Simultaneous lymphoma and squamous cell carcinoma presenting as a neck lump.

We describe the unusual presentation of a patient with simultaneous follicular lymphoma and metastatic head and neck squamous cell carcinoma. He was initially treated for his lymphoma and then, following no regression in his cervical lymphadenopathy was referred for further assessment. This revealed squamous cell carcinoma arising from the left tongue base with metastatic disease in the left neck.

An unusual cause of oro-antral fistula.

A case of oro-antral fistula associated with an apparent foreign body following antral packing for a zygomatic complex fracture 10 years previously is presented. This was treated by antral exploration, removal of the antral contents and repair of the fistula. The complications of antral packing for zygomatic and orbital floor fractures are reviewed and those situations where antral packing may be the treatment of choice are defined.

FDG-PET. A possible prognostic factor in head and neck cancer.

Previous studies have shown that high uptake of (18)F-fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value on positron emission tomography scan, was associated with poor survival. The aim of this study was to confirm the association and to establish whether a high standardized uptake value had prognostic significance. Seventy-three consecutive patients with newly diagnosed squamous cell carcinoma of the head and neck underwent a positron emission tomography study before treatment. Age, gender, performance status tumour grade, stage, maximal tumour diameter and standardized uptake value were analyzed for their possible association with survival. The median standardized uptake value for all primary tumours was 7.16 (90% range 2.30 to 18.60). In univariate survival analysis the cumulative survival was decreased as the stage, tumour diameter and standardized uptake value increased. An standardized uptake value of 10 was taken as a cut-off for high and low uptake tumours. When these two groups were compared, an standardized uptake value >10 predicted for significantly worse outcome (P=0.003). Multivariate analysis demonstrated that an standardized uptake value >10 provided prognostic information independent of the tumour stage and diameter (P=0.002). We conclude that high FDG uptake (standardized uptake value>10) on positron emission tomography is an important marker for poor outcome in primary squamous cell carcinoma of the head and neck. Standardized uptake value may be useful in distinguishing those tumours with a more aggressive biological nature and hence identifying patients that require intensive treatment protocols including hyperfractionated radiotherapy and/or chemotherapy.

Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants.

OBJECTIVE: The objective of this study was to compare the use of a resorbable oxycellulose dressing with a fibrin adhesive for the prevention of postextraction hemorrhage in patients taking anticoagulants. STUDY DESIGN: A control group of 26 patients with a preoperative international normalized ratio (INR) in the range of 2.0 to 4.2 had extractions performed with the use of local anesthesia and the socket(s) dressed with a resorbable oxycellulose dressing and sutured with a resorbable suture. The study group with a comparable INR range of 2.1 to 4.1 was treated in a similar manner, except the sockets were dressed with a fibrin adhesive. RESULTS: No discernible difference in the postoperative outcome with regard to hemorrhage was noted. Postoperative pain was reported more frequently in the group that used a resorbable oxycellulose dressing. Only 1 patient had significant postoperative bleeding. CONCLUSIONS: This study shows that in patients receiving warfarin whose INR is within the therapeutic range, the fibrin adhesive is as effective as the resorbable oxycellulose dressing in preventing postextraction hemorrhage.

Facial paralysis with an inflammatory parotid mass.

Facial paralysis in association with a parotid mass is usually associated with a diagnosis of malignancy. Benign parotid neoplasms and inflammatory processes resulting in facial paralysis are extremely rare. This report describes such a case and highlights some of the difficulties surrounding the diagnosis and management of these cases.

Cystic and glial mixed hamartoma of the tongue.

Choristomas and mixed hamartomas of the oral cavity are uncommon lesions that show a variety of clinical presentations, histological appearances and growth patterns. We report a case of an unusual mixed hamartoma of the posterior tongue composed of dermoid cyst, sebaceous and glial elements. Magnetic resonance imaging indicated a predominantly cystic lesion limited to the pharyngeal and posterior part of the anterior tongue. A conservative approach was adopted and the lesion has shown minimal growth for 2 years following diagnosis.

Stomal recurrence following temporary tracheostomy.

The development of a stomal recurrence after temporary tracheostomy for malignant disease of the head and neck is a rare complication, but is a well-recognized phenomenon following total laryngectomy. The risk factors and mechanisms involved are still not well understood. In a review of 265 patients having a temporary tracheostomy for head and neck malignancy, three (one per cent) developed a stomal recurrence. All recurrences occurred in the group where tracheostomy had been performed pre-resection and of these three patients all had N+ disease. The findings suggest that tumour-cell implantation is an important mechanism of stomal recurrence and that operative technique and timing of tracheostomy placement is important in reducing the risk of encountering this complication.

Early fracture of clavicle following neck dissection.

Fracture of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4-0.5 per cent. We report a case where fracture occurred early following a selective neck dissection.

Myxoma of the mandibular condyle. A case report and review of the literature.

Myxoma of the mandibular condyle is extremely rare and may cause signs and symptoms like those seen in patients with temporomandibular joint dysfunction (TMD). The histogenesis, histologic profile, and management of myxoma of the jaws remain controversial. We report a case of myxoma involving the mandibular condyle appearing as TMD, and we review the literature to highlight current controversies surrounding this lesion.

Analysis of tracheostomy-associated morbidity after operations for head and neck cancer.

Tracheostomy is a safe and effective way of securing the airway in patients who have radical resections for head and neck cancer. We audited the morbidity after 265 tracheostomies to identify the risks in relation to head and neck surgery, and to propose recommendations to improve care.Twenty-one tracheostomy-related complications were encountered in 256 patients (8%). Most complications occurred during the early postoperative period (72%). There were no tracheostomy-related deaths.Tracheostomies were retained for a median of 10 days (range 1-160). Delayed extubation was associated with extent of resection [P = 0.006], site of tumour (floor of mouth and anterior two thirds of tongue [P = 0.02]), and age (<61 years [P = 0.02]). Patients who were given preoperative radiotherapy were significantly more likely to develop a tracheostomy-related complication (P = 0.03). Patients with a tracheostomy complication were more likely to have other serious complications (P = 0.05) and in these patients there was a risk of delayed extubation (P = 0.06). We conclude that elective tracheostomy is essentially event-free, and most complications occur in the ward.

Observations on the use of rectally administered diazepam for sedating children before treatment of maxillofacial injuries: report of nine cases.

The use of diazepam in solution, administered per rectum, as an adjunct to treatment of paediatric maxillofacial injuries, has not been previously reported. Its use in a series of nine cases is described. The authors recommend this route of administration as an alternative form of management in the treatment of maxillofacial injuries in anxious children.