Multiple Choice Questions MCQ

Question 36# Print Question

The following statement is true with regards to the facial nerve:

A. The buccal branch is crucial for lower eyelid function

B. The function of the stapedius muscle is lost if the facial nerve nucleus itself is ablated or infarcted, leading to hyperacusis

C. It is the most commonly damaged nerve during facelift surgery

D. Branches include the postauricular branch to occipitalis and a branch to the anterior belly of digastric

E. Damage to the mandibular branch is less likely to cause sequelae than damage to the buccal branch

Question 37# The following is true in relation to ‘malar bags’ or festoons:
A. Interestingly, they are hardly ever seen in smokers
B. They should be excised directly with minimal margins
C. There is no accepted and routinely successful treatment
D. They can be treated with minimal-skin-excision lower lid blepharoplasty
E. They can be significantly improved by a combined course of steroids and diuretics, but only in patients under the age of 40, without comorbidity, and for a maximum period of 4 weeks
There is no accepted and routinely successful treatment. Prominence of tissue and skin folds can occur in the malar region with ageing, but in some patients these may present as proliferative skin folds. Lower lid blepharoplasty will not help this condition, which is commoner in smokers. Direct excision is rarely satisfactory and leaves unsightly scars in prominent areas. One approach that can help is subcutaneous dissection and redraping combined with a subperiosteal cheek lift. References: 1. McCord CD, Codner MA. Eyelid and periorbital surgery. St Louis, USA: Quality Medical Publishing Inc., 2008.

Question 38# The blood vessels immediately supplying the eyelids include all except:
A. Medial superior palpebral artery
B. Superior arcade
C. Angular artery
D. Facial artery
E. Marginal arcade
Facial artery. The facial artery branches into other vessels and eventually supplies the eyelids, including the angular artery. The other vessels or arcades listed directly supply the lids. References: 1. McCord CD, Codner MA. Eyelid and periorbital surgery. St Louis, USA: Quality Medical Publishing Inc., 2008.

Question 39# 9 Concerning the facial nerves and facelift, which of the following is false?
A. The frontal branch is found on Pitanguy’s line, from 0.5cm below the tragus to 1.5cm above the lateral eyebrow and is accompanied by the anterior branch of the facial artery
B. Above the zygoma the nerve runs on the undersurface of the temporoparietal fascia
C. McKinney’s point refers to the position of the greater auricular nerve, 6.5cm caudal to the external acoustic meatus with the head turned to 45°, at which point it crosses the anterior belly of sternocleidomastoid
D. The buccal branch is the most commonly injured branch of the facial nerve during facelift
E. If the buccal branch is injured, it is not typically symptomatic as it demonstrates collateral innervation in up to 70% of individuals
The frontal branch is found on Pitanguy’s line, from 0.5cm below the tragus to 1.5cm above the lateral eyebrow and is accompanied by the anterior branch of the facial artery. A is false. The frontal branch is found on Pitanguy’s line, from 0.5cm below the tragus to 1.5cm above the lateral eyebrow and is accompanied by the anterior branch of the temporal artery.

Question 36# The following statement is true with regards to the facial nerve:
A. The buccal branch is crucial for lower eyelid function
B. The function of the stapedius muscle is lost if the facial nerve nucleus itself is ablated or infarcted, leading to hyperacusis
C. It is the most commonly damaged nerve during facelift surgery
D. Branches include the postauricular branch to occipitalis and a branch to the anterior belly of digastric
E. Damage to the mandibular branch is less likely to cause sequelae than damage to the buccal branch
The buccal branch is crucial for lower eyelid function. The medial canthal fibres of the buccal branch of VII are important innervators of the inferior/medial orbicularis. Although innervated by the facial nerve, the cell bodies of origin supplying stapedius lie outside the facial nerve nucleus - hence preserved stapedius function can be of diagnostic use when tested. The most commonly injured nerve during facelift surgery is the greater auricular nerve. Due to greater arborisation, the buccal branch of the facial nerve is less likely to reveal a functional deficit when damaged. Damage to the mandibular branch almost inevitably leads to loss of depressor anguli oris function. The facial nerve supplies the posterior belly of digastric.