K. Sneddon

Extracranial meningioma of the oral cavity

A case of a maxillary tumour resembling an extracranial meningioma is reported. So far as can be ascertained no other instance of this same tumour has been recorded occurring in the oral cavity.

Surgical Management of the Severely Contracted Socket Following Reconstruction

Purpose: To present a surgical technique for the early maintenance of the severely contracted socket following reconstruction. Methods: Two patients with severely contracted sockets following multiple procedures and recurrent failure were identified over a 1 year period. Following fornix and eyelid reconstruction, silicone fixative was injected into the fornix through a standard conformer. The silicone fixed around a pre-placed K-wire passed from the lateral orbital rim to the posterior lacrimal crest. Both silicone and wire were removed at 3 months. Results: Both patients were able to wear and maintain an acceptable prosthesis following the surgical procedure. Conclusion: This is a safe and effective method for the early maintenance of a severely contracted socket. This technique minimizes cheesewiring or extrusion and avoids damage to superior and inferior muscles and structures.

Total mandibular subapical osteotomy: modification of the technique

The indica-tions are: mandibular dentoalveolar hypoplasia with goodprojection of the chin, mandibular vertical alveolar defi-ciency, lateral open bite deformity, condylar agenesis andhypoplasia,infantileopenbite,andcorrectionofrelapseafterpreviousramusosteotomy.Eliadesetal.reportedapatientinwhomatotalmandibularsubapicalosteotomywascombinedwith the bilateral sagittal split osteotomy (BSSO) to reducethe extent to which the mandible would have to be advancedwith the BSSO alone.

Synchronous Reconstruction of the Exenterated Orbit with a Pericranial Flap, Skin Graft and Osseointegrated Implants

Reconstruction of the exenterated orbit remains a surgical challenge. Here, the authors present a case in which orbital exenteration was performed for an extensive, infiltrating medial canthal basal cell carcinoma; the resulting defect was reconstructed with osseointegrated implants and a pericranial flap onto which a split thickness skin graft was placed. The second stage of the aesthetic rehabilitation of this patient (placement of the transcutaneous abutments) was completed under local anaesthetic 16 weeks later. Subsequently, the patient was fitted with an oculoplastic prosthesis four weeks later. The above technique accelerates the prosthetic rehabilitation of the patient by performing the primary reconstructive procedures simultaneously with the exenteration and by removing the need for secondary surgical procedures under general anaesthetics. The whole process from orbital exenteration to the fitting of an ocular prosthesis was completed in just five months.

Dentigerous Cyst and Ameloblastoma of the Jaws: Correlating the Histopathological and Clinicoradiological Features Avoids a Diagnostic Pitfall.

Aim. To determine how many ameloblastomas were misdiagnosed as dentigerous cysts (DCs) by correlating the radiological and histopathological features of a series of both entities. Methods and results. Histopathology reports and radiological imaging of 135 DCs and 43 ameloblastomas were reviewed. Any clinical or radiological feature that suggested that the diagnosis of DC was wrong—for example, absence of an unerupted tooth—prompted review of the original histology. A total of 34 cases coded as DC at diagnosis were excluded; in the remaining 101 patients, the clinicoradiological and histopathological features were consistent with DC in 96 (95.0%). Review of the histology revealed that 4 patients had actually had odontogenic keratocysts (OKCs) and one a luminal/simple unicystic ameloblastoma (UA). One other OKC and 3 other ameloblastomas (1 luminal UA, 2 solid/multicystic) had originally been diagnosed as DC; these had been identified prior to the study. Of the 9 misdiagnosed patients, 6 were ≤20 years old. Clinically, DC had been the only, or one of the differential, diagnoses in 7 patients; in the other 2, the clinical diagnosis was radicular cyst. In none of the 4 misdiagnosed ameloblastomas was the radiology compatible with a diagnosis of DC. Incorrect terminology had been used on the histopathology request form in 5 of the 34 excluded cases where the clinical diagnosis was DC, despite the cyst being periapical to an erupted carious or root-filled tooth. Conclusions. The entire clinical team must ensure that a histopathological diagnosis of DC is consistent with the clinicoradiological scenario, particularly in younger patients.

The E-Z(easy) clamp--a new instrument to facilitate medial ectropion repair.

The medial spindle/retropunctal diamond procedure is a useful technique to correct medial ectropion. Unfortunately, the procedure is difficult, due to the limited size of the surgical field, the bleeding that is seen when the marginal artery is encountered and because of the ever present risk of damaging the canaliculus. We have developed a clamp that overcomes the anatomical opposition outlined above and at the same time improves access to the surgical field.