The SECONDI MAPZ(©) system: new approach for the classification of oncological defects of the midface.

The appearance and function of the midface are crucial physiologically, psychologically, and aesthetically, and defects in the region can be devastating. Most of these defects are caused by operations for cancer, for which surgical access and rehabilitation can be challenging. Clinical evidence in midfacial ablative surgery is limited because differences between existing classifications do not allow a uniform approach to data recording, which makes comparison difficult. We explore the history of the classification of midfacial and maxillary defects, we analyse the shortcomings of those currently in use, and propose a new system that enables defects to be mapped simply, logically, and accurately.

Tumour depth of invasion of pT1 squamous cell carcinoma of the oral tongue and risk of pathologically detected neck metastases.

BACKGROUND: Tumour depth of invasion (TDI) is considered a predictor of pathologically detected neck metastases (PDNM) for squamous cell carcinoma (SCC), but different investigators have arrived at different cut-off of TDI. However, the relationship between TDI of pT1 SCC of the oral tongue and PDNM remains unknown. METHODS: Data was collected for patients with pT1SCC of the oral tongue. TDI, neurovascular invasion, pattern of invasion and presence of PDNM were recorded. The relationship between data was studied using logistic regression and ROC methods. RESULTS: With all other factors held constant, data showed that the odds ratio for each millimetre increase in TDI and risk of PDNM was 1.09 (95% CI: 0.95 - 1.25, p = 0.234), which was insignificant. CONCLUSION: TDI is not accurate and cannot be used as predictor of PDNM in patients with pT1 SCC of the tongue. Further, true TDI can only be assessed on resection specimens. This article is protected by copyright. All rights reserved.

Clear cell odontogenic carcinoma: a rare neoplasm of the maxillary bone.

Clear cell odontogenic carcinoma (CCOC) is an extremely rare neoplasm, with only 74 cases in the English-language literature. It displays a propensity for the mandible, most commonly presenting in the fifth to seventh decades. Histopathologically, CCOC is characterized by sheets and islands of vacuolated and clear cells. The aggressive nature of CCOC was noted in its first description in 1985, although it was not formally classified as malignant by the World Health Organization until 2005. This report describes a case of CCOC presenting atypically in a young patient and at an uncommon site. The authors review the details of this case, outlining management strategies referencing their experience and that described in the other limited cases in the literature.

Presentation of intramuscular myxoma as an unusual neck lump.

Intramuscular myxoma (IM) has a distinct diagnostic identity among soft tissue myxomas. IMs have an approximate incidence of 1 per million of the population per year, with a female-to-male ratio of 14:3. The age range for presentation is 40 to 70 years, and the thigh is affected most frequently. IMs most commonly affect larger muscle groups, making the head and neck a rare site. To the authors' knowledge, there is 1 previous report of an IM presenting in the sternocleidomastoid muscle. In addition, IMs usually present as slow-growing asymptomatic swellings. Although abnormal gag reflexes have been reported in cases of glossopharyngeal schwannoma and neurofibroma in patients with neurofibromatosis-1, a gag reflex has not been reported previously as a complication of IM in the head and neck. A case of IM in the left sternocleidomastoid muscle, presenting with an intense gag reflex on palpation, in a 70-year-old woman is presented.

First do no harm: should routine tracheostomy after oral and maxillofacial oncological operations be abandoned?

Tracheostomy is traditionally used to secure the airway after major oral and maxillofacial oncological operations. In our unit, as an alternative, patients are intubated overnight without tracheostomy. We reviewed the case notes of 55 patients who had had a major intraoral resection, neck dissection, and reconstruction with a free flap. All patients were extubated and fit for transfer to the ward the following morning. We conclude that overnight intubation is a safe alternative to tracheostomy, and that the routine use of tracheostomy for oral and maxillofacial oncological operations should be used only for a few selected cases.

Angiolymphoid hyperplasia with eosinophilia successfully treated with oral steroids.

Angiolymphoid hyperplasia with eosinophilia is a rare benign vascular lesion most commonly affecting the head and neck region. This article reports a case of a 26-year-old white woman with rapidly enlarging nodules of the upper lip and cheek treated successfully with oral corticosteroids and cetirizine. Morbidity and cosmetic deformity associated with radical surgery to the face and possible consequences of radiation treatment were avoided. There were no long-term complications.

Foetal Anticonvulsant Syndrome: Implications on Dento-facial Development in General Dental Practice.

Epilepsy affects around 1% of the population and approximately 1 in 250 pregnancies are exposed to antiepileptic drugs (AEDs). Epilepsy is the most common neurological disorder to occur in this group. Exposure to these drugs can result in teratogenic effects, referred to as foetal anticonvulsant syndrome (FACS). The older generation anticonvulsants, such as phenytoin, valproate and carbamazepine, have been shown to be teratogenic and it is hoped that the 'newer' drugs (eg gabapentin and lamotrigine) will be different. We present two siblings born to an epileptic mother and the literature is reviewed.

Bazex syndrome (acrokeratosis paraneoplastica): persistence of cutaneous lesions after successful treatment of an associated oropharyngeal neoplasm.

Acrokeratosis paraneoplastica is a rare paraneoplastic syndrome commonly affecting males over 40 years of age. There exists a strong association with squamous cell carcinoma (SCC) of the upper aerodigestive tract or cervical metastatic disease originating from an unknown primary. We report a case associated with SCC of the right tonsil with persistent paraneoplastic cutaneous lesions 2 years after successful treatment of the underlying neoplasm.

Oral squamous cell carcinoma associated with khat chewing.

The incidence of oral squamous cell carcinoma has been long associated with smoking, alcohol, and betel quid/areca nut chewing. This article presents a case of a 42-year-old female patient with squamous cell carcinoma of the floor of the mouth, associated with khat chewing. This relatively early presentation of oral squamous cell carcinoma may be linked to the synergistic effect of khat chewing and other known carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines such as 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone, 4-(N-methyl-N-nitrosamino)-4-(3-pyridyl)-1-butanal. With the changing demographic structure and migration between countries, khat chewing is of increasing significance as it may contribute to the etiology of squamous cell carcinoma in developed countries.

Metastasising clear cell odontogenic carcinoma: a case report and review of the literature.

Primary odontogenic carcinomas are rare and examples which have metastasised are even more uncommon. We describe the first reported case of a clear cell odontogenic carcinoma which metastasised to distant bones, namely the 5th lumbar vertebra and hip, 3 years after initial diagnosis. The initial incisional biopsy was thought to represent a calcifying epithelial odontogenic tumour, but in the subsequent resection the tumour showed a prominent clear cell component admixed with squamous cells showing peripheral palisading, widespread infiltration and necrosis indicating a malignant neoplasm. Radiologically guided biopsy revealed a metastatic lesion in L5 vertebrae and left hip, confirmed by immunohistochemistry. The metastatic lesion had similar appearances to the first biopsy, and diagnosis was confirmed by comparison of histological features, immunohistochemistry and exclusion of a second primary lesion by clinical examination and imaging. The diagnosis of clear cell odontogenic carcinoma is a difficult one to make. The behaviour of these tumours is unpredictable. This case confirms that clear cell odontogenic carcinomas have the potential for distant metastasis and require long-term follow up.