.

  29. (B) Trismus – though it causes a difficulty of opening – does not lead to ankylosis as it is an extracapsular process.

  30. (D) Osteosarcoma is malignant, the others are benign.

  31. (A) Arthroscopy provides information concerning the condition of the synovial membranes and the cartilage surface thus it is mainly used for the detection of ’internal derangement’. A tumour is visible on the X-ray as well, the other symptoms of a rheumatoid arthritis are quite clear; in the case of luxation diagnostic tests are superfluous.

  32. (D) Its main advantage is that there is no need for a mandible resection and grafting. The other statements are true.

  33. (E) None is characteristic of acute sialoadenitis, except for the ultrasound result, which reports a homogeneous swelling.




  1. (D) Diffusion property: it expresses the property of local anaesthetic drugs how far they can penetrate into tissues far from the point of injection, that is how much they can cross tissue barriers.




  1. (D) The time of effect of Marcaine is very long (3 to 30 hours), that of Procaine is quite short, that of Lidocaine and Ultracaine is 2-3 hours.




  1. (B) The maximal daily dosage of 2% Lidocaine without epinephrine is 10 mls, that of the most often used 2% solution with epinephrine is 20 mls.




  1. (A) The region of the superior labial frenulum is very sensitive, therefore upon anaesthetising the upper incisors the point of insertion is always at the distal tooth.




  1. (E) Lower teeth can be anaesthetised through the inferior alveolar nerve, the upper molars with the tuberal anaesthesia method, the upper front teeth with the infraorbital block anaesthesia method. The upper premolars are usually not anaesthetised with a block anaesthesia method.




  1. (D) No injection is administered into the abscess as the infection might be spread with the injection.




  1. (B) A passing complication of erroneous block anaesthesia may be the paresis of the facial nerve which is associated with the palsy of the mimic muscles.




  1. (E) The purpose of premedication is to calm the patient with drugs. With its help unpleasant psychological effects and unwanted vegetative reactions may be reduced or prevented.




  1. (C) Ketamine is an intravenous anaesthetic drug.




  1. (D) Primary closure has to be performed within the first 48 hours. After this primary closure is usually not successful because of the infection.




  1. (C) 4 to 6 weeks after extraction osteoid tissue fills the alveolus. Final, osseous regeneration happens in 3 to 6 months.




  1. (C) In the classic case the cyst is located in the maxilla between the roots of the lateral incisor and the canine. The cyst often pushes the roots of these teeth apart.




  1. (E) In chronic periapical periodontitis there is periapical bone resorption (granuloma); in chronic purulent osteomyelitis there is an osteolysis with a blurred edge, sequestration and around it a radiolucent zone; in focal sclerotising osteomyelitis there is a condensation of the bone in a small area, that is related to the root and often has the shape of a pear; while in diffuse sclerotising osteomyelitis there are multiple osteolytic lesions. In acute periapical periodontitis there is no visible lesion in the bone due to the shortness of time.




  1. (B) The percentage of head injuries in road accidents is about 70%, in other accidents it is 30%.




  1. (E) In the corpus it is 21%, in the angle it is 20%, in the ramus 3%, in the condylar process 36% and in the muscular process it is 2%, thus a fracture is least likely to occur in the muscular process.




  1. (A) Trismus is classified as a functional disorder, which may be due to fracture, contusion of masticatory muscles and soft tissues. That is why trismus is just an uncertain sign of fracture.




  1. (D) The fracture of the orbit base is a lateral midface fracture, the others are central or centrolateral ones.




  1. (C) Adams’s internal wire fixation may be used in central of centrolateral midface fractures, thus, out of the ones listed, only in the case of a Le-Fort II. fracture.




  1. (C) Multinuclear giant cells are characteristic of gigantocellular epulis. Fibrous epulis is of a light pink colour and does not bleed easily. Small size is characteristic of a granulomatous epulis.




  1. (E) All these statements are characteristic of an ameloblastoma, but it does not give metastases.




  1. (B) About 20-25% of all oral cancer is lip cancer. It is five times more frequent in men than in women.




  1. (E) A basalioma develops in parts of the skin, mainly of the face that are mostly touched by external effects (wind, sunshine, rain).




  1. (A) A sagittal ramus osteotomy of the mandible is the most often applied surgical method in the surgery of dysgnathia. This method was developed by Obwegeser, and slightly modified by Dal Pont.




  1. (D) Le Mesurier’s and Tennison’s methods are used to close a cleft lip, whereas Schuchardt’s and Rosenthal’s are used to close a cleft palate.

  2. (C) Symptoms are similar to those of a chronic sinusitis. It has quite a bad prognosis because of a late diagnosis. It is relatively rare. Histologically it is mostly squamous cell carcinoma.

  3. (D) Transplantation of full and half thickness skin is free grafting. Cylindrical flaps are ’wandering’ flaps from various parts of the body surface.

  4. (C) Grafting with metal and plastic (foreign materials) is alloplasty. Grafting with the patient’s own bone is autoplasty.

  5. (E) Those listed are characteristic.

  6. (A) The first three of the answers are characteristic. Grape-like retention is characteristic of the benign Sjögren’s syndrome.

  7. (E) All those listed are incision types used to this day.

  8. (A) The first three symptoms are characteristic. Haematoma is an additional symptom – it might not necessarily mean jaw bone fracture.

  9. (E) As a tumour of the mandibular condyle is quite rare, utmost care most be taken to acquire a certain diagnosis if the suspicion arises. All the methods listed help in proving or excluding the diagnosis.

  10. (A) An ameloblastoma has a sharp edge on the X-ray. It can have extreme size and be unilocular, but most commonly it is multilocular. It also involves cortical bone.

  11. (B) Step formation, major bleeding of the maxillary sinus and injury (paraesthesia) to the infraorbital nerve are characteristic. It usually does not influence occlusion.

  12. (E) All the listed factors significantly influence the mode of treatment of the fracture and the outcome of it.

  13. (E) All the answers given here (separately and together9 contribute to the frequent fractures of the mandible.

  14. (E) All these symptoms may occur due to the fracture of the alveolar process, the horizontal fracture of the maxilla (Le Fort I.) and a pyramidal (Le Fort II.) fracture.

  15. (A) The first three are appropriate methods of fixation. There no such thing as a Neuner-splint. His method is used to fix fractured bone fragments.

  16. (D) The sternocleidomastoid muscle has no origin or insertion on the mandible, thus it cannot influence the position of fractured segments. The condition of the periodontium has no influence either.

  17. (A) The most often performed osteotomy is the sagittal one. Rarer is an oblique and a reverse ’L’ shape osteotomy (Trauner’s operation). Dingmann’s operation is performed on the corpus.

  18. (A) The advantages listed in the first three points have almost completely ousted the extraoral intervention from clinical practice, which however, provides better visibility.

  19. (B) It is rarely used as intraoral miniplate osteosynthesis has made the method spurious. Its disadvantage is that it does not provide functionally stable fixation.

  20. (C) When an extraoral approach is chosen there is a visible scar. The facial nerve might be injured. An injury to the lingual nerve and the periodontium is not likely.

  21. (A) The reasons listed in the first three points might have a role in difficulty of swallowing or breathing. The fracture of the articular process is a mandibular fracture.

  22. (A) Apart from those listed in the first three points a paediatric dentist, an ENT specialist and a genetician are important. A neurosurgeon is usually not needed.

  23. (D) The formation of a pseudo-arthrosis and ankylosis are complications of mandibular fractures. The other two complications may occur after maxillary fractures as well.

  24. (D) The zygomatic arch may be elevated with a surgical hook or the Gillies-method. The zygomatic bone may be repositioned with the balloon method and osteosynthesis.

  25. (B) Papilloma is of an epithelial origin, the others originate from connective tissue.

  26. (D) Central fibroma and chondroma are jaw tumours independent of teeth. The other two are benign odontogenic tumours. The name of the Pindborg-tumour is ’calcifying odontogenic epithelial tumour’.

  27. (C) Sarcoma – thus fibrosarcoma and endothelial myeloma (Ewing-sarcoma) – are of mesenchymal origin.

  28. (B) Epulis and parodontoma are synonyms; the name peripheral giant cell granuloma is also used. Central giant cell reparative granuloma is not an epulis.

  29. (E) All those listed may be used. Apart from these a surgical treatment or laser therapy are also common.

  30. (D) Leiomyoma develops from smooth-, rhabdomyoma from striated muscle. Schwannoma (neurinoma) derives from neural tissue. Myxoma is a jaw tumour.

  31. (A) The first three characteristics are true. It makes the fabrication and use of a removable denture difficult; therefore it has to be removed.

  32. (B) Cc. keratoides is an old classification. The other three belong to the classification accepted nowadays.

  33. (E) All these methods are used depending on the localisation and size of the tumour.

  34. (A) The first three are monoblock principles; the fourth one is already part of the ’composite’ operation.

  35. (D) The functional neck dissection introduced by Bocca in 1967 preserves the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve.




  1. (E) Effectiveness means the minimal concentration, which suspends conduction in the nerve, toxicity means the tolerable dose of the drug, diffusion means the drug’s ability to penetrate tissues, the term of effect the time of anaesthesia, thus these all play a role in the therapeutic value of a local anaesthetic drug.




  1. (B) Terminal anaesthesia is also called infiltration anaesthesia, thus it cannot be a specific form of it. The other answers are correct.




  1. (E) A haematoma might occur following tuberal or lower block anaesthesia, trismus might occur following lower block anaesthesia (injury to the medial pterygoid muscle or infection), while injury to the lip and tongue mainly occur in children due to biting because of the long anaesthesia. All those listed are complications of local anaesthesia.




  1. (B) Barbiturates may have significant complications, such as laryngospasm, fall of blood pressure and depressed breathing. Hallucination may be due to Ketalar that is not a barbituric acid derivate.



  1. (E) Transdental fixation has the four indications listed here.




  1. (D) In the case of a retained upper canine on the intraoral X-ray the crown of the canine in a palatinal position gives a more intensive image than the neighbouring teeth. On the bite-on X-ray the crown of the palatinally positioned canine appears to be in the apex of the roots of the neighbouring teeth, while that of the buccally positioned in the area of the crowns of the neighbouring teeth. The two other types of X-rays give no significant information.




  1. (E) The cysts listed are all odontogenic in origin, they are all located in the bone, their internal epithelial lining is multilayer squamous epithelium.




  1. (D) The first answer is characteristic of a perinatal cyst, the third one of the eruptional cyst, while the second and fourth of the follicular cyst.




  1. (B) The branchyogenic cyst develops in the line of the sternocleidomastoid muscle. The others are characteristic locations of the dermoid cyst.




  1. (A) A pus is flowing from a fistula of the facial skin is characteristic of a chronic purulent osteomyelitis. The others are characteristic of an acute osteomyelitis.




  1. (A) Angina Ludowici is a very dangerous bilateral cellulitis of the sublingual, submandibular and parapharyngeal spaces. The submandibular area is swollen, the patient’s mouth is open, he cannot swallow, the tongue is significantly swollen and risen, there is increased danger of suffocation.




  1. (A) Repositioning the fractured bone ends does not belong to first aid, as it is part of the definitive treatment. As a first aid the fractured bone may be brought into tranquillity (e.g. a mandibular fracture with a sling bandage).




  1. (D) The distal (bigger) fragment is pulled downwards and outwards by the muscles that open the mouth and the contralateral lateral pterygoid muscle. The proximal (smaller) fragment is pulled upwards and medially by the muscles that close the mouth.




  1. (B) Healthy teeth in the fracture line should be left in their places, antibiotics have to be administered and immediate surgery performed. In the other cases listed the teeth in the fracture line should be removed.




  1. (D) The fracture line of a Le-Fort II. fracture goes through the back of the nose or the lateral portion of the apertura pyriformis to the medial-lower wall of the orbit and to the inferior orbital fissure, then to the zygomatico-maxillary suture and caudally and dorsally on the infratemporal surface of the maxilla. The fracture lines described in points 1. and 3. are characteristic of a Le-Fort III. fracture.




  1. (C) A dislocated zygomatic bone may be repositioned with a percutaneous method (Strohmeyer) and from a temporal incision with an elevator (Gillies). A depressed zygomatic arch may be repositioned by elevating the temporalis muscle (Berényi) or by pulling a thread introduced under the zygomatic arch (Matas).




  1. (E) As contrasted to Sjögren’s syndrome, no inflammatory signs are seen in sialosis. The aetiology of the disease includes drugs, hormonal disorders, nutritional problems, hepatic cirrhosis and chronic alcoholism. All the characteristics listed are those of sialosis.




  1. (B) Pleomorphic adenoma contains cartilaginous elements as well as epithelial, mucoid and myxomatous elements, but no enamel-dentine elements.




  1. (A) In the case of an acute sialoadenitis sialometry shows decreased amount of saliva, scintigraphy presents early normal enrichment and a longer period of discharge. The ultrasound reports a homogeneous swelling. All these are recommended diagnostic tests. Sialography is quite painful and may increase inflammation therefore it is not recommended.




  1. (D) Frey’s syndrome has typical vegetative symptoms: the preauricular region of the face becomes red and perspiration starts when the patient is eating. Thus the essence of the disease is not pain, even though the other name of the disease is auriculotemporal neuralgia.




  1. (A) Papilloma is an exophytic tumour, which is the papillary hyperplasia of epithelial cells. Points 1., 2. and 3. are true of it.




  1. (C) Ameloblastoma mostly occurs in the region of the lower molars, it can have considerable size and no calcification can be seen. In contrast adenoameloblastoma mostly occurs in the region of the upper canines and lower incisors; it does not grow to be big and might contain small calcifying centres.




  1. (A) The first three statements are true of tongue carcinoma, while a histologically less differentiated form is more common, therefore it gives a metastasis more frequently.

  2. (E) All statements are true of an osteosarcoma.

  3. (A) Both statements are true and there is a correlation between them.

  4. (D) Fractures of the muscular process are very rare, just as dislocation as the temporalis muscle protects the process.

  5. (E) Intra-arterial chemotherapy is a useful method in the maxillofacial region, but it is also risky because of its disadvantages (it destroys the cells mentioned, too).

  6. (E) A sialolith is most commonly found in the submandibular gland. Stenon’s duct is that of the parotid gland.

  7. (B) In the case of an acute sialoadenitis sialography is very painful and may make the certain diagnosis uncertain. Secretion is decreased.

  8. (A) Both statements are true and there is correlation. Central and peripheral facial paresis can be differentiated on the basis of the movements of the forehead.

  9. (D) An increased muscle tone is characteristic and it needs to be relaxed. No smooth muscle relaxant is useful for this, as this muscle tone is caused by striated muscles.

  10. (A) Both statements are true and there is correlation. At the same time it has to be noted that intra-arterial chemotherapy is not risk-free.

  11. (B) Both statements are true but there is no correlation. The reason for bilateral metastases is the location close to the midline or in the midline. Frequency is 10-15%.

  12. (D) Rhinogenic sinusitis is more common. Its treatment is mainly medical (conservative).

  13. (A) Both statements are true and there is correlation. That is why the necessary surgical intervention has to be performed before radiation therapy.

  14. (E) Surgery is rarely performed (repositioning, fixation) and only in the case of major dislocation, which is relatively rare.

  15. (C) Mouth opening may be restricted because the dislocated bone stops the movement of the muscular process.

  16. (A) In most cases this is the method to follow. If the zygomatic bone does not stay in its original position then fixation is necessary.

  17. (E) Treatment is exclusively medical (conservative); similarly to the treatment of other joints.

  18. (A) Both statements are true and there is correlation.

  19. (A) Both statements are true and there is correlation.

  20. (D) If during the operation the oral cavity is opened the graft may become infected and may be lost. That is why the frequency of free bone transplants is decreasing. Instead a microvascular bone transplant is performed.

  21. (A) Both statements are true and there is correlation.

  22. (B) Both statements are true but there is no correlation.

  23. (C) In the case of maxillary retrognathia the dental characteristics of the upper jaw include él- vagy fordított túlharapása, while protruded upper incisors are characteristic of maxillary prognathia as the upper jaw is bigger and/or in anteroposition relative to the mandible or the skull base.




  1. (D) In Pierre-Robin syndrome it is not the maxilla but the mandible that is hypoplastic, therefore the chin is flattened and in neonates in a lying position the tongue may fall backwards and cause suffocation.




  1. (E) Osteoarthrosis of the temporomandibular joint is a degenerative disease and occurs when the joint surface can no more adept to the external effects on it.




  1. (A) Even though fibrous dysplasia of unknown origin is not a tumour, its X-ray image with a blurred edge and structure of bone is similar to that of a tumour.




  1. (C) In the case of an onlay plasty in the maxilla an autogenous bone graft is placed on the extremely atrophied very thin upper jaw from the buccal (labial) side. Le-Fort I. osteotomy is performed in the case of a maxillary interpositional plasty.




  1. (B) The good diffusional property of Lidocaine makes it possible to use it a spray for anaesthesia of the mucosa, or to use it as an injection for block anaesthesia. It is true that diluted it is a possible treatment of certain arrhythmias, but this has no correlation with the good diffusional property of the local anaesthetic drug.




  1. (A) Collapses occurring in the dental chair are reversible peripheral circulatory insufficiencies, which are introduced by paleness, perspiration, increased frequency of breathing and nausea. Its characteristics are hypotension and bradycardia, which very well characterise peripheral circulatory insufficiency.




  1. (B) Following high dose radiation therapy to the jaws the risk of osteoradionecrosis following tooth extraction due to infection is high, therefore this is among contraindications. Coagulopathy is also a contraindication, but this is the only connection between these two.




  1. (C) Because the tendon of the temporalis muscle is tensed at maximal mouth opening, it often has to be avoided and in these cases the active help of the assistant is needed. Anaesthesia or a mouth gag will not help.




  1. (A) During cystectomy it might happen that it cannot be removed with all certainty because the epithelium is full of scars and tears easily or there is a danger of injury to important neighbouring tissues. In these cases the surgical plan has to be modified and a cystostomy has to be performed.




  1. (E) In most cases a mixed (aerobe and anaerobe) infection develops from the root canal. These inflammations may be localised to the periapical space, but they may spread as well. The form of the inflammation is determined by several factors, such as the present status of the immune system, the number of bacteria, their virulence, the blood supply of the region, certain general conditions, etc.




  1. (A) Phlegmon (acute cellulitis) develops in spaces of fibrous tissue and spreads quickly, in which the almost completely avascular nature of the area also plays a role, as well as the presence of virulent bacteria, among which the most important ones are beta haemolytic Streptococci, which produces hialuronidase, as it provides a lysis of connective tissue.




  1. (A) Fractures of the condylar process are mostly due to indirect trauma, because this are is protected. Such indirect trauma is a punch to the mental region received with an open mouth.




  1. (A)

  2. (D)

  3. (C)

  4. (B) Dal Pont’s operation is performed on the ramus, Dingmann’s on the corpus of the mandible. Dal Pont’s operation is a sagittal osteotomy, during Dingmann’s the inferior alveolar nerve is transposed into a cavity prepared on the bony surface to protect it. After both types of surgery intermaxillary fixation is necessary.

  5. (A)

  6. (D)

  7. (C)

  8. (B) Radical neck dissection was first described by Crile (1906), functional neck dissection by Bocca (1967). The hypoglossal nerve is to be spared in both types of surgery, while the internal jugular vein is spared by functional neck dissection, but it is not by radical. The indication of radical neck dissection is decreasing: the first point gives the correct range of indication.

  9. (C)

  10. (A)

  11. (B)

  12. (C) The musculo-cutaneous flap mostly used for reconstruction is a pedicled one, during the preparation of which utmost care has to be taken to preserve the integrity of the supplying artery and vein and that these be included in the flap. The pectoral flap is supplied by the thoracoacromial artery, the latissimus dorsi flap by the thoracodorsal artery.

  13. (C)

  14. (B)

  15. (D)

  16. (A) The drug combination mentioned is used in both treatments as a protocol, in systemic therapy as a palliative solution, in intra-arterial chemotherapy as pre-postoperative or palliative treatment. In the latter case the cannula is introduced into the external carotid artery. Thus more drug can be administered with less side effect.

  17. (A)

  18. (B)

  19. (D)

  20. (D) The frequency of unilateral complete cleft is about 40 %, that of a bilateral one is about 15%. In the case of a bilateral cleft the most characteristic feature is a prominent premaxilla, in the case of a unilateral cleft the most characteristic feature is that the nasal septum deviates towards the healthy side. Endogenous and/or exogenous factors exerting their effect on the 5th embryonic week cause cleft lip, while those on the 7th and 8th weeks cause cleft palate.

  21. (C)

  22. (A)

  23. (B)

  24. (D) The modern surgery of both cleft lip and palate derives from Veau. One method of closing the lip is Tennison’s operation (with a triangular flap), and that of closing the palate is Rosenthal’s operation (with a pedicled palatinal flap). The method mentioned in point 4. is used for a pharyngeal plasty.

  25. (A)

  26. (B)

  27. (B)

  28. (D) A Guérin fracture (also called Le Fort I.) is a central, while a blow-out fracture is a lateral midface fracture. Gillies’s method is used for the surgical treatment of a zygomatic fracture. A Halo device is used for the external fixation of midface fractures following repositioning.

  29. (A)

  30. (A)

  31. (D)

  32. (C) Extracapsular fractures may be high or deep so called subcondylar fractures. Intracapsular fractures are not treated surgically; while the management of dislocated subcondylar fractures depends on whether it is high or deep (no surgical fixation is applied for high subcondylar fractures). Condylar fractures always result in malocclusion.

  33. (C)

  34. (D)

  35. (D)

  36. (C) Both are salivary gland tumours of an epithelial origin. They mostly occur in the lower pole of the parotid gland (superficial lobe). Both have a capsule.

  37. (A)

  38. (A)

  39. (B)

  40. (B) Glossopharyngeal neuralgia is associated with typical pain and a trigger zone in the lingual radix and tonsillar region. Constant, dull pain with vegetative symptoms is characteristic of the atypical auriculotemporal neuralgia that is also called Frey’s syndrome after the scholar who first described it.




  1. (A)

  2. (C)

  3. (C)

  4. (B) These two benign lesions (fibroma, fibrous epulis) are usually similar on palpation (touch of a horse hair - pillow); their colour is the same as that of healthy mucosa or a shade lighter. Their size differs, as fibroma is usually of a few millimetres in size and fibrous epulis can grow to the size of a nut or even plum. Fibroma is not prone to recur, whereas fibrous epulis recurs often.




  1. (C)

  2. (B)

  3. (B)

  4. (C) It is characteristic of both cementoma and central fibroma that they both occur at a young age; they are both painless and are benign tumours. An encapsulated circumscript form resembling a cyst suggests a central fibroma, while cementoma is connected to the roots of teeth and is a strongly radiolucent entity. The loosening of teeth and a resulting occlusal difference is only characteristic of a central fibroma. Cementoma rather causes the fixation of a tooth, thus makes it difficult to remove the tooth.




  1. (A)

  2. (A)

  3. (B)

  4. (B) Lip carcinoma has three types, carcinoma of the tongue has two (exophytic and ulcerative). Lip carcinoma gives a late metastasis, carcinoma of the tongue often and quickly, therefore an elective neck dissection is not recommended in the case of a lip carcinoma, whereas it is in the case of a lingual carcinoma. The treatment of a lip carcinoma is radical surgery, while in the case of a carcinoma of the tongue the combined therapy of chemotherapy-surgery-radiation therapy is recommended because of the bad prognosis.




  1. (B)

  2. (B)

  3. (D)

  4. (B) Osteosarcoma is characteristic of young patients whereas fibrosarcoma is of middle-aged people. The X-ray image of osteosarcoma may show contradicting signs of sclerotising and osteolytic forms, out of which the osteolytic form is more aggressive. Radiation therapy is not effective in either disease. The treatment is surgery for both tumours, combined with chemotherapy in the case of osteosarcoma.




  1. (C)

  2. (A)

  3. (C)

  4. (A) Neck dissections are used to remove the lymphatic system of the neck. In the radical type all anatomical structures above the deep neck fascia are removed except for the common and internal carotid artery, the vagal nerve, the phrenic nerve and the hypoglossal nerve; in the functional type the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve are also salvaged. A radical dissection is performed in the case of an advanced metastasis connected to surrounding tissues; in other cases the less radical, functional dissection is recommended.




  1. (C)

  2. (D)

  3. (A)

  4. (B) Both operations are performed in the surgery of dysgnathia on the mandible. In Dal Pont’s operation a sagittal osteotomy is performed on the mandibular ramus, thus the whole corpus of the mandible is mobilised together with the teeth in it. In Dingmann’s operation an osteotomy is performed on the mandibular corpus on its entire width, then an ostectomy is done. The section of the alveolar process between the mental foramina has to be mobilised during a frontal segment osteotomy.




  1. (A)

  2. (B)

  3. (C)

  4. (B) Paget’s disease is characteristic of the middle age and its characteristic symptom is the slow enlargement of the skull. In contrast, osteopetrosis may occur in early infancy, though it may start later on as well. Bones may be painful in both diseases. In Paget’s disease there is a mosaic-like pattern in the X-ray (osteolytic-osteosclerotic alternation), while in osteopetrosis a diffuse, homogeneous sclerotic lesion of the bones is seen.




  1. (D)

  2. (B)

  3. (A)

  4. (B) Detaching the insertion of the mylohyoid and genioglossal muscles is the operation of lowering the floor of the mouth. Submucous vestibule plasty is usually performed on the maxilla and rarely on the mandible together with raising the alveolar process. An open vestibule plasty may be performed on the mandible. During a submucous vestibule plasty a double tunnel (superficial and deep) is prepared and the muscle insertion between the two is detached and moved cranially. During an open vestibule plasty labial mucosa is used as a flap, the periosteum is cut through and laid over the labial mucosal defect.



^ Oral Medicine


Explanations


ORM-1 (D) Crust is a secondary skin lesion, which occurs after the presence of a primary skin lesion.


ORM-2. (B) The main local etiological reason of the coated tongue /lingua fuliginosa/ is the decrease in the self-cleaning ability of the tongue. Self-cleaning is provided by the lingual movements and the abrading effect of the foods. To the reduction of these actions can lead dental- and periodontal disorders, which are accompanied by pain. An increased coated tongue formation can be detected in xerostomia, cigarette-smoking and diseases accompanied by fever.


ORM-3. (B) In the development of angular cheilitis streptococci and staphylococci are the causative agents in children and young adults, while candida albicans causes angular cheilitis in the older ages.


ORM-4. (C) The characteristic symptom of the glossitis migrans (geographical tongue) is that the spots with the white margins change their shape and their size, which is not characteristic of the acute glossitis. In case of the median rhomboid glossitis a rhomboid or oval shape red lesion can be detected at the posterior one third on the dorsum of the tongue. Black hairy tongue is accompanied by a brownish blackish discoloration of the tongue.


ORM-5. (C) Boil or furuncle is a skin disease caused by the inflammation of hair follicles, thus resulting in the localized accumulation of pus following a staphylococcus infection. It predilection area is the upper lip, and the occipital area. The furuncle manifesting on the upper lip area is very dangerous, as the pressing of the boil can lead to the thrombosis of the cavernous sinus, meningitis or brainabscess because of the convenience of the angular vein. The adequate therapy is the surgical draining of the boil and administration of a broad spectrum antibiotic.


ORM-6. (A) This alteration is called the “strawberry tongue” because of the distinctive white coating of the tongue and because of the swelling of the filliform papillae, which is detectable in patients with scarlet fever. After the disappearance of the white spots only the red papilla alteration is visible this is the status which is called “raspberry tongue”. Other oral symptoms are less characteristic in scarlet fever, but this lingual alteration is typical in scarlet fever.


ORM-7. (B) The characteristic symptom of the recurrent childhood parotitis is the reduced saliva production because of the destruction of the glandular tissue, which increases the risk for infections because of the consequent xerostomia. The glandular tissue is continuously reducing, because of the recurrences. The other statements are tru for the recurrent childhood parotitis.


ORM-8. (D) Vesicle is the primary skin lesion of the herpetic gingivostomatitis and the labial herpes, which is macerated rapidly to the effect of saliva in the oral cavity, thus an erosion will soon be detectable in its place, vesicle is visible only for a short period of time.


ORM-9. (B) The causative agent of the herpes zoster is the herpes varicellae virus, which causes chicken-pox in the childhood, and causes herpes zoster in the adults. The latently present virus becomes reactivated to the effect of reinfection with the virus. The reactivation can also be caused by a tumor (paraneoplastic zoster), trauma, immune-suppression and certain drugs, when the virus gets to the skin or to the mucosa from the Gasserian ganglion or from the spinal ganglions along the nerve fibers.


ORM-10. (A) Rubella infection can occur both in children and in adults, which is usually not accompanied by consequences, but on some adults arthralgia could be detected. The highest is the risk in case of pregnant women, because it can most oftenly cause heart-, eye- ear- and brain damage in the first 16 days (so in the first trimester) of the maternity. Therefore pregnant women must be saved against the risk for rubella infection.


ORM-11. (D) In the treatment of the oral candidiasis the antimycotics are used, like Nystatin, Pimafucin, Nizoral and Borax-glycerin. Application of the Augmentin antibiotic is contraindicated.


ORM-12. (A) The main predilection area of the papillary hyperplasia induced by a chronic fungal infection is the hard palate, which makes the palatal mucosa uneven and nodular.


ORM-13. (D) Chronic hyperplastic candidiasis is similar to leukoplakia because of its appearance, therefore it is also called candida-leukoplakia. It can be detected usually on removable denture wearers and cigarette smokers, its predilection area is the angle of the mouth the retrocommissural area, the tongue and the palate.


ORM-14. (E) Candida granuloma can be noticed in chronic mucocutan candidiasis on the skin or on the mucosa, in the form of nodi extended from the surface.

ORM-15. (E) It is necessary to always carry out a search for foci in case of recurrent oral ulcers (aphthas), bacuse the allergy provoking agent can also be spread from a focus. It is important to perform and maintaining a good oral hygiene, which can be assisted by Neomagnol or chlorhexidine mouth rinses. Suspensio anaesthetica can also be prescribed in order to reduce pain, vitamin-B, iron and folic acid have advantageous effect too.


ORM-16. (A) The troublesome subjective complaint of the patients with Sjögren’s syndrome is the xerostomia, which can be improved by increasing salivation. For this aim are suitable the parasympathomimetic drugs (Stigmosan and Mestinon tablets, Pylocarpin injection). If the glandular tissue is damaged to an extent that the salivation can not be increased, then artificial saliva can be given to the patient to reduce xerostomia.


ORM-17. (E) Taking of certain drugs can result in allergic reactions in some persons. Symptoms are not specific, there can be different reaction to the same drug, the immune reaction is not specific, thus the causative drug can not be determined straight forwardly from the symptoms. the stomatitis medicamentosa as an allergic reaction is rather dependent on the individual reaction of the body, than on the type of the drug.

ORM-18. (D) The production of autoantibodies in pemphigus- patients is often provoked by the presence of a malignant tumor with a heterogeneous cross reaction, or it develops after the drug therapy. Therefore in patients with pemphigus always necessary to search for the presence of malignant tumors, pemphigus are considered as paraneoplastic syndromes.


ORM-19. (C) Erythema exsudativum multiforme is a type III. immune reaction, the Arthus’ type immune reaction, which is accompanied by an immune complex production. The disease develops with oral symptoms, or sets up in combination with skin lesions, it is accompanied by an exsudative inflammation, and it is prone to recurrences.


ORM-20. (A) Mitotic activity increases in the epithel to the effect of vitamin-A and keratinization becomes reduced, thus the keratolytic activity of vitamin-A is used in the treatment of different mucosa alterations (leukoplakia, lichen oris, cheilitis actinica chronica).


ORM-21. (A) Among the listed vitamin-B derivates vitamin-B1 has the smallest effectivity onto the oral mucosa. The defect of vitamin B2 (riboflavin) causes angular cheilitis and glossitis, the defect of vitamin A3 leads to pellagra. Vitamin B5 (pantotheic acid) is used in oral diseases accompanied by hyperkeratosis and erosion, in the defect of vitamin B12 pernicious anemia and its characteristic oral manifestations occur.


ORM-22. (B) The typical alteration of the tongue in pernicious anemia is called Hunter- Möller glossitis, which can be characterized by the deeply striated surface, and the uncooked flesh appearance.


ORM-23. (D) If unilateral oropyrosis (burning sensation of the oral mucosa) is detected in the patient, it most probably reveals onto neurological background (for example the damage of the lingual nerve during an operation in the region of the floor of the mouth). Symptoms are more severe in this case, their intensity can change depending on the daytime.


ORM-24. (B) In case of the erythroleukoplakia (erythroolasia or mottled leukoplakia) belonging to the non homogeneous group of lekoplakias, occur most often and easiest carcinoma. In case of the simplex or homogeneous type should not be expected a malignant transformation. Reticular type does not exist.


ORM-25. (D) The earmark of the lichen oris is the Wickham’s stria. Koplik’s spots appear in measles, “raspberry tongue” is typical in scarlet fever. Crater-like keratin-peg can be detected in some praecancerous alterations, like keratoacanthoma, while ulcus rodens is one clinical form of the basalioma.


ORM-26. (D) The bruxism or the sucking of the buccal mucosa during night can have a role in the occurrence of the white oral lesion of linea alba. Malignant transformation however should not be expected, so the alteration is not considered as a precancerous lesion. The alteration does not require treatment.


ORM-27. (A) Nystatin is the used drug in case of a candida infection, since it is the only antimycotic drug among the listed ones, and in the given situation in this infection the administration of an antifungal drug is the necessary.


ORM-28. (B) Central hemangioma is a rare neoplasm growing inside the bone, which can destruct the surrounding bone matrix, can cause the loosness of the teeth, and by developing a bony window, it can grow into the oral cavity. At this time tooth extraction or other surgical intervention can be accompanied by a sever bleeding.


ORM-29. (D) Fibroma is a benign alteration of conjunctive tissue origin.


ORM-30. (E) Every nevus changing its characters from its rest state is predisposed to malignant transformation: if it is changed in color or size, it is ulcerated, itching or bleeding or becomes inflamed. These symptoms are called “movement symptoms”. Noticing this a surgical excision is suggested in order to prevent malignant transformation.


ORM-31. (A) At presence of a hemangioma, care must be taken not to hurt the vascular tumor, because a severe bleeding can be the consequence. Namely tumor cells originated from the wall of the blood vessel highly damage the wall of the blood vessel, and therefore the vasoconstriction which is normally accompanied by a damage of the wall, can not occur.


ORM-32. (C) The parodontoma gigantocellularis is the last developmental stage of the parodontoma, in which the appearance of the osteoclast like giant cells is characteristic. These cells differentiate them from the other two types: the granulomatous, and the fibrous types of the epulis. Also the name of the gigantocellular form is originated from this.


ORM-33. (C) Most of the oral cancers are located in floor of the mouth.


ORM-34. (B) Cancers appearing on the palate most frequently manifest on the soft palate. Less alteration has been described on the hard palate, while the uvular localization is extremely rare.


ORM-35. (A) Clinical symptoms of the maxillary sinus have a wide variety, which become straightforward just after the destruction of the surrounding bone tissue. Nearby the symptoms listed in the points of B to E, important may be the followings in the diagnosis a loosen tooth, the slow extraction wound healing, the paresthesia or anesthesia because of the infiltration of the supplying nerve, and additionally exophtalmus and diplopia because of the infiltration of the orbit. Trismus is a typical sign of the buccal cancer.


ORM-36. (D) Metastasis can be diagnosed rarely in the orofacial region, namely secondary malignance, which, in case of its appearance, infiltrates the jaws. The metastatic tumors occurring in this regions, are originated from their primary neoplasm of the breast, or of the kidneys the or of the thyroid gland or of the prostate


ORM-37. (C) In a normal state there are not follicles and sebaceous glands in the oral mucosa, but sometimes sebaceous glands of heterotropic (ectopic) localization can be found in the oral cavity on the bucca or on the internal surface of the lips, in general bilaterally. These features are called Fox- Fordyce- granules.


ORM-38. (E) The congenital epulis is a benign tumor detectable in newborns, which is ought to be removed if the larger tissue increment prevents the breast-feeding of the infant.


ORM-39. (A) During an alkali poisoning a deeply diffusing colliquation necrosis occurs. The mucosa is edematous, ulcerated and painful. Coagulation necrosis occurs at the effect of an acidic poisoning.


ORM-40. (D) Denture irritation induced alteration is called denture induced hyperplasia, or granuloma fissuratum. In the development of this alteration the ill fitting denture has the main role, and additionally the fact that the surrounding tissues are under the pressure of the prosthesis. The epulis fibrosum and granulomatosum are tumor like alterations, while the granuloma pyogenicum and gravidarum are also tumor like trauma induced lesions.


ORM-41. (D) The bulla and nodus are primary skin lesions, characterized by belonging to the direct consequences of a given disease, while the erosion and the ulcer are secondary lesions developing from primary skin lesions.


ORM-42. (E) Agents predisposing to angular cheilitis are: streptococci and staphylococci in children, while presence of Candida albicans in the older ages, and it can be accompanied by other states present, like iron deficiency anemia, diabetes mellitus or pellagra.


ORM-43. (A) In a case like this cheilitis allergica is the diagnosis, according to the symptoms it is considered to be a contact cheilitis. The adequate therapy is: the elimination of the irritating agents (cosmetics), for diminishing inflammation corticosteroids and fomentation with Camilla tea can be administered. It is redundant to give antibiotics the cases of this alteration.


ORM-44. (B) Scarlet fever, impetigo and erysipelas are caused by a Streptococcus-infection, while the causative agent of diphtheria is the Corinebacterium diphtheriae.


ORM-45. (E) Actinomycosis develops at the effect of an Actinomyces israeli bacterial infection, its clinical picture is: unilateral, the skin becomes infiltrated above it, a painless swelling develops. The inflamed skin is red or livid. In the differential diagnosis THE followings should be considered: periostitis, phlegmone, osteomyelitis, tuberculosis, syphilis AND the presence of a malignant tumor.


ORM-46. (E) parotid swelling is characteristic of all listed diseases.


ORM-47. (D) Two lesions are considered to be indicative in case of an HIV-positive person: Kaposi- sarcoma, which appears as livid or brownish-reddish spot with an obliterated margin on the hard palate or on the tongue, or on the bucca; and firther more the hairy leukoplakia, appearing on the tongue in a form of a whitish verrucous form on the margin of the tongue.


ORM-48. (E) All of the listed methods and drugs are employed in the treatment of the herpes zoster. In order to avoid the ophthalmologic consequences, a consultation with an ophthalmologist is essential in this case.


ORM-49. (E) The causative agent of the labial herpes is the Herpes simplex virus, which persist in the trigeminal ganglia after the primary infection. To its reactivation can lead sunbathing, fevered state, disease of the upper respiratory tract, pneumonia, malaria, physical or psychological stress, menstruation, gravity, etc.


ORM-50. (E) All the listed agents can make susceptible to oral candidiasis.


ORM-51. (B) Among the listed causative agents the wearing of a maxillary removable denture has a greater role in the development of chronic atrophic candidiasis, and not in the thrush.


ORM-52. (D) The characteristic of the thrush is: the most frequent form of candidiasis, which forms a whitish yellowish coat on the oral mucosa, it can be rubbed off, and after rubbing off a bleeding eroded surface remains.


ORM-53. (B) The parotid gland of the patients with Sjögren’s syndrome is swollen, the alteration is a benign lymphoepithelial lesion, and the lymphocytic infiltration destroys the glandular tissue. As regards, a continuous decrease in the salivation and its break off can be detected.


ORM-54. (E) In the treatment of the angioneurotic edema, in an acute case Calcimusc injection, antihistamines (Sandosten tabl., Fenistil retard tabl.), corticosteroids, in more severe cases Tonogen injection are administered.


ORM-55. (E) Diagnosis of the Sjögren’s syndrome can be set up by sialometric, sialochemical, sialographic, scintigraphic methods or by the help of a minor salivary gland biopsy. This last method is indicative, since lymphocytic infiltration occurs in the minor salivary glands too.


ORM-56. (A) Recurrent oral ulcers are the Mikulitz’s, the Sutton’s, and the Cooke’s aphta. Möller- aphta does not exist.


ORM-57. (D) The benign mucosa- pemphigoid occurs mainly on the conjunctiva and on the oral mucosa. Other predilection areas are the anus, the throat, the nose, the esophagus, and the vulvar mucosa.


ORM-58. (E) The erythema exsudativum multiforme, as a blistering disease of allergic origin, can be manifested to the effect of different allergens, like: drugs, bacteria, viral antigens, heteroantigens deliberated in other diseases, but in a number of cases the origin is unknown.


ORM-59. (E) All of the listed methods are employed in the tereatment of the patient with pemphigus. The restriction of the immune reaction is carried out by a large dose of corticosteroids and immune suppressive drugs. Oral hygiene is improved by a Neomagnol mouth rinse, while the Doxcyclin capsule is used for the prevention of the overinfection of the oral lesions and oral erosions. .


ORM-60. (B) The defect of vitamin B3 vitamin (nicotinic acid) results in the pellagra, its characteristic symptoms are: the dementia, the dermatitis and the diarrhea.


ORM-61. (A) The symptoms of the Plummer- Vinson syndrome are: iron deficiency anemia, glossitis (smooth, shiny tongue, because of the papillary atrophy sometimes erosions) and dysphagia.


ORM-62. (E) All of the listed alterations can be detected in the oral cavity of the patients with Plummer-Vinson’s syndrome.


ORM-63. (C) In the development of the pellagra (vitamin B3 deficiency) and in the pernicious anemia (vitamin B12 deficiency) have a role of the deficiency of any vitamin B. Scorbut occurs because of the vitamin C deficiency, while hemeralopia (xerophthalmia) develops in case of the deficiency of vitamin A.


ORM-64. (E) diseases, states and alterations, predisposing to xerostromia are: diabetes mellitus, diarrhea, loss of blood, endogenous depression, vitamin deficiency states, autoimmune diseases, climax, gravidity, thyroid diseases, irradiation therapy, taking of certain drugs, like diuretics, antihistamines, antiparkinson drugs.


ORM-65. (C) Sunlight as a risk factor is important in the development of the cheilitis actinica chronica and the keratoma senile. In the development of the oral lichen psychological agents, autoimmune origin and hypertension are assumed, but many authors consider it as an idiopathic disease. In the formation of the submucosal fibrosis the bethel nut chewing has a chief role, which is a chronic disease detected in the people of India.


ORM-66. (B) The therapeutic use of the vitamin A is not indicated among the listed ones only in case of the cornu cutaneum. Namely its adequate treatment is the surgical removal, krio- or laser therapy the of the cornu cutaneum, or removal by electrocoagulation.


ORM-67. (A) Predisposing factors in the development of leukoplakia are: smoking (mainly because of its thermal effect), mechanical irritation (broken, or ill fitting prosthesis with sharp margins), consumption of concentrated alcoholic beverages, spicy foods, galvanism. Oral manifestations of the leukemia are: pale mucosa because of the anemia, gingival hyperplasia, gingival bleeding because of the thrombocytopenia, purpura, and ulcers because of the lack of functioning white blood cells.


ORM-68. (E) Lichen oris is praecancerous state, (its origin see in: ORM-65.), its clinical forms are: anular, papular, reticular, plaque, atrophic, erosive and bullous. Steroids may have a role in the therapy if a severe case is to be treated.

ORM-69. (D) The most important in the treatment of the cheilitis actinica chronica is the elimination of the causing agents (forbidding smoking, wearing a wide boater). In order to decrease inflammation administration of vitamin B and a local application of vitamin A oil is suggested, incidentally a surgical, cry- or laser therapy can be used.


ORM-70. (D) The papilloma is of epithelial origin, pleomorphic adenoma is originated mainly from the glandular epithel. Fibroma is a benign tumor developing from the connective tissue, while myoma is a benign alteration appearing in the muscular tissue.


ORM-71. (B) Among the listed alterations, the Warthin- tumor (cystadenoma lymphomatosum papillare) is a real benign tumor, which occurs nearly always in the parotid gland. The other alterations are considered as tumor like alterations.


ORM-72. (D) Hemangiomas are sorted into two groups according to their structure: capillary type consisting of groups of capillaries, and the cavernous type, consisting of deep vascular sinuses.


ORM-73. (C) Criteria of the malignancy are: local infiltrative growing, giving of metastasis to regional organs and/or to distant organs, contrary to the expansive growing, or rather to the lack of metastasis formation of the benign tumors.


ORM-74. (C) The Kaposi’s sarcoma is a vascular originated malignant tumor, which occurs mainly on the extremities, on the skin of the trunk, on the mucosa and in the inner organs, most often on males. As the symptoms of the diseases livid or brownish-reddish nodules appear on the hard palate or on the tongue, or on the bucca. It has a higher frequency in people with immune suppressive therapy or on those who suffer from AIDS.


ORM-75. (E) Treatment of the acute leukemia is the task of the physician, but also the dentist has to take part in the therapy of the oral alterations, by considering and employing all the treatment modalities listed in the question..


ORM-76. (B) In the development of the lingual cancer, the followings can have a role: alcoholism accompanied by hepatic cirrhosis, smoking, local irritations, intake of hot and spicy foods. Geographical tongue (lingua geographica, glossitis migrans, exfoliatio areata linguae) is a benign alteration, malignant transformation should not be expected.


ORM-77. (E) Because of the hypertrophia frenuli labii superioris often a disthema appears between the maxillary first incisors, and a gingival recession may occur because of the increased pulling. The enlarged frenum also predispose to periodontitis, inflammation and pocket may be formed because of the constant tension.


ORM-78. (D) Frenulectomia means the surgical removal of the enlarged frena, which may be carried out in case of the pathological change of the frena of the lips or the lingual frenum. In case of the first it is called hypertrophia frenuli labii, while the second is called ankyloglossia.


ORM-79. (C) As its name shows: morsicatio buccarum et labiorum , it occurs in these two places: a whitish lesion, erosion or ulcer because of morsication on the bucca or on the lip.


ORM-80. (A) The bady reacts with general symptoms (fever, nausea, vomiting) and local symptoms too to irradiation. Thus radiation induced xerostomia results in an increased caries of the teeth, periodontitis, loosening of the teeth, and circular caries (“irradiation caries”). Late consequence of the irradiation can be osteoradionecrosis, if a trauma (for example tooth extraction) occurs in the oral cavity following the irradiation, which becoming overinfected, will spread into the bone.


ORM-81. (D) Hematological examination is not requested routinely in every patient, if there is a suspicion to one of the listed diseases, because in these cases hematological examination (blood test) is suitable for detecting the given diseases.


ORM-82. (A) In the development of the median rhomboid glossitis more causative agents are presumed (developmental disorder, inflammatory or degenerative origin), but the presence of the Candida albicans is almost always detectable, therefore fungicide drugs have aprimary role in the treatment. Laser- and kryosurgery treatment or surgical excision can be indicated in case of a long term existence of the disease.


ORM-83. (A) See: ORM-5.


ORM-84. (D) The Hutchinson’s triad can be detected in case of the connatal syphilis with the listed symptoms, but this form is transmitted from the mother to the fetus, and not the opposite.


ORM-85. (C) Measles is caused by the morbilli virus; infectious mononucleosis is caused by the Epstein- Barr virus. In the diagnosis of the patients suffering from the Pfeiffer’s disease (mononucleosis infectoisa) the petechiae of the palate have a definitive role among the clinical symptoms. Maculo papulous exanthema arise on the skin, the uvula and the palate are infiltrated.


ORM-86. (E) Most effective protection against measles, developing because of the morbilli virus, is vaccination. The number of the patients with measles have been dramatically decreased since its introduction. Skin and mucosa alterations appearing in measles require only symptomatic treatment.


ORM-87. (C) Among the forms of the oral candidiasis the acute pseudomembranous form is the most frequent type. The chronic atrophic candidiasis occurs mainly in the removable denture-wearing subjects, most often on the palate. In this case the palate is erythematous, and the tongue is red and depapillated. Differentiation can be difficult from the contact palatal allergy, caused by the removable denture too.


ORM-88. (D) The existing chronic candidiasis infection carries the risk of malignization in itself, therefore it is very important to continuously monitor these patients. Malignant alteration developed on the base of chronic candidiasis infection can be detected accordingh to the histopathological findings, in the picture of epithelial dysplasia and cancer. A slight pain and a burning sensation may be caused rather only by the atrophic candidiasis.


ORM-89. (E) Since the lymphocytic infiltration appears in the minor salivary glands too, the minor salivary gland biopsy is an important method of the diagnosis of Sjögren’s syndrome.


ORM-90. (C) Contact allergy against acrylic resin is really a rare disease; in this case, dentures made of acrylic resins provoke an allergic immune reaction in the body. It is likely that the allergen is the monomer fluid.


ORM-91. (B) Pemphigus’ characteristic symptom is the Nikolsky’s sign, when an intact skin surface rubbed off becomes exfoliated, and leaves back erosion. In its histological picture the Tzank cells can be detected (acantholytic, round shape epithelial cells with a puffy nucleus). In the differential diagnosis from pemphigoid it is important that the Nikolsky’s test is positive in both cases, but the Tzank’s cells can not be found in pemphigoid, the Tzank test is negative in this case.


ORM-92. (D) In patients with Diabetes mellitus, who are not treated or not adequately treated, characteristic oral alterations can be detected. From a periodontal point of view the swollen gingiva and the increased bleeding ability of the interdental papillae are important and additionally those periodontal diseases which lead to the loosening of the teeth and to the periodontal abscesses. The subjective complaints of the patients are xerostomia, feeling a sweet taste, itching of the gum.


ORM-93. (A) The effect of progesterone onto the mucosa is the increased vascularization, which makes the tissue more vulnerable and predisposes to recurrent bleedings. Progesteron level is increased in prenant women, therefore gravidity gingivitis and frequent gingival bleeding is usual.


ORM-94. (B) The denomination of leukoplakia is used in a clinical understanding to the white lesions or to the plaques of the mucosa, which is an alteration, accompanied by a chronic inflammation and keratinization, and clinically can not be sorted to any other well defined disease groups. In the development of the alteration mechanical, electrical, bacterial stimuli, chronic inflammations, cigarette smoking, alcohol consumption, immunological origin can have a role.


ORM-95. (C) Lichen oris occurs in the oral cavity on the bucca (most often), on the tongue, on the lips, on the gingiva, but the appearance of this does not result in 100% cancer, thus it can not be considered an obligate precancerous alteration.


ORM-96. (A) The mandibular torus is a tumor like alteration, bony extension, on the lingual surface of the mandibular jaw, which can bother the proper fit of the dental prosthesis, thus the surgical removal of it may be indicated before the denture fabrication.


ORM-97. (C) The content of the dermoid cysts contain the auxiliary elements of the skin, so sebaceous glands, sweat glands and follicles. The epidermoid cyst is different from the dermoid cyst, because it does not contain these skin elements


ORM-98. (B) Gingival cancer is more frequent on the mandibular gingiva compared to the maxillary gingiva. Also the statement about the histological finding is right, but there is not a logical connection between the two statements. s.


ORM-99. (A) See: ORM-75.


ORM-100. (A). the first symptoms in acute keukemia can occur in the oral cavity see: ORM-75.), thus the dentist can be the first who is able to detect symptoms related to leukemia. Therefore it is very important to consult with the physician in all the cases when there are non healing ulcers, gingival hyperplasia, recurrent gingival bleeding in the oral cavity of the patients.


ORM-101. (C) Masseteric hypertrophia can be originated from a congenital or a functional reason (state after surgical intervention or bad habit). Only the last one can be improved by the elimination of the bad habit, by administration of sedatives, and by wearing a Gottlieb’s splint. In case of hypertrophia masseterica the number of the muscle fibers do not change, only their size is increased.


ORM-102. (D) At the recognition of the oral lesions of the patients and at the diagnosis of the Peutz- Jeghers’ syndrome the most important is the consultation with the physician, because in the gastrointestinal tract of these patients numerous polypous alterations can be found, which is considered by some experts to be an obligate precancerous lesion


ORM-103. (C) See: ORM-40. Regarding the frequency of the granuloma fissuratum it is more frequent on the edentulous maxillary jaw, compared to the mandibular jaw, and its predilection area is the frontal region.


ORM-104. (B) Hydantoin induced fibrous gingival hyperplasia can only be detected on those places where there are teeth, thus it cannot be detected on edentulous jaws. Besides these, examinations revealed the causative role of the bad oral hygiene in the disease.

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