Facial Plastics, Trauma and Reconstruction (Nasal/Facial Fractures) MCQs

ENT · 32 free questions with answers & explanations.

1. A 30-year-old male presents after a road traffic accident with bilateral periorbital ecchymosis ('raccoon eyes'), CSF rhinorrhea, and a step deformity across the nasal bridge. Axial CT shows bilateral medial orbital wall fractures with involvement of the nasoethmoid complex. The Le Fort classification of this fracture pattern is best described as:
2. In rhinoplasty, the 'open sky' (external) approach provides superior visualization compared to the endonasal approach. The transcolumellar incision is placed at the narrowest part of the columella. Healing of this transcolumellar scar in the standard open rhinoplasty is primarily dependent on closure of which anatomical layer?
3. A 25-year-old sustains a blow to the left cheek. He develops diplopia on upward gaze, enophthalmos, and hypoesthesia below the left eye. CT shows a 'trapdoor' type fracture of the orbital floor. What is the most important immediate surgical indication?
4. In the management of acute septal hematoma following nasal trauma, which complication is most feared if the hematoma is left untreated?
5. A patient sustains a blow to the cheek and presents with enophthalmos, diplopia on upgaze, and infraorbital nerve hypaesthesia. CT face shows fracture of the orbital floor with herniation of orbital contents into the maxillary sinus. The mechanism causing diplopia in this injury is:
6. In Le Fort fracture classification, which level of midface fracture passes through the pterygoid plates and causes a floating palate (separation of the entire hard palate and dental arch from the cranial base)?
7. A 30-year-old male presents 12 hours after nasal trauma with a smooth, fluctuant, non-tender swelling obliterating the columellar definition bilaterally. The swelling does not transilluminate. What is the immediate priority in management and why?
8. A patient involved in a road traffic accident presents with a telecanthus, flattened nasal bridge, CSF rhinorrhea, and marked periorbital edema. CT facial bones show comminuted fractures of the naso-ethmoid-orbital (NOE) complex. Based on the Markowitz-Manson classification, a Type III NOE fracture is distinguished by:
9. In rhinoplasty, the 'osseocartilaginous vault' refers to the middle third of the nose. A 'open roof deformity' occurring after hump reduction is caused by which specific structural problem, and how is it corrected?
10. A patient sustains nasal trauma and presents with bilateral bluish subconjunctival hemorrhage, periorbital ecchymosis (raccoon eyes) and CSF rhinorrhea. The most likely associated fracture pattern is:
11. Following nasal trauma, a patient develops a tender, fluctuant swelling of the nasal septum bilaterally, occluding both nasal passages. This complication, if left untreated, most commonly leads to:
12. In a Le Fort II fracture, the fracture line passes through:
13. A patient sustains a blunt facial trauma and presents with enophthalmos, infraorbital hypoesthesia, and restricted upward gaze. The most likely diagnosis is:
14. The septodorsal cartilage (quadrilateral cartilage) of the nose articulates posteroinferiorly with the:
15. Following a significant nasal fracture, closed reduction is ideally performed within:
16. A patient involved in a road traffic accident presents with epistaxis, bilateral periorbital haematoma ('raccoon eyes'), and inability to occlude the teeth (malocclusion). CT face shows a horizontal fracture through the pterygoid plates bilaterally. This fracture pattern is classified as:
17. A nasal fracture with deviation is best treated by closed reduction. The optimal timing for closed nasal reduction after acute injury is:
18. A patient sustains a blow to the zygoma and presents with trismus, flattening of the cheek, anaesthesia of the cheek and upper lip, and diplopia on upward gaze. The most likely injury is:
19. A 28-year-old man sustains blunt facial trauma. CT scan shows a 'tripod fracture' (zygomaticomaxillary complex fracture). Which three suture lines define this fracture?
20. A patient with nasal fracture presents 36 hours after injury with a bluish, fluctuant, tender swelling occupying the full width of the nasal septum blocking both nostrils. The most urgent treatment is:
21. Which of the following is the ideal timing for closed reduction of a nasal fracture?
22. A patient sustains a nasal injury and presents with a smooth, tense, non-tender, fluctuant swelling entirely within the nasal septum that developed over 48 hours. The immediate management is:
23. Le Fort II fracture (pyramidal fracture) involves which structures?
24. Rhinoplasty for correction of a post-traumatic saddle nose deformity most commonly uses which type of graft?
25. A 28-year-old man sustains a blunt trauma to the nose. On examination, there is lateral displacement of the nasal bones, bilateral periorbital ecchymosis, and crepitus on palpation. The optimal timing for closed reduction of a nasal fracture is:
26. A patient involved in a road traffic accident presents with facial swelling, bilateral periorbital oedema ('raccoon eyes'), and cerebrospinal fluid rhinorrhoea. CT face shows a fracture through the anterior skull base. This injury pattern is most consistent with which Le Fort fracture level?
27. A septal haematoma following nasal trauma, if left untreated, leads to which sequence of complications?
28. A 28-year-old sustains a blunt nasal trauma. Two days later, examination reveals a smooth, fluctuant, bilateral septal swelling that obliterates both nasal passages, is non-reducible, and is tender. What is the MOST urgent complication that must be addressed within 1 week?
29. A Le Fort II fracture of the midface involves which structures?
30. A patient with a zygomaticomaxillary complex (ZMC) fracture shows enophthalmos, limitation of upward gaze, and diplopia on upward gaze. This occurs due to:
31. A 28-year-old man sustains blunt trauma to the nose. Nasal bones appear fractured on examination. He presents 12 days later. The most appropriate management now is:
32. A patient involved in a road traffic accident develops flattening of the malar prominence, trismus, and numbness over the cheek and upper lip. CT shows a fracture of the zygomatic arch and orbital floor. This pattern is most consistent with: