A.E. Brown

Late extrusion of alloplastic orbital floor implants

Complications following the use of alloplastic orbital floor implants are well documented but it is not widely recognised that these can occur many years after initial treatment. Three patients who presented with late extrusion of an implant through the facial skin are reported. This complication occurred 10, 16 and 17 years respectively after treatment of the orbital floor fracture. The tissue reaction to silicone rubber and Teflon inplants is reviewed and the possible cause for this late complication is discussed.

A simplified method for the internal fixation of fractures of the mandibular condyle

The morbidity following conservative management of fracture dislocations of the mandibular condyle is considered, and the theoretical advantages of open reduction discussed. The various methods described in the past are reviewed and a new technique is described whereby a Kirschner wire is drilled into the condylar fragment and then inlaid into the ramus. Advantages over previous methods include easy manipulation of the fragment and lack of danger to the facial nerve.

Combined radial forearm and pharyngeal flap for soft palate reconstruction

The use of a free vascularised fascio-cutaneous radial forearm flap in combination with a cranially based pharyngeal flap for soft palate reconstruction has not been previously reported. We present the technique and illustrate its use in two cases of total and one case of subtotal soft palate reconstruction. The functional outcome is discussed with particular reference to nasal airway patency, speech and swallowing.

Oral metastasis in malignant pleural mesothelioma

A case is reported of a 48-year-old man with malignant sarcomatous pleural mesothelioma, who presented with a secondary deposit in the mandibular alveolus. We believe that this is the first reported case of this nature.

Management of Jehovah's witness patients undergoing major head and neck surgery

Several diverse strategies have been recommended to manage Jehovahs Witness patients undergoing surgery when significant blood loss is expected. However, many of the proposed management strategies cannot be used when the urgent nature of the disease precludes adequate preoperative preparation of the patient. We present our experience of the management of two Jehovahs Witnesses with oral carcinoma requiring extensive resection, neck dissection, and reconstruction with free tissue transfer.

The utility of molecular diagnostics to predict recurrence of head and neck carcinoma

Background:Locoregional recurrence is the major cause of treatment failure after surgery for oral squamous cell carcinoma. Molecular diagnostics have the potential to improve on clinicopathological parameters to predict this recurrence and plan adjuvant treatment. The test most frequently applied is based on detecting TP53 mutations, but alternative methodology is required for cases that harbour the wild-type gene.Methods:One hundred and two cases with tumour-adjacent margins, considered to be clear margins by microscopy, were examined using carefully optimised molecular diagnostics based on detection of the TP53 and Ly-6D markers. The markers were also combined to provide a dual approach.Results:The dual molecular diagnostic identified cases with a significant increase in the probablility of developing locoregional recurrence when tumour-adjacent positive and clear margins were compared (P=0.0001). These tests were most useful when the clearance at the resection margins was 5 mm or less. The TP53-based diagnostic was a better predictor of locoregional recurrence than established clinicopathological parameters.Conclusion:The optimised TP53-based diagnostic rapidly identifies an important subgroup of cases with close margins that will benefit from new treatment modalities to reduce the risk of recurrence.

Malakoplakia of the face: A rare but important diagnosis

Malakoplakia that presents in the head and neck is rare. We describe a case in a man who presented with a fungating mass in the periauricular skin that was thought to be a malignant tumour. Histopathological and microbiological investigations established a diagnosis of malakoplakia.

Valve obturation of the nasopharynx.

Complete obturation of the nasopharynx can cause functional problems with breathing and swallowing due to obstruction of the nasal airway. A technique is described whereby a one way valve was incorporated in an obturator to allow normal nasal inspiration whilst maintaining an oropharyngeal seal during swallowing and speech.