B.

Masticator space swellings are masked by

masseter. Are present more anteriorly. Whereas

lateral pharyngeal space infection is posteriorly

placed with characteristic shifting of palatine

tonsil to midline.

6 C. Though it can be done by all means but ideal is

(C). Since trismus is acute and intraoral method

is really difficult. With subangular incision one

can directly reach the pus pocket of masticator

space and allow dependent drainage.

7 B. The apices of 1st molar are present superior to

the attachment of mylohyoid muscle. Above the

mylohyoid lies sublingual space and below it lies

submandibular space. Whereas apices of 2nd

and 3rd molars lie below the attachments of

mylohyoid muscle therefore infections from

these teeth travel to submandibular space.

8 C. Structures in submandibular space

i. Superficial part of submandibular gland

ii. Branches of facial artery

iii. Mylohyoid nerve and vessels

Structures in sublingual space

i. Deep part of submandibular gland

ii. Submandibular duct

iii. Lingual and hypoglossal nerve

iv. Branches of lingual artery

9 C. Classical signs of Ludwig's angina

i. Submandibular, sublingual and submental spaces

are bilaterally involved

ii. Tongue is raised

iii. Brawny induration

Tongue does not fall back, but since it is raised

and has swelling at its base, the oropharyngeal

isthmus decreases in size causing respiratory

embarrassment and later laryngeal oedema

causing respiratory embarrassment.

10 D. To reach sublingual space the incision has to be

deep uptill the mucous membrane. Sublingual

space (which has also to be drained) is bounded

superiorly by mucous membrane, inferiorly by

mylohyoid, medially by geniohyoid and genioglossus

and laterally by mandible.

11 B. Just medial to masticator space lies lateral

pharyngeal space whereas other infections have

to first travel to masticator space and then reach

lateral pharyngeal space.

12 D. The major structures present in lateral

pharyngeal space are the carotid sheath with its

IJV, vagus and ICA. Moreover infection of this

space rapidly spreads to larynx.

13 C. Infections from lateral and posterior pharyngeal

space travel to superior mediastinum to posterior

mediastinum whereas infections from

submental region travel to pretracheal region to

anterior mediastinum.

14 A. Submandible space—^sublingual space—> submental

space—>superior mediastinum—>anterior

mediastinum.
15 B. The investing layer to deep cervical fascia splits

to enclose submandibular and parotid salivary

glands. This is firmly adherent to capsule of

gland. Any infection of the glands cannot swell

out and resulting pressure causes acute pain.

16 B. The injecting needle transverses through this

space.

17 B. Infection due to this infection would travel to:

Infratemporal fossa

'i Pterygopalatine fossa

I' Pterygomandibular fossa

i Temporal fossa.

18 C. Infection from middle part of upper face

(premaxilla and nose) can travel in a retrograde

direction to cavernous sinus. The veins of this

dangerous area are valveless and allow

retrograde infection in form of cavernous sinus

(CS) thrombosis which is characterised by:

i. Ophthalmoplegia 6 since III, IV, VI cranial

nerves are present in relation to (CS).

ii. Meningitis

iii. Proptosis due to increased venous pressure in

superior and inferior veins of the orbit.

19 D.

20 B. This is a typical subperiosteal infection, it occurs

several weeks after an apparently uneventful

healing of a mandibular third molar extraction.

The swelling may be present as far forward as

1st molar or 2nd bicuspid.

21 B. If antibiotics are given first for few days and

incision/drainage not done an abscess usually

develops into an indurated hard swelling known

as an antibioma. This would take 2 / 3 months to

resolve. Therefore incision/drainage should be

done first then broad spectrum antibiotic should

be started and when culture sensitivity report is

available the specific drug should be given.

22 C. Osteomyelitis is an inflammatory condition of

bone that begins as an infection of the medullary

cavity and haversian system. It extends to

involve the periosteum of the affected area.

23 D. Conditions which alter the vascularity of bone

predispose to the onset of osteomyelitis. In all

conditions the vascularity of bone is compromised.

24 B. Osteomyelitis is more common in bones which

have extensive medullary bone and