Test Bank For Plastic Surgery: Volume 3,
5th Edition
Author :
Peter C. Neligan
,Chapter 1: Management of Facial Trauma
1. A 35-year-old male presents to the emergency department after a motor vehicle collision
with visible facial trauma. Which of the following is the priority intervention in the
management of this patient?
A. Assess the extent of facial fractures
B. Administer pain medication
C. Secure the airway and assess for breathing
D. Apply ice packs to reduce swelling
Answer: C. Secure the airway and assess for breathing
Rationale: The priority intervention in any trauma patient is ensuring a patent airway and proper
ventilation. Airway compromise is a leading cause of morbidity in trauma patients, particularly
with facial injuries, which can lead to difficulty breathing due to swelling or structural damage.
Assessing breathing and ensuring that the patient is able to adequately oxygenate is the first step
before focusing on pain management or detailed assessment of fractures.
2. Which of the following is a common complication associated with fractures of the
zygomatic arch in facial trauma?
A. Vision impairment
B. Sinusitis
C. Temporomandibular joint dysfunction
D. Mandibular instability
Answer: C. Temporomandibular joint dysfunction
Rationale: The zygomatic arch is closely connected to the temporomandibular joint (TMJ).
When fractures occur in this region, they can disrupt the alignment and function of the TMJ,
leading to dysfunction. This can present as pain, clicking, or difficulty with jaw movement.
Vision impairment is more commonly associated with fractures involving the orbital region,
while sinusitis is typically seen with maxillary fractures.
3. A patient with a severe mandibular fracture is scheduled for surgery. What is the most
critical preoperative consideration for this patient?
A. Obtain an MRI of the facial bones
B. Perform a full blood panel
C. Secure the airway
D. Administer prophylactic antibiotics
Answer: C. Secure the airway
Rationale: For any patient with facial trauma, particularly mandibular fractures, securing the
airway is crucial. These fractures can lead to airway obstruction, especially if the jaw is
displaced or there is significant swelling. Ensuring the airway is clear and that the patient can
breathe adequately before proceeding with surgery is the most critical preoperative
consideration.
,4. A patient is admitted with a comminuted nasal fracture and requires reduction. Which
of the following interventions should be implemented to reduce the risk of complications,
such as bleeding or infection, during the reduction procedure?
A. Apply a cold compress to the nasal region
B. Administer local anesthesia to the nasal area
C. Keep the patient in a semi-Fowler’s position
D. Use a nasal packing to support the nasal bones
Answer: B. Administer local anesthesia to the nasal area
Rationale: To ensure that the reduction procedure is done with minimal discomfort and pain,
local anesthesia is necessary. Nasal fractures can be painful, and local anesthesia can help
provide adequate pain control during the procedure. Cold compresses may help with swelling,
but anesthesia is more important for controlling pain during the procedure. Semi-Fowler's
positioning is generally used for head trauma patients, but it is not specific to nasal fracture
management. Nasal packing may be used after the procedure to support the fracture, but it’s not
used during the reduction.
5. Following the reduction of a displaced nasal fracture, which of the following signs would
indicate the need for further evaluation?
A. Mild swelling at the site of the fracture
B. Persistent epistaxis (nosebleed)
C. A small hematoma around the eyes
D. Slight bruising around the nose
Answer: B. Persistent epistaxis (nosebleed)
Rationale: While mild swelling, bruising, and a small hematoma around the eyes are common
after nasal fracture reduction, persistent nosebleeds (epistaxis) after the procedure may suggest
complications such as unrecognized vascular injury or infection. Epistaxis that does not resolve
requires further investigation to ensure no additional damage has occurred.
6. A 25-year-old patient presents with a laceration and facial fracture involving the orbital
floor after a fall. What is the most important consideration in managing this injury?
A. Administer pain medications
B. Assess for vision changes
C. Apply cold compresses to reduce swelling
D. Clean the wound with antiseptic solution
Answer: B. Assess for vision changes
Rationale: An orbital floor fracture can involve damage to the eye or optic nerve, which can
result in vision impairment. Therefore, it is crucial to assess for any visual disturbances, diplopia
(double vision), or changes in pupil reaction. Pain management and cold compresses are
secondary to the concern of potential vision loss. Cleaning the wound is important but not as
critical as assessing visual changes.
7. Which of the following facial fractures is most commonly associated with a risk of airway
compromise?
, A. Zygomatic fracture
B. Mandibular fracture
C. Nasal fracture
D. Orbital fracture
Answer: B. Mandibular fracture
Rationale: The mandibular region is closely linked to the airway, and fractures in this area can
lead to displacement that obstructs the airway. This makes airway management a priority when
managing mandibular fractures. Other fractures, like those of the zygomatic, nasal, or orbital
regions, are less likely to directly compromise the airway.
8. A 50-year-old patient with a midface fracture is being evaluated for surgical
intervention. What is the most important preoperative assessment?
A. Baseline radiographs of the skull
B. Evaluation of the patient's nutritional status
C. Thorough airway assessment
D. Assess for allergic reactions to anesthesia
Answer: C. Thorough airway assessment
Rationale: Midface fractures can often lead to airway obstruction due to swelling or structural
disruption. A thorough airway assessment is critical to ensure that the patient is able to breathe
properly before undergoing surgery. Other assessments, such as baseline radiographs and
evaluations of nutrition and anesthesia allergies, are important but secondary to airway
management.
9. Which of the following would most likely be a complication of a Le Fort III fracture?
A. Impaired vision
B. Loss of sense of smell
C. Respiratory distress
D. Hearing loss
Answer: C. Respiratory distress
Rationale: Le Fort III fractures involve the midface and often disrupt the bony structures around
the nasopharynx, potentially compromising the airway. This can lead to respiratory distress.
Vision and sense of smell may be affected by orbital or nasal injuries, but the airway concern is
more immediate with a Le Fort III fracture.
10. When should a patient with a suspected facial fracture receive a CT scan?
A. When facial swelling is minimal
B. If there is no loss of consciousness
C. If there is concern for underlying facial fractures or brain injury
D. Only if the patient has multiple fractures
Answer: C. If there is concern for underlying facial fractures or brain injury
Rationale: A CT scan is the imaging modality of choice when there is concern for facial
fractures or brain injury. It provides detailed information about both bone and soft tissue damage.
5th Edition
Author :
Peter C. Neligan
,Chapter 1: Management of Facial Trauma
1. A 35-year-old male presents to the emergency department after a motor vehicle collision
with visible facial trauma. Which of the following is the priority intervention in the
management of this patient?
A. Assess the extent of facial fractures
B. Administer pain medication
C. Secure the airway and assess for breathing
D. Apply ice packs to reduce swelling
Answer: C. Secure the airway and assess for breathing
Rationale: The priority intervention in any trauma patient is ensuring a patent airway and proper
ventilation. Airway compromise is a leading cause of morbidity in trauma patients, particularly
with facial injuries, which can lead to difficulty breathing due to swelling or structural damage.
Assessing breathing and ensuring that the patient is able to adequately oxygenate is the first step
before focusing on pain management or detailed assessment of fractures.
2. Which of the following is a common complication associated with fractures of the
zygomatic arch in facial trauma?
A. Vision impairment
B. Sinusitis
C. Temporomandibular joint dysfunction
D. Mandibular instability
Answer: C. Temporomandibular joint dysfunction
Rationale: The zygomatic arch is closely connected to the temporomandibular joint (TMJ).
When fractures occur in this region, they can disrupt the alignment and function of the TMJ,
leading to dysfunction. This can present as pain, clicking, or difficulty with jaw movement.
Vision impairment is more commonly associated with fractures involving the orbital region,
while sinusitis is typically seen with maxillary fractures.
3. A patient with a severe mandibular fracture is scheduled for surgery. What is the most
critical preoperative consideration for this patient?
A. Obtain an MRI of the facial bones
B. Perform a full blood panel
C. Secure the airway
D. Administer prophylactic antibiotics
Answer: C. Secure the airway
Rationale: For any patient with facial trauma, particularly mandibular fractures, securing the
airway is crucial. These fractures can lead to airway obstruction, especially if the jaw is
displaced or there is significant swelling. Ensuring the airway is clear and that the patient can
breathe adequately before proceeding with surgery is the most critical preoperative
consideration.
,4. A patient is admitted with a comminuted nasal fracture and requires reduction. Which
of the following interventions should be implemented to reduce the risk of complications,
such as bleeding or infection, during the reduction procedure?
A. Apply a cold compress to the nasal region
B. Administer local anesthesia to the nasal area
C. Keep the patient in a semi-Fowler’s position
D. Use a nasal packing to support the nasal bones
Answer: B. Administer local anesthesia to the nasal area
Rationale: To ensure that the reduction procedure is done with minimal discomfort and pain,
local anesthesia is necessary. Nasal fractures can be painful, and local anesthesia can help
provide adequate pain control during the procedure. Cold compresses may help with swelling,
but anesthesia is more important for controlling pain during the procedure. Semi-Fowler's
positioning is generally used for head trauma patients, but it is not specific to nasal fracture
management. Nasal packing may be used after the procedure to support the fracture, but it’s not
used during the reduction.
5. Following the reduction of a displaced nasal fracture, which of the following signs would
indicate the need for further evaluation?
A. Mild swelling at the site of the fracture
B. Persistent epistaxis (nosebleed)
C. A small hematoma around the eyes
D. Slight bruising around the nose
Answer: B. Persistent epistaxis (nosebleed)
Rationale: While mild swelling, bruising, and a small hematoma around the eyes are common
after nasal fracture reduction, persistent nosebleeds (epistaxis) after the procedure may suggest
complications such as unrecognized vascular injury or infection. Epistaxis that does not resolve
requires further investigation to ensure no additional damage has occurred.
6. A 25-year-old patient presents with a laceration and facial fracture involving the orbital
floor after a fall. What is the most important consideration in managing this injury?
A. Administer pain medications
B. Assess for vision changes
C. Apply cold compresses to reduce swelling
D. Clean the wound with antiseptic solution
Answer: B. Assess for vision changes
Rationale: An orbital floor fracture can involve damage to the eye or optic nerve, which can
result in vision impairment. Therefore, it is crucial to assess for any visual disturbances, diplopia
(double vision), or changes in pupil reaction. Pain management and cold compresses are
secondary to the concern of potential vision loss. Cleaning the wound is important but not as
critical as assessing visual changes.
7. Which of the following facial fractures is most commonly associated with a risk of airway
compromise?
, A. Zygomatic fracture
B. Mandibular fracture
C. Nasal fracture
D. Orbital fracture
Answer: B. Mandibular fracture
Rationale: The mandibular region is closely linked to the airway, and fractures in this area can
lead to displacement that obstructs the airway. This makes airway management a priority when
managing mandibular fractures. Other fractures, like those of the zygomatic, nasal, or orbital
regions, are less likely to directly compromise the airway.
8. A 50-year-old patient with a midface fracture is being evaluated for surgical
intervention. What is the most important preoperative assessment?
A. Baseline radiographs of the skull
B. Evaluation of the patient's nutritional status
C. Thorough airway assessment
D. Assess for allergic reactions to anesthesia
Answer: C. Thorough airway assessment
Rationale: Midface fractures can often lead to airway obstruction due to swelling or structural
disruption. A thorough airway assessment is critical to ensure that the patient is able to breathe
properly before undergoing surgery. Other assessments, such as baseline radiographs and
evaluations of nutrition and anesthesia allergies, are important but secondary to airway
management.
9. Which of the following would most likely be a complication of a Le Fort III fracture?
A. Impaired vision
B. Loss of sense of smell
C. Respiratory distress
D. Hearing loss
Answer: C. Respiratory distress
Rationale: Le Fort III fractures involve the midface and often disrupt the bony structures around
the nasopharynx, potentially compromising the airway. This can lead to respiratory distress.
Vision and sense of smell may be affected by orbital or nasal injuries, but the airway concern is
more immediate with a Le Fort III fracture.
10. When should a patient with a suspected facial fracture receive a CT scan?
A. When facial swelling is minimal
B. If there is no loss of consciousness
C. If there is concern for underlying facial fractures or brain injury
D. Only if the patient has multiple fractures
Answer: C. If there is concern for underlying facial fractures or brain injury
Rationale: A CT scan is the imaging modality of choice when there is concern for facial
fractures or brain injury. It provides detailed information about both bone and soft tissue damage.
