Oral & Maxillofacial Surgery Prometric exam questions with answers

1. Question 1Anaesthesia, Sedation and Medical Emergenciesmedium

   During intravenous midazolam sedation, a patient becomes unrousable with a respiratory rate of 6 per minute and falling oxygen saturation despite airway support. What drug should be given?

   1. ANaloxone
   2. BAtropine
   3. CFlumazenil
   4. DGlucagon
   Show answer and explanation▾

   Answer: C. Flumazenil

   Flumazenil is a benzodiazepine antagonist, usually given as 200 micrograms intravenously and repeated at intervals, while maintaining the airway and oxygenation. Its effect may wear off before the midazolam, so the patient needs observation. Naloxone reverses opioids, not benzodiazepines.

2. Question 2Dentoalveolar Surgeryhard

   A 30-year-old has a vital, caries-free horizontally impacted lower third molar causing recurrent pericoronitis. CBCT shows the canal grooving the roots. Which feature would make coronectomy unsuitable?

   1. AThe patient is under 40 years of age
   2. BPrevious episodes of pericoronitis
   3. CHorizontal angulation of the tooth
   4. DMobility of the tooth on luxation
   Show answer and explanation▾

   Answer: D. Mobility of the tooth on luxation

   Coronectomy removes the crown and leaves vital roots in place below the crest to avoid nerve damage, so the roots must be firmly anchored. A mobile tooth may have roots that move and act as a foreign body, so it should be extracted. Pericoronitis and horizontal angulation are not contraindications, and active infection of the roots or a cyst involving them would be.

3. Question 3Ethics, Consent and Infection Controlmedium

   A professional singer consents to removal of a lower third molar that lies close to the canal. Which approach to consent best meets current legal standards?

   1. ADiscuss only risks over 10% in frequency
   2. BDiscuss risks that a typical surgeon would mention
   3. CDiscuss risks only if the patient asks about them
   4. DDiscuss risks this patient would find significant
   Show answer and explanation▾

   Answer: D. Discuss risks this patient would find significant

   Current standards require disclosure of material risks, meaning risks a reasonable person in the patient's position would consider significant or that this patient would find significant, together with reasonable alternatives including no treatment. Nerve injury affecting lip and tongue sensation would be material to a singer. A fixed frequency threshold or the custom of surgeons is not the test.

4. Question 4Head and Neck Oncologymedium

   During excision of the submandibular gland through a skin crease incision below the mandible, which nerve is protected by raising the flap deep to the investing fascia?

   1. AHypoglossal nerve
   2. BLingual nerve
   3. CGreat auricular nerve
   4. DMarginal mandibular nerve
   Show answer and explanation▾

   Answer: D. Marginal mandibular nerve

   The marginal mandibular branch lies superficial to the gland, deep to platysma within the investing fascia, and is protected by placing the incision two finger-breadths below the mandible and raising the fascia with the flap. Injury causes weakness of the lower lip depressors. The lingual and hypoglossal nerves lie deeper and are at risk later in the dissection.

5. Question 5Orthognathic Surgery and TMJeasy

   A patient is consented for bilateral sagittal split osteotomy to set back the mandible. Which complication is most common after this operation?

   1. AWeakness of the facial muscles
   2. BNumbness of the lower lip and chin
   3. CPermanent limitation of opening
   4. DLoss of taste on the palate
   Show answer and explanation▾

   Answer: B. Numbness of the lower lip and chin

   The inferior alveolar nerve runs through the split, so altered lower lip and chin sensation is the most common complication, often improving over months. Facial nerve injury is rare. Patients must be warned specifically about this risk during consent.

6. Question 6Infections and Airway Emergenciesmedium

   A previously well adult with no allergies is admitted with a spreading odontogenic infection needing drainage. Which empirical antibiotic regimen best covers the usual organisms?

   1. AIntravenous gentamicin alone
   2. BOral ciprofloxacin alone
   3. CIntravenous amoxicillin with metronidazole
   4. DOral nitrofurantoin with trimethoprim
   Show answer and explanation▾

   Answer: C. Intravenous amoxicillin with metronidazole

   Odontogenic infections are polymicrobial, mainly viridans streptococci and oral anaerobes, which are covered by a penicillin with metronidazole or by amoxicillin-clavulanate. Gentamicin and ciprofloxacin have poor activity against these organisms. Drainage of pus and removal of the source remain the key treatment.

7. Question 7Oral Pathology, Cysts and Tumourshard

   A 40-year-old has a large multilocular soap-bubble radiolucency of the mandibular body and ramus with root resorption and cortical expansion. Biopsy confirms conventional ameloblastoma. What is the most appropriate treatment?

   1. AEnucleation and curettage only
   2. BMarsupialisation followed by enucleation
   3. CPrimary radiotherapy to the mandible
   4. DResection with a margin of about 1 to 1.5 cm
   Show answer and explanation▾

   Answer: D. Resection with a margin of about 1 to 1.5 cm

   Conventional ameloblastoma infiltrates cancellous bone beyond its radiographic edge, so resection with a bony margin of about 1 to 1.5 cm is recommended to reduce recurrence. Enucleation and curettage give high recurrence rates. Ameloblastoma is relatively radioresistant, so radiotherapy is not first-line.

8. Question 8Pre-prosthetic and Implant Surgeryeasy

   When planning an implant in the posterior mandible, what minimum safety distance is commonly kept between the implant tip and the inferior alveolar canal?

   1. A0.5 mm
   2. B2 mm
   3. C5 mm
   4. D8 mm
   Show answer and explanation▾

   Answer: B. 2 mm

   A safety margin of about 2 mm above the inferior alveolar canal is widely recommended to allow for drill overpreparation and measurement error. Smaller margins increase the risk of nerve injury. Larger margins would waste available bone height unnecessarily.

9. Question 9Maxillofacial Traumamedium

   After a road traffic collision, a patient has a mobile nose and upper jaw that move together when the anterior maxilla is rocked, with bilateral steps along the infraorbital rims. The zygomatic arches are intact. Which fracture is most likely?

   1. ALe Fort I fracture
   2. BLe Fort II fracture
   3. CLe Fort III fracture
   4. DBilateral zygomatic complex fractures
   Show answer and explanation▾

   Answer: B. Le Fort II fracture

   A Le Fort II fracture is pyramidal, passing through the nasal bones, medial orbital walls, infraorbital rims and zygomaticomaxillary buttresses, so the nose and maxilla move together. A Le Fort I fracture separates only the tooth-bearing maxilla below the nose. A Le Fort III separates the whole midface including the zygomas from the cranial base.

10. Question 10Maxillofacial Traumamedium

    A 12-year-old's upper central incisor was avulsed 20 minutes ago and has been kept in milk. The apex is closed. After replantation, what splint is recommended?

    1. ARigid wire-composite splint for 6 weeks
    2. BFlexible splint for about 2 weeks
    3. CFlexible splint for about 3 months
    4. DNo splint, with a soft diet only
    Show answer and explanation▾

    Answer: B. Flexible splint for about 2 weeks

    Current trauma guidance recommends a flexible passive splint for about 2 weeks after replantation of an avulsed permanent tooth, as physiological movement reduces replacement resorption. Rigid or long splinting increases the risk of ankylosis. Root canal treatment should start within 2 weeks for a tooth with a closed apex.

11. Question 11Medically Compromised Patientsmedium

    A woman who received intravenous zoledronic acid for bone metastases has exposed bone in the lower jaw. She has never had head and neck radiotherapy. For how long must the bone have been exposed to meet the definition of medication-related osteonecrosis of the jaw?

    1. AMore than 2 weeks
    2. BMore than 4 weeks
    3. CMore than 8 weeks
    4. DMore than 6 months
    Show answer and explanation▾

    Answer: C. More than 8 weeks

    MRONJ is defined as exposed bone, or bone that can be probed through a fistula, in the maxillofacial region persisting for more than 8 weeks in a patient with current or previous antiresorptive or antiangiogenic therapy and no history of jaw radiotherapy or metastatic disease to the jaws. Shorter periods may represent normal delayed healing.

12. Question 12Oral Pathology, Cysts and Tumoursmedium

    A multilocular radiolucency in the posterior mandible is enucleated. Histology shows a thin parakeratinised epithelium with a corrugated surface and a palisaded basal cell layer. Which statement about this lesion is correct?

    1. AIt rarely recurs after enucleation
    2. BIt is caused by pulp necrosis of the adjacent tooth
    3. CIt has a significant risk of recurrence
    4. DIt always surrounds the crown of an unerupted tooth
    Show answer and explanation▾

    Answer: C. It has a significant risk of recurrence

    These features are diagnostic of an odontogenic keratocyst, which recurs more often than other odontogenic cysts because of a thin friable lining and satellite cysts. Adjuncts such as peripheral ostectomy or Carnoy solution are often used, and long-term follow-up is needed. Multiple lesions suggest Gorlin syndrome.

13. Question 13Oral Pathology, Cysts and Tumoursmedium

    A fine needle aspirate of a firm parotid mass shows a mixture of mucin-producing cells, intermediate cells and squamoid cells. Which malignant tumour is most likely?

    1. AAdenoid cystic carcinoma
    2. BPolymorphous adenocarcinoma
    3. CMucoepidermoid carcinoma
    4. DSalivary duct carcinoma
    Show answer and explanation▾

    Answer: C. Mucoepidermoid carcinoma

    Mucoepidermoid carcinoma, the most common malignant salivary tumour in the parotid, contains mucous, intermediate and epidermoid cells. Adenoid cystic carcinoma shows cribriform basaloid cells and is known for perineural spread. Polymorphous adenocarcinoma occurs mainly in minor glands of the palate.

14. Question 14Orthognathic Surgery and TMJmedium

    A 25-year-old has a click when opening and a softer click shortly before closing in the right temporomandibular joint, with normal mouth opening and mild pain. What is the most likely diagnosis?

    1. ADisc displacement without reduction
    2. BOsteoarthritis of the condyle
    3. CAnterior disc displacement with reduction
    4. DFibrous ankylosis of the joint
    Show answer and explanation▾

    Answer: C. Anterior disc displacement with reduction

    A reciprocal click, on opening and again on closing, with normal opening is typical of anterior disc displacement with reduction. Disc displacement without reduction causes limited opening and deviation to the affected side without a click. Treatment is usually conservative, with education, soft diet and splints.

15. Question 15Pre-prosthetic and Implant Surgerymedium

    A patient needs an implant in the upper first molar site. CBCT shows only 3 mm of residual bone below the maxillary sinus. Which approach is usually preferred?

    1. ACrestal osteotome sinus lift with a 10 mm implant
    2. BLateral window sinus augmentation
    3. CShort 4 mm implant without augmentation
    4. DImplant angled into the nasal floor
    Show answer and explanation▾

    Answer: B. Lateral window sinus augmentation

    With very limited residual bone height, a lateral window sinus augmentation gives better access and more predictable bone gain, often with staged implant placement. Crestal osteotome techniques suit sites with more residual bone, usually around 5 mm or more. A 3 mm crest cannot stabilise a standard implant.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.