Jonathan P. Hayter

Ameloblastoma--a diagnostic problem.

A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstrated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.

Case report: Ameloblastoma |[mdash]| a diagnostic problem

A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.

External carotid artery pseudoaneurysm following microvascular free flap reconstruction. The role of endovascular thrombin injection in embolization: a case report and review.

Pseudoaneurysm at the anastomosis of the free flap following ablative head and neck surgery is uncommon. We present a case of external carotid artery pseudoaneurysm in a patient who had previously undergone a subtotal glossectomy, neck dissection, and radial forearm free flap reconstruction. The traditional treatment for pseudoaneurysm has been open surgical repair. Our patient underwent successful treatment with an endovascular embolization utilizing thrombin injection of the aneurysmal sac. This case highlights the role of interventional radiology in the management of this rare but important complication of microvascular reconstructive surgery.

Head and neck cancer surgery provision in England: A current analysis of contributing specialties caseloads

To ascertain the current provision for surgery for head and neck cancer in England with respect to the operative caseloads of oral and maxillofacial, ear nose and throat (ENT) and plastic surgeons, we analysed data from the 2013 report of the National Head and Neck Audit (DAHNO). Clinicians were grouped by specialty of affiliation and assigned surgical caseloads were compared. There was a wide disparity in the extent of surgical activity between the specialties (p<0.001), and the percentage of those active in head and neck oncology within each specialty similarly varied (p<0.001).

How often does the operating list follow the planned order? An analysis of elective maxillofacial operating lists

OBJECTIVES The authors explored consistency of the observed running order in operating sequence compared with prior scheduled listing. We analysed potential variables felt to be predictive in the chances of a patient having their procedure as previously scheduled. METHODS Data were retrospectively collected for a consecutive group of patients who underwent elective maxillofacial procedures over a four week period. The consistency of scheduled and observed running order was documented. We considered four independent variables (original list position, day of week, morning or afternoon list, seniority of surgeon) and analysed their relationship to the probability of a patient undergoing their operation as per listing. Logistic regression analysis was used to determine significant associations between predictor variables with an altered list order. RESULTS Data were available for 35 lists (n = 133). 49% of lists were found to run according to prior given order, the remainder subject to some alteration. Logistic regression analysis showed a statistically significant association between original scheduled position and day of week, with list position consistency. Patients listed first were twelve times more likely to have their operation as listed compared to those placed fourth (OR 12.7, 95% CI 3.7-43, p < 0.05). Operating lists at the start of a week were subject to less alteration (p < 0.05). There was no demonstrated relationship between the grade of surgeon operating and alteration in operating sequence. CONCLUSION Approximately half of lists showed some alteration to the previously printed order. It appears that being first on an elective list offers the greatest guarantee that a patient will have their operation as per prior schedule. It may be reasonable for clinicians to be mindful of potential operating list alterations when preparing their patients for elective surgery.

Businessman and holy man: a shared experience of oral malignancy

f m atient A, a 55-year-old local businessman with no past medcal history or risk factors for oral malignancy, was referred to he department with a lesion on the tongue, which was diagosed as a T4 N1 squamous cell carcinoma (SCC). Patient B ho chewed tobacco, was a 55-year-old man from the same ocal community who worked as a Brahmin priest. He was eferred to the clinic with an oral lesion involving the bucal mucosa, which was diagnosed as a T2 N0 SCC. Both ere recommended primary resection and reconstruction on n urgent elective basis. After diagnosis, Patient A had some difficulty acceptng his condition given his clear past medical history and ifestyle, and the likely impact radical surgery would have on is occupation. Patient B initially took the view that God ould provide a solution to his problem, but after maniest enlargement of his tumour, he agreed to urgent elective urgery. In the period immediately before his planned operation,