Alan W. Wilson

Cutaneous head and neck SCCs and risk of nodal metastasis – UK experience

AIM To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck. METHODS A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis. RESULTS One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively. CONCLUSIONS The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

Severe tissue necrosis following intra-arterial injection of endodontic calcium hydroxide: a case series

We present 2 cases of intra-arterial injection of endodontic calcium hydroxide via the root canal system of molar teeth. Nonsetting calcium hydroxide paste was used as a temporary dressing during endodontic treatment and in both cases delivered via an injectable syringe technique. Retrograde flow of the calcium hydroxide occurred along the artery until its origin where orthograde flow continued to the capillary bed. Case 1 demonstrates calcium hydroxide injected into the distal root canal of a lower second molar resulting in its distribution to the external carotid bed and case 2 demonstrates calcium hydroxide injected into the palatal root of an upper second molar with flow into the infraorbital artery. In both cases this resulted in severe clinical signs and symptoms ending in tissue necrosis. Long-term sequelae included scarring, deformity, and chronic pain. This case series illustrates the high toxicity of calcium hydroxide when displaced into vessels and soft tissues. Caution should be exercised when using injectable systems for endodontic calcium hydroxide.

Tongue tremor: a rare initial presentation of essential tremor

Tongue tremor is commonly associated with essential tremor, but rarely presents as an initial finding. Essential tremor is the most common movement disorder and is characterised by 4-12 Hz postural and kinetic tremor, but there is no universally accepted diagnostic criterion. It commonly affects the arms, and to a lesser extent, other regions of the body, and signs and symptoms tend to worsen during emotional or physiological stress. We describe a rare isolated presentation of tongue tremor as a part of essential tremor, its management, and the diagnostic dilemma. To our knowledge isolated tongue tremor as a presentation of essential tremor has not previously been described in maxillofacial publications.