has been postulated that bleeding can occur from

any of these vessels.

The growth fails to occur on the side of ankylosis

whereas normal growth is occurring on the

contralateral side which pushes the chin to the

side of ankylosis.

In bilateral TMJ ankylosis case there would be

no deviation of chin as growth is retarded

equally on both the sides. But marked retrogenia

and retrognathia would be there resulting in

classical bird face of 'shrew mouth' deformity.

When there occurs recurrent dislocation of

mandibular condyle, any of the following could

be carried out surgically:

a. Dautrey procedure

b. Eminectomy

c. High condylotomy

(B) and (C) are methods which remove the bony

interference thus allowing easy gliding in or out

of glenoid fossa. Now dislocation becomes self

reducing.

In Dautrey procedure the zygomatic arch is

sectioned and pushed down in front of condyle.

This prevents the dislocation to occur.

MPDS is characterised by

M Muscle tenderness

P Pain on function in TMJ

D Dysfunction of disc (clicking)

10 C. Dislocation or subluxation can occur if capsule

has become lax. Therefore these solutions are

injected paracapsular to bring about fibrosis of

capsule thus checking its laxity.

16 D.

9 A.

11 B.

12 D. MPDS is a psycosomatic disorder and occurs in

a cyclic manner

High filling—>TMJ pain—^muscle spasm—> mouth

opening —>pain. Tension (Psycogenic)—>bruxism

—» muscle overacting —> spasm -» mouth opening

—> pain.

13 B. TMJ arthroscope as name suggests is an instrument

which can see inside the joint. To this is

added an armamentarium by which various soft

tissue surgeries can be done in TMJ.

14 B. Though by classical method of pushing the

condyle downward and chin upward the

operator can reduce TMJ dislocation. But better

would be to inject LA in muscles/tissues around

TMJ. Since dislocation occurs due to spasm of

depressor group of muscle therefore LA breaks

this spasm and dislocation reduces on its own.

15 D. See answer 8.

17 B.

18 B.

19 C.

20 B.

21 A.
22 B.

23 A.

24 C.

25 A,

26 C

27 A.

28 A.

Carbamethexamol—A muscle relaxant to break

spasm of muscle

Diazepam—(for psycologic factor) sedation

Analgesic—Relief of pain

Fomentation—Increases blood supply to muscle

therefore helps in checking spasm (vasodilation

removes lactic acid, etc.).

Cold compresses make area numb and allow

muscles to function allowing stretching which

also helps to break spasm.

Mucoperiosteal mobilization from buccal tissue.

Palatal flap whenever used for closure of OAF,

should include a branch of greater palatine

artery. A vascular flap has very less chances ot

failure.

The principle of nasal antrostomy is to allow

drainage from sinus to occur in nose. If opening

is above the level of nasal floor, drainage would

not be complete.

If infection in sinus is present, OAF should never

be closed as failure is bound to occur. Patient

should be given antibiotics and antral lavage

should be done regularly.

In all other events surgery can be done by other

means such as by using tongue flap, etc.

Only signs of infection should make one defer

the surgery for closure.

Shrinkage of lining prevents oedema of lining

and thus healing is better and infection controlled

earlier. But nasal decongestants directly do

not do so.

Sialoangiectasis or dilation of salivary acinoductal

system can occur due to infection, sialolithiasis,

stricture, etc.

This is known as Hilton's method of treating

parotid abscess.

The lingual nerve has a characteristic relation

with submandibular duct. In posterior region it

lies laterally and superiorly, therefore for posterior

stone the incision is more laterally and

superficially. In anterior region the nerve runs

beneath the duct to reach medially and lies deep.

Therefore the typical approach to the stone (A)

is carried out.

If placed transversely the duct never recanalises.

Therefore incision is longitudinal and not

sutured and it canalises again. If duct is sutured

there are chances of stricture formation.

Acinar system is dilated in chronic sialadinitis

Ductal system is dilated distal to stricture