APC gene is mutated in:

 # APC gene is mutated in:

A. Hereditary intestinal polyposis syndrome

B. Gardner’s syndrome

C. Gorham stout syndrome

D. Caffey Silverman Syndrome

The correct answer is B. Gardner's syndrome.

Gardner syndrome, inherited as an autosomal-dominant disorder, is characterized by intestinal polyposis, multiple osteomas, fibromas of the skin, epidermal and trichilemmal cysts, impacted permanent and supernumerary teeth, and odontomas. The genetic defect is found in a small region on the long arm of chromosome 5 (5q21), where the familial adenomatous polyposis (APC) gene resides. Most patients with Gardner’s syndrome do not exhibit the complete spectrum of clinical disease expression. Osteomas associated with this syndrome may be found in the jaws (especially the mandibular angle) and in facial and long bones. Intestinal polyps associated with Gardner syndrome are commonly located in the colon and rectum. Significantly, these polyps, found microscopically to be adenomas, exhibit a very high rate of malignant transformation to invasive colorectal carcinoma.

Reference: ORAL PATHOLOGY: CLINICAL PATHOLOGIC CORRELATIONS, SEVENTH EDITION, Joseph A. Regezi, DDS, MS, James J. Sciubba, DMD, PhD, Richard C.K. Jordan, DDS, MSc, PhD, FRCD(C), FRCPath

Obstructive sleep apnea syndrome (OSAS) often results in all of the following except:

 # Obstructive sleep apnea syndrome (OSAS) often results in all of the following except: 

A. Excessive daytime sleepiness 

B. Aggressive behavior 

C. Personality changes 

D. Depression 

The correct answer is B. Aggressive behavior.

Signs and symptoms

Generally, symptoms of OSA begin insidiously and are often present for years before the patient is referred for evaluation.

Nocturnal symptoms may include the following:

• Snoring, usually loud, habitual, and bothersome to others
• Witnessed apneas, which often interrupt the snoring and end with a snort
• Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience
• Nocturia
• Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night

Daytime symptoms may include the following:

• Nonrestorative sleep (ie, “waking up as tired as when they went to bed”)
• Morning headache, dry or sore throat
• Excessive daytime sleepiness that usually begins during quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving)
• Daytime fatigue/tiredness
• Cognitive deficits; memory and intellectual impairment (short-term memory, concentration)
• Decreased vigilance
• Morning confusion
• Personality and mood changes, including depression and anxiety
• Sexual dysfunction, including impotence and decreased libido
• Gastroesophageal reflux
• Hypertension

Reference: https://emedicine.medscape.com/article/295807-overview

The most common mandibular surgical osteotomy to advance the mandible is:

 # The most common mandibular surgical osteotomy to advance the mandible is ____. 

A. Le Fort I osteotomy 

B. Segmental maxillary osteotomy 

C. Bilateral sagittal split osteotomy 

D. Intraoral vertical ramus osteotomy 

The correct answer is C. Bilateral sagittal split osteotomy.

Bilateral sagittal split osteotomy (BSSO) is one of the most commonly performed and versatile mandibular procedures. It can be used for backward or forward correction of the mandible in isolation or in combination with a maxillary osteotomy. It is usually performed while the patient is under general anaesthesia. It was originally described by Trauner and Obwegeser in 1957. The procedure has since undergone numerous modifications, including those by Dalpont, Hunsuck, Bell and Epker.

Even when there are large advancements, bone grafting is rarely required because of the long bony interface between the two fragments. Indications for BSSO include mandibular advancement, setback and correction of asymmetry. It is contraindicated in ramus hypoplasia, narrow lateral to medial ramus thickness and severe asymmetries.

Ref: An Introduction to Oral and Maxillofacial Surgery SECOND EDITION, David A. Mitchell, Page 306

Distraction osteogenesis is preferred over a traditional osteotomy:

 # Distraction osteogenesis is preferred over a traditional osteotomy: 

A. When a large advancement is needed 

B. When a small advancement is needed 

C. When exacted interdigitation of the occlusion is needed 

D. When the treatment needs to be done in a very short period of time 

The correct answer is A.  When a large advancement is needed.

Distraction osteogenesis is preferred over traditional osteotomies when large skeletal movements are required and the associated soft tissue cannot adapt to the acute changes and stretching that results. Larger movements may be at increased risk of some relapse; this is particularly true in a patient with a cleft palate, where there is significant soft tissue scarring from previous surgeries.