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Head & neck for FRCS (Plast)

Head, neck and craniofacial is one of the broadest categories on the paper. Facial trauma covers soft tissue injury and mandibular, midface and Le Fort, orbital and zygomatic fractures. The facial nerve section runs from anatomy and grading of palsy to static and dynamic reanimation. Reconstruction spans the scalp and calvarium, lip, nose, eyelid and ear — including prominent ear and microtia — and the mandible and intraoral cavity, alongside head and neck oncology. The craniofacial and cleft components cover craniosynostosis, craniofacial syndromes, orthognathic surgery, cleft lip, and cleft palate with velopharyngeal insufficiency. Questions reward working anatomy, because the right reconstruction or the right emergency step usually follows from exactly which structure is involved.

220 questions in the bank · 10 topics Updated 3 October 2026
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Topics in this domain

  • Facial trauma45
  • Facial nerve & reanimation18
  • Head & neck reconstruction35
  • Head & neck oncology20
  • Ear (prominent ear, microtia)15
  • Nasal reconstruction15
  • Eyelid & periorbital15
  • Craniofacial30
  • Cleft lip13
  • Cleft palate & VPI14

What the paper tends to test

  • Expect reconstructive choices by subunit: which flap or graft for a defect of a given size and site on the nose, lip, eyelid or ear.
  • The paper tends to test emergencies in facial trauma, such as retrobulbar haemorrhage and orbital floor entrapment, where timing is the discriminator.
  • Facial reanimation questions usually turn on how long the palsy has lasted and whether the facial muscles are still viable.
  • Expect craniosynostosis questions on head shape, the suture involved and syndromic associations.
  • Cleft questions tend to focus on the timing and sequence of surgery and on assessing and managing velopharyngeal insufficiency.

Classic traps and discriminators

  • Retrobulbar haemorrhage with a tense orbit and threatened vision needs lateral canthotomy and cantholysis at the bedside; waiting for imaging is the wrong answer.
  • A child with an orbital floor fracture, a quiet white eye, restricted upgaze and nausea or bradycardia has an entrapped muscle (the white-eyed blowout) and needs urgent release.
  • Positional plagiocephaly gives a parallelogram head with the ipsilateral ear displaced forwards; unilateral lambdoid synostosis gives a trapezoid head with the ear displaced backwards.
  • Once facial muscles have been denervated for a prolonged period, reinnervating them is unlikely to work; long-standing palsy points to free functional muscle transfer rather than nerve repair alone.
  • Lower lip defects up to about a third of the lip width can usually be closed directly; larger defects need lip-switch or advancement flaps.

Free head & neck practice questions

From the free sample — original, referenced, with the full explanation. Rate your confidence first.

05Head & neck·Facial trauma
medium

A 20-year-old rugby player has a tense, fluctuant swelling of the upper antihelix and scaphoid fossa of the right ear that developed after a scrum three days ago. The overlying skin is intact and the ear is not inflamed.

What is the most appropriate management?

How sure are you?
06Head & neck·Facial nerve & reanimation
medium

During a coronal approach to fix a comminuted zygomatic arch, the surgeon elevates the flap in the subgaleal plane and reaches a point 2 cm above the arch, where the superficial temporal fat pad begins.

What is the most appropriate next step to protect the frontal branch of the facial nerve?

How sure are you?

Interactive 3D: Radial forearm flap

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Also in this domain: Anterolateral thigh (ALT) flap

Head & neck questions, answered

What is the immediate treatment of retrobulbar haemorrhage?

Lateral canthotomy and inferior cantholysis at the bedside as soon as the diagnosis is made clinically. Imaging should not delay decompression when vision is threatened.

How do I tell positional plagiocephaly from lambdoid synostosis?

Look from above. Positional plagiocephaly gives a parallelogram with the ipsilateral ear forward; lambdoid synostosis gives a trapezoid with the ipsilateral ear pushed back and down, often with a mastoid bulge on that side.

Does cleft surgery come up in Section 1?

Yes. Cleft lip, cleft palate and velopharyngeal insufficiency are part of the head, neck and craniofacial curriculum, and the JCIE syllabus blueprint lists primary and secondary cleft repair and speech surgery among its areas.

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