Mandibular condyle fractures: a consensus.

A consensus was obtained following a two-day international conference to review the management of mandibular condyle fractures. Whilst areas of disagreement still exist, there are many areas of agreement. It is hoped this editorial will stimulate debate leading to internationally accepted guidelines.

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.

Lympho-epithelial cysts: a maxillofacial surgeon's perspective.

Cervical swellings are referred to Oral and Maxillofacial Surgeons and may subsequently be diagnosed as lympho-epithelial cysts. The clinical presentation of such swellings appears to differ from that seen in other specialties also treating these cysts in that a larger proportion of lympho-epithelial cysts presenting to our specialty are infected, which complicates the diagnosis and also the subsequent management. We present our recent experience of 5 patients who underwent excision of a lympho-epithelial cyst, all of which were infected on initial presentation and four of which were associated with concurrent ipsilateral dento-alveolar infection. The fifth case presented with rapid development of a cervical swelling in the immediate post-natal period. As these cysts contain abundant lymphoid tissue as an integral part of the lymph drainage system of the head and neck, we propose that the management of an infected lympho-epithelial cyst should include a full clinical and radiographic examination of the oral cavity for a possible focus of infection and indeed any patient awaiting surgery for a non-infected cyst would benefit from an examination of the mouth and treatment of any sites of chronic infection.

Polycystic disease of the parotid glands: two familial cases.

Polycystic (dysgenetic) disease of the parotid glands is a rare disorder with only three fully documented reports in the literature containing a total of six cases. This developmental disorder of the distal ductal system appears limited to the parotid glands of female patients and is usually bilateral. We present two further cases with a confirmed familial background to add to the literature. This is the first documented report of familial polycystic disease of the parotid glands. The pathogenesis, mode of inheritance, clinical features, histological appearance and management of this interesting condition are discussed.

Cowden's disease: a rare but important manifestation of oral papillomatosis.

A case of Cowden's disease is reported, and possible differential diagnosis for the oral lesions is suggested.

Obstructive sleep apnoea syndrome presenting as lingual ulceration.

Two patients with obstructive sleep apnoea syndrome are reported where the initial presenting complaint was of lingual ulceration. This unusual presentation has not been reported previously. Both patients experienced frequent apnoeic episodes during sleep with a profound fall in the arterial oxygen saturation. It is postulated that the lingual ulceration resulted from repeated trauma to the tongue by the teeth as the patient made violent inspiratory efforts at the termination of an apnoeic episode. The diagnosis of sleep apnoea syndrome was based upon suggestive symptoms of snoring, morning fatigue and day-time somnolence plus a minimum of 15 apnoeic episodes per hour of sleep. The first-line investigations of this condition are available in all district general hospitals and a diagnosis of sleep apnoea syndrome obtained. Referral to a regional sleep study centre may be appropriate prior to the commencement of therapy. Management is predominantly medical, consisting of weight loss and the administration of nocturnal nasal continuous positive airways pressure.

Use of polyglactin 910 knitted mesh tubing to stabilize particulate hydroxyapatite in alveolar ridge augmentation. A preliminary report.

A universal problem with the use of hydroxyapatite (HA) particles has been the tendency for these particles to migrate beyond planned boundaries. This is a preliminary report on the use of polyglactin 910 knitted mesh (Vicryl) tubing containing HA particles in ridge-augmentation procedures, assessing the technique and the containment of HA particles. The technique is described and experience with six cases is presented. This study found no clinical or radiographic evidence of particle migration after normal function had been resumed. In one case the graft failed to become firmly incorporated with the bone and the whole graft migrated anteriorly on the mandible but still provided improved function for the patient. The technique facilitates the placement of HA particles and would be particularly useful if open mucosal flap techniques were being used for ridge augmentation. The use of Vicryl tubing for HA augmentation procedures prevents the migration of particles and allows an easier and more accurate placement of the grafts.

Recurrent buccal space abscesses: a complication of Crohn's disease.

A patient is described with generalized gastrointestinal involvement by Crohn's disease. Symptoms of recurrent ulceration and mucosal tags are well-described oral manifestations of Crohn's disease; however, in our patient recurrent facial abscesses, which required extraoral drainage, also developed. This complication has not previously been reported.

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.

Combined use of Doppler and conventional ultrasound for the diagnosis of vascular and other lesions in the head and neck.

Twenty-three patients with swellings of the head and neck were prospectively investigated by Doppler ultrasound and ultrasound imaging to determine the type and vascularity of the lesions and thereby aid pre-operative diagnosis. Four vascular lesions were correctly identified while vascularity was not found in patients with lipoma, cysts, abscess, or muscular hypertrophy. Increased vascularity was found in or near some tumours and lymphangiomas, but by careful comparison of findings these lesions were not confused with true vascular lesions. The value of the investigations was demonstrated by a change in the treatment in 6 of the cases in this series.

Recurrent oral carcinoma in Ferguson-Smith disease.

A patient with multiple self-healing squamous cell carcinomas of the skin is presented. Mucous membrane involvement in this condition is very uncommon and the lesions may show aggressive behaviour.

Orbital decompression of dysthyroid eye disease.

Two cases of Graves ophthalmopathy (GO) are presented, both of which required orbital decompression. The indications for orbital decompression and techniques used are discussed and the advantages of inferior orbitotomy presented.

Arterio-venous malformation following a radical neck dissection.

A case is described of an arterio-venous malformation (AVM), which followed a radical neck dissection, and was treated by intra-arterial embolisation for the control of symptoms. Other iatrogenic causes in head and neck surgery are listed and the management is discussed.

The fate of miniplates in facial trauma and orthognathic surgery: a retrospective study.

The fate of 279 Champy miniplates used routinely as permanent implants over a 5-year-period in the management of maxillofacial trauma and orthognathic surgery has been analysed retrospectively. Trauma patients (62) and orthognathic patients (47) were analysed separately; in each group those patients who had plates removed were compared to the patients with retained plates. This study indicates that the morbidity of retaining plates is within acceptable limits and that the routine removal of plates at 3 months may be unnecessary.

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.

Cricothyroidotomy, a useful alternative to tracheostomy in maxillofacial surgery.

Tracheostomy and prolonged intubation are traditionally used in maintaining the airway, particularly after extensive maxillofacial surgery. The literature reports significant morbidity and mortality from both these procedures. Cricothyroidotomy is proposed as a useful alternative in certain circumstances. Recent documentation suggests that traditional fears of subglottic stenosis after cricothyroidotomy are ill-founded. Cricothyroidotomy may also benefit the patient by quicker rehabilitation and in early mobilisation, compared with prolonged intubation. The surgical procedure is quick and easily performed, making it suitable for emergency airway control. Cricothyroidotomy is not appropriate in children or in patients with inflammation to the trachea, since these may predispose to subglottic stenosis.