A 27-year-old woman in oral surgery clinic has unilateral electric-shock right V2 pain lasting seconds, triggered by washing her face. Dental examination is normal. She previously had optic neuritis.

What is the most appropriate next step?

1. Diagnose trigeminal neuralgia, reassure and refer back to GP for ongoing management
2. Refer for urgent MRI brain and high resolution FIESTA protocol
3. Request urgent review in oral surgery after repeat panoramic radiography
4. Start carbamazepine and defer further investigation unless symptoms persist
5. Urgently refer to neurology without arranging MRI

The correct answer is B.

Justification: The correct answer matches the guideline-supported response to a red-flag TN presentation. B tests recognition of an orofacial pain presentation requiring referral to another specialty and the appropriate next step. B correctly responds to the red-flag combination with the appropriate specialist imaging pathway. The guideline supports both the red flags and the MRI scope. The decisive claims are directly grounded in the 2021 RCS/FDS guideline.

A symptom-free 46-year-old patient undergoes panoramic radiography. The image shows a well-defined, dome-shaped, faintly radiopaque lesion arising from the floor of the right maxillary sinus. The adjacent teeth are vital, and there is no radiographic evidence of sinus wall expansion or complete sinus opacification.

What is the most appropriate management of this radiographic finding?

1. Arrange a routine ENT referral, as panoramic imaging alone cannot confirm a maxillary sinus pathology
2. Arrange an oral surgery review for odontogenic disease extending into the sinus
3. Arrange non-urgent CBCT to confirm an antral pseudocyst before deciding whether treatment is required
4. Prescribe medical treatment for chronic sinus inflammation and repeat imaging to confirm resolution
5. Reassure the patient that no treatment is required unless sinonasal symptoms develop

The correct answer is E.

Justification: On panoramic imaging, a retention pseudocyst appears as a broad-based, dome-shaped opacity from the sinus floor without cortical destruction; it is usually incidental/asymptomatic. CBCT confirms location when doubt exists but is not always required.

A patient presents with lingual dysaesthesia eight months after LL8 removal. Clinical examination shows severe intermittent electric‑shock pain triggered by light touch at the right lingual mucosa; two‑point discrimination is absent. MRI suggests a 4 mm neuroma located 8 mm distal to the lingula.

Which option offers the highest likelihood of functional recovery?

1. Excision of the neuroma and burying of proximal stump in medial pterygoid muscle
2. Excision of the neuroma with an end‑to‑end primary repair under tension
3. Excision of the neuroma with conduit repair using a collagen tube with a 1 cm gap left between the stumps
4. Excision of the neuroma with interpositional autologous greater auricular nerve graft
5. No surgical intervention with high‑dose gabapentin

The correct answer is D.

Justification: Persistent severe dysaesthesia with absent two‑point discrimination at 8 months suggests a significant lingual nerve injury with neuroma‑in‑continuity (supported by MRI). Where neuroma excision creates (or reveals) a segmental defect, the best chance of functional sensory recovery is restoration of nerve continuity with a tension‑free interpositional graft; primary repair under tension compromises intraneural perfusion and regeneration. Evidence‑based reviews of IAN/LN repair recommend direct epineurial/perineurial coaptation only for small gaps (≈<10 mm) and nerve grafting (e.g., greater auricular) for larger gaps.