Survival of microvascular free flaps in head and neck surgery after early interruption of the vascular pedicle.

Six to nineteen days after insertion of free flaps in oral defects three patients had secondary haemorrhages that necessitated the abolition of venous drainage in two cases and venous and arterial connections in the third. The flaps survived.

Is the two week rule of any benefit to patients with oral cancer?

In the UK the government introduced the 'two week rule' for head and neck cancer in December 2000, which sought to guarantee that any patient with suspected cancer would be seen by a specialist within 2 weeks of being referred. Our aim was to find out whether referral under the 'two week rule' resulted in patients being given an appointment and starting treatment faster than those who had been referred urgently directly to a consultant surgeon. A retrospective review of case notes of all patients diagnosed with oral cancer over a six-month period showed that only 3 of 22 were referred under the 'two week rule'. A total of 48 referrals under the 'two week rule' were recorded during the same period. There was no significant difference between the two groups in terms of time waiting for an outpatient appointment and time spent waiting for treatment.

Craniosynostosis in babies: complications and management of 40 cases.

Forty consecutive craniofacial cases in babies operated on in a district general hospital by a craniofacial team consisting of maxillofacial and neurosurgeons are reviewed with regard to diagnosis, surgical treatment, complications and outcome. Surgery achieved the release of craniosynostosis and the treatment protocol, and perioperative complications are discussed. Dural breaches occurred on four occasions with no postoperative sequelae. Blood transfusion was required in all cases with an average replacement of 36 percent estimated blood volume (EBV). No central nervous system complications occurred but in one case a brachial plexus haematoma resulted in a temporary neuropraxia to the shoulder. No major infections or deaths occurred in this series.

Screening for syphilis in patients with carcinoma of the tongue.

The oral signs of syphilis have been comprehensively described and can be identified at each stage of the infection. Despite the historical recognition that inadequately treated or untreated syphilitic leukoplakia may undergo malignant transformation, many surgical units no longer routinely screen patients presenting with malignant or premalignant lesions. In this study, five of the 63 patients (8%) who presented with neoplasms of the tongue reacted to syphilis antibodies. These results indicate that syphilis is still prevalent in this group of patients and suggest that serological investigations may be warranted in the initial assessment of all patients with oral cancer.

A survey of in-dwelling intravenous cannula use in general dental practice.

A study to ascertain the use of in-dwelling intravenous cannulae in general dental practice was performed. A self-completion questionnaire was distributed to the 149 dental practitioners registered with the Cleveland Family Health Services Authority. A total of 131 dentists (88%) completed and returned the questionnaire: 58% of practitioners were practising either general anaesthesia (GA) or intravenous sedation (IVS) and 59% of these practitioners routinely used an in-dwelling intravenous cannula to administer the anaesthetic or sedative agents. This was supervised by a medically qualified anaesthetist in 100% of GA cases and 55% of IVS cases. Sixty per cent of respondents had received didactic instruction at undergraduate level on gaining intravenous access, but 72% of these stated that the teaching had been inadequate. Seventeen per cent of the practitioners had never received formal training in gaining intravenous access. These results suggest the need for formal practical instruction in obtaining intravenous access may have to be addressed.

Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases.

Employment of tracheostomy in head and neck cancer surgery remains controversial. This study details those cases in which the life-saving potential of tracheostomy placement was considered to outweigh the observed disadvantages. Sixty consecutive cases of tracheostomy in head and neck cancer patients were assessed and revealed a relatively low complication rate (11% of cases). Chest infection was the commonest problem encountered, although none were life threatening and all responded to treatment. Surgical and medical management aimed at reducing tracheostomy complications is discussed.

Malignant melanoma of the oral cavity--an increasing clinical diagnosis?

Oral malignant melanoma is fortunately a rare lesion. However the actual incidence in the population at present is unknown but may be increasing. The overall prognosis remains poor despite more radical surgery with adjuvant radiotherapy, chemotherapy and immunotherapy. The clinical presentation of oral malignant melanoma can vary widely from a typically pigmented macular or proliferative lesion to a non-pigmented soft vascular tumour; single or multiple, primary or metastatic. Our experience of five patients with malignant melanoma of the oral cavity is presented and the management of such lesions discussed.

Gram negative aerobic bacillus pneumonia in oral and maxillofacial surgery--a case for comment.

A case illustrating the potentially fatal complication of endogenous Gram Negative Aerobic Bacillus (GNAB) septicaemia secondary to nosocomial pneumonia is presented along with current theories as to its aetiology. The technique of selective decontamination of the digestive tract is designed and advocated to prevent such occurrences; oral and maxillofacial surgeons should be aware of this approach. It may be, however, that by using much simpler manoeuvres such as changes in policy regarding gastric stress ulcer prophylaxis, the already small risk of such an occurrence will be further reduced. Awareness of this condition will allow a higher index of suspicion when presented with catastrophic septic complications on the ITU and aid in more rational planning of antimicrobial therapy.

Oral carcinoma in pregnancy.

Oral cancer presenting in pregnancy is a rare combination which, because of current epidemiological changes in the disease, may present more often in the future. Treatment of the condition can be very difficult. Decisions have to be made about terminating the pregnancy or finding a balance between the treatment of the mother and protecting the foetus from the effects of various treatment modalities. This may result in a compromise treatment of the disease. To illustrate the problems, we discuss a case of carcinoma of the tongue presenting in a 23-week pregnant Gravida 1 Para 0 lady, and review the literature.

Gorlin's syndrome and von Recklinghausen's disease occurring in one family.

A family is presented in which both Gorlin's Syndrome (Basal Cell Naevus Syndrome) and von Recklinghausen's neurofibromatosis have been inherited. The features and treatment of these syndromes are discussed and the management of families with these diseases is considered.

Primary intraosseous carcinoma of the jaws. Three new cases and a review of the literature.

Three new cases of primary intraosseous carcinoma are presented. The clinical features of these cancers often mimics odontogenic cysts, dental abscesses or periodontal disease; all benign dental conditions. This may delay the diagnosis and probably accounts for the poor prognosis associated with these tumours of 30-40% 5-year survival. A total of 24 cases of primary intraosseous carcinomas have been analysed, which includes reports collected from the literature and the three new cases presented in this paper.

Side-by-side double paddle pectoralis major flap for cheek defects.

A method of using the pectoralis major flap with two horizontally opposed skin paddles for simultaneous reconstruction of both intra-oral mucosa and skin in full-thickness cheek defects is described.

Parotid lymph node metastases from primary intra-oral squamous carcinomas.

Intra-oral carcinomas, depending on their primary sites, metastasis to various groups of cervical lymph nodes. Tumour involvement of the lymph nodes related to the parotid gland is unusual and controversy exists in the literature as to whether direct drainage from the oral cavity to parotid nodes is possible. The possible mechanisms of spread to the parotid nodes are reviewed. 2 cases of intraoral carcinoma which involved the parotid lymph nodes are reported.

Advanced central myxoma of the jaws in Nigeria. Clinical features, treatment and pathogenesis.

18 advanced cases of myxoma of the jaws are described. These had a typical age, sex and site distribution and characteristic clinical and radiographic features. Surgical treatment was radical as benefits large, poorly defined tumours, but there was no evidence that these were aggressive lesions. It is argued that the designation of myxoma as an odontogenic tumour is uncertain though not excluded. Attention is drawn to evidence that many myxomas of the jaws may be examples of myxomatous degeneration in other neoplasms.

Cardiac arrest following chlormethiazole infusion in chronic alcoholics.

Two chronic alcoholics who had cardiac arrests (one fatal) while receiving chlormethiazole by infusion are reported. Although a causal relationship has not been indisputably established, caution is advised when administering this drug to chronic alcoholics during withdrawal.