Eight months after a superficial parotidectomy for a pleomorphic adenoma, a 45-year-old woman notices sweating and redness of the skin over her left cheek every time she eats. Fibres of which nerve have regrown into the sweat glands of the skin?

Buccal branch of the facial nerve

Before a total thyroidectomy for a large goitre, a 46-year-old woman's CT shows that her right subclavian artery arises as the last branch of the aortic arch and passes behind the oesophagus. What should the surgeon expect on the right side of the neck?

Laryngeal nerve running directly from the vagus

Recurrent nerve hooking under the common carotid artery

Recurrent nerve hooking under the arch of the aorta

Recurrent nerve hooking under the subclavian artery

Neck triangles, thyroid, parotid and pharynx

12 NEET-PG practice questions on Neck triangles, thyroid, parotid and pharynx, part of Anatomy. The first 12 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Consider four statements about the secretomotor nerve supply of the parotid gland: 1. The preganglionic fibres arise in the inferior salivatory nucleus. 2. They travel in the glossopharyngeal nerve, its tympanic branch and the lesser petrosal nerve. 3. They relay in the otic ganglion. 4. The postganglionic fibres reach the gland through the auriculotemporal nerve. Which statements are correct?
1. A1 and 4 only
2. B1, 2, 3 and 4
3. C1, 3 and 4 only
4. D2 and 3 only
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Answer: B · 1, 2, 3 and 4
All four statements are correct. The parasympathetic pathway to the parotid begins in the inferior salivatory nucleus, runs in the glossopharyngeal nerve and its tympanic branch through the tympanic plexus, and leaves as the lesser petrosal nerve to relay in the otic ganglion below the foramen ovale. Postganglionic fibres join the auriculotemporal nerve to reach the gland, even though the gland lies among branches of the facial nerve. This pathway explains Frey syndrome after parotid surgery.
- A: Omits the glossopharyngeal route and the otic ganglion relay, both correct.
- C: Omits the glossopharyngeal, tympanic and lesser petrosal route, which is correct.
- D: Omits the inferior salivatory nucleus and the auriculotemporal nerve, both correct.
Question 2 · Easy
Eight months after a superficial parotidectomy for a pleomorphic adenoma, a 45-year-old woman notices sweating and redness of the skin over her left cheek every time she eats. Fibres of which nerve have regrown into the sweat glands of the skin?
1. AAuriculotemporal nerve
2. BGreat auricular nerve
3. CBuccal branch of the facial nerve
4. DChorda tympani nerve
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Answer: A · Auriculotemporal nerve
Gustatory sweating after parotid surgery is Frey syndrome. The parasympathetic secretomotor fibres to the parotid reach it through the auriculotemporal nerve; when they are cut, they regrow into the sympathetic-supplied sweat glands and vessels of the overlying skin. Eating then causes sweating and flushing. The starch-iodine (Minor) test maps the area, and botulinum toxin injection into the skin controls it.
- B: The great auricular nerve is sensory; its injury numbs the ear lobe.
- C: The buccal branch is a motor branch to facial muscles and carries no secretomotor fibres.
- D: The chorda tympani supplies the submandibular and sublingual glands, not the parotid.
Question 3 · Hard
Before a total thyroidectomy for a large goitre, a 46-year-old woman's CT shows that her right subclavian artery arises as the last branch of the aortic arch and passes behind the oesophagus. What should the surgeon expect on the right side of the neck?
1. ARecurrent nerve hooking under the common carotid artery
2. BRecurrent nerve hooking under the arch of the aorta
3. CLaryngeal nerve running directly from the vagus
4. DRecurrent nerve hooking under the subclavian artery
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Answer: C · Laryngeal nerve running directly from the vagus
The recurrent laryngeal nerves hook under the arteries of the sixth arch on the left (ductus arteriosus) and the fourth arch on the right (right subclavian artery), because the arteries caudal to these disappear as the heart descends. When the right subclavian artery arises aberrantly from the distal arch and runs behind the oesophagus, there is no artery on the right for the nerve to hook under. The inferior laryngeal nerve then passes almost directly from the vagus in the neck to the larynx, a non-recurrent nerve. It can easily be mistaken for a vessel or a band and cut, so the surgeon should look for it at the level of the thyroid.
- A: The recurrent nerve does not hook around the common carotid artery on either side.
- B: Only the left recurrent nerve hooks under the arch of the aorta.
- D: The aberrant artery runs behind the oesophagus, so the nerve cannot hook under it.
Question 4 · Medium
A 16-year-old boy has had a tiny opening at the anterior border of the lower third of the right sternocleidomastoid since birth, which discharges a little mucus now and then. Excision of the tract is planned. Where does such a tract usually open internally?
1. ATonsillar fossa
2. BVallecula
3. CPiriform fossa
4. DForamen caecum
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Answer: A · Tonsillar fossa
A congenital opening at the anterior border of the lower sternocleidomastoid is usually a second branchial fistula, the remnant of the second cleft and pouch. The tract runs upwards between the internal and external carotid arteries, superficial to the glossopharyngeal and hypoglossal nerves, to open in the tonsillar fossa, the adult remnant of the second pouch. Complete excision, often through two stepped incisions, prevents recurrence. Knowing these relations protects the nerves during dissection.
- B: The vallecula is not the site of a branchial fistula opening.
- C: The piriform fossa is the internal opening of third and fourth arch anomalies.
- D: The foramen caecum is linked to the thyroglossal duct, not a branchial fistula.
Question 5 · Easy
A 32-year-old man had an enlarged lymph node removed from the posterior triangle of the right side of his neck to look for tuberculosis. Three weeks later his right shoulder droops, he cannot shrug it fully, and he has difficulty raising the arm above his head. Which nerve was injured?
1. ALong thoracic nerve
2. BDorsal scapular nerve
3. CSuprascapular nerve
4. DSpinal accessory nerve
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Answer: D · Spinal accessory nerve
The spinal accessory nerve crosses the posterior triangle superficially, just under the investing layer of deep cervical fascia, from the posterior border of sternocleidomastoid to the trapezius. It is the nerve most often injured during lymph node biopsy in this triangle. Trapezius paralysis causes a drooping shoulder, weak shrugging and difficulty raising the arm overhead, because trapezius helps rotate the scapula upwards. The nerve's course should be explained and marked before any posterior triangle biopsy.
- A: The long thoracic nerve supplies serratus anterior; its injury causes winging, not a weak shrug.
- B: The dorsal scapular nerve supplies the rhomboids and levator scapulae and lies deep.
- C: The suprascapular nerve supplies supraspinatus and infraspinatus and does not cross the posterior triangle superficially.
Question 6 · Hard
A 50-year-old woman has a total thyroidectomy with right lateral neck dissection for papillary carcinoma; during the dissection the carotid sheath is retracted and nodes are cleared from behind it. The next day her voice is normal and there is no stridor, but her right upper eyelid droops by about 2 mm and her right pupil is smaller. Which structure was most likely injured?
1. APhrenic nerve on scalenus anterior
2. BSuperior root of the ansa cervicalis
3. CCervical sympathetic trunk
4. DVagus nerve within the carotid sheath
Answer and explanation in LearnFree account
Question 7 · Medium
A 36-year-old man has a hard 2 cm nodule in the upper part of the right thyroid lobe. FNAC shows tumour cells in a background of amyloid, and his serum calcitonin is markedly raised. The cells from which this tumour arises reach the thyroid through which embryonic structure?
1. AUltimobranchial body
2. BThyroglossal duct
3. CSecond pharyngeal pouch
4. DThird pharyngeal pouch
Answer and explanation in LearnFree account
Question 8 · Medium
A 72-year-old retired farmer from Punjab has had difficulty swallowing for a year. He brings up undigested food eaten hours earlier, has bad breath, and a soft swelling on the left side of his neck gurgles when pressed. Through which weak area of the pharyngeal wall has this lesion herniated?
1. ABetween superior and middle constrictors
2. BBetween thyropharyngeus and cricopharyngeus
3. CThrough the thyrohyoid membrane
4. DBetween middle and inferior constrictors
Answer and explanation in LearnFree account
Question 9 · Medium
A 30-year-old woman from a hilly district of Uttarakhand has a smooth swelling in the front of her neck. When she is asked to sip water and swallow, the swelling moves upwards with the larynx. Ultrasound shows a diffusely enlarged thyroid gland. Why does the gland move with swallowing?
1. ACarotid sheath binds it to the trachea
2. BInvesting fascia binds it to the hyoid
3. CPretracheal fascia binds it to the larynx
4. DPrevertebral fascia binds it to the pharynx
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Question 10 · Medium
A 40-year-old man is consented for a superficial parotidectomy for a pleomorphic adenoma, and the surgeon explains that one structure will be dissected out and preserved throughout the operation. Within the parotid gland, which structure lies most superficially?
1. AExternal carotid artery
2. BRetromandibular vein
3. CFacial nerve branches
4. DMaxillary artery
Answer and explanation in LearnFree account
Question 11 · Medium
A 54-year-old woman still has a high serum calcium and PTH after a neck exploration in which the surgeon found only three normal-sized parathyroid glands. A sestamibi scan now shows an adenoma in the anterior mediastinum, within the thymus. Which developmental fact explains its position?
1. AInferior parathyroids arise from the fourth pouch with the thyroid
2. BParathyroids arise from the foramen caecum of the tongue
3. CInferior parathyroids arise from the third pouch with the thymus
4. DSuperior parathyroids arise from the third pouch with the thymus
Answer and explanation in LearnFree account
Question 12 · Medium
During a right hemithyroidectomy at a district hospital, the inferior thyroid artery is ligated close to the lower pole of the gland. The next day the patient, a 42-year-old schoolteacher, has a weak, breathy voice, and laryngoscopy shows the right vocal cord fixed close to the midline. Which nerve was most likely injured?
1. AInternal laryngeal nerve
2. BExternal laryngeal nerve
3. CRecurrent laryngeal nerve
4. DAnsa cervicalis
Answer and explanation in LearnFree account

Neck triangles, thyroid, parotid and pharynx

Eight months after a superficial parotidectomy for a pleomorphic adenoma, a 45-year-old woman notices sweating and redness of the skin over her left cheek every time she eats. Fibres of which nerve have regrown into the sweat glands of the skin?

Before a total thyroidectomy for a large goitre, a 46-year-old woman's CT shows that her right subclavian artery arises as the last branch of the aortic arch and passes behind the oesophagus. What should the surgeon expect on the right side of the neck?

A 16-year-old boy has had a tiny opening at the anterior border of the lower third of the right sternocleidomastoid since birth, which discharges a little mucus now and then. Excision of the tract is planned. Where does such a tract usually open internally?

A 32-year-old man had an enlarged lymph node removed from the posterior triangle of the right side of his neck to look for tuberculosis. Three weeks later his right shoulder droops, he cannot shrug it fully, and he has difficulty raising the arm above his head. Which nerve was injured?

A 36-year-old man has a hard 2 cm nodule in the upper part of the right thyroid lobe. FNAC shows tumour cells in a background of amyloid, and his serum calcitonin is markedly raised. The cells from which this tumour arises reach the thyroid through which embryonic structure?

A 72-year-old retired farmer from Punjab has had difficulty swallowing for a year. He brings up undigested food eaten hours earlier, has bad breath, and a soft swelling on the left side of his neck gurgles when pressed. Through which weak area of the pharyngeal wall has this lesion herniated?

A 30-year-old woman from a hilly district of Uttarakhand has a smooth swelling in the front of her neck. When she is asked to sip water and swallow, the swelling moves upwards with the larynx. Ultrasound shows a diffusely enlarged thyroid gland. Why does the gland move with swallowing?

A 40-year-old man is consented for a superficial parotidectomy for a pleomorphic adenoma, and the surgeon explains that one structure will be dissected out and preserved throughout the operation. Within the parotid gland, which structure lies most superficially?

A 54-year-old woman still has a high serum calcium and PTH after a neck exploration in which the surgeon found only three normal-sized parathyroid glands. A sestamibi scan now shows an adenoma in the anterior mediastinum, within the thymus. Which developmental fact explains its position?