Mark Singh

Squamous cell carcinoma arising in mucosal plasmacytosis

The authors present an unusual case of invasive squamous cell carcinoma (SCC) developing in a pre-existing plasmacytosis of the lip. The roles of chronic inflammation, immunosuppression, and smoking in the pathogenesis of this tumour are briefly discussed. The authors highlight a significant side effect of the use of immunosuppressive drugs in benign conditions.

Recent advances in the management of salivary gland disease

The management of salivary gland disease forms a considerable part of the work done by oral and maxillofacial surgeons. Fast track and one-stop head and neck lump clinics allow for early diagnosis of salivary gland tumours in most units, the emphasis being on outcome after operation for benign disease. There have been limited advances in salivary gland surgery in recent years. Most recent publications have compared outcome of new methods of treatment with conventional techniques. This article reviews papers related to diseases of the salivary glands published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) over a two-year period (2007-2008), and includes other relevant articles to bring readers up to date about salivary gland disease.

Two non-surgical treatments for chondrodermatitis nodularis helicis

he exact cause of chondrodermatitis nodularis helicis is nknown, although it is thought to be caused by prolonged nd excessive pressure,1 and is initiated by dermal inflammaion, oedema, and necrosis. The ear is predisposed to this as it as little subcutaneous tissue for cushioning, and because of he small vessels and lack of subcutaneous tissue a secondary erichondritis follows. Classically it presents in middle-aged en as a spontaneously painful nodule on the helix or antiheix, which is usually well demarcated, round and raised, with olled edges and a central crust (Fig. 1).2 Because of the disfiguring nature of surgical techniques nd the high rates of recurrence associated with it, we suggest on-surgical treatment of chondrodermatitis nodularis helicis efore considering operation. We describe two methods of treatment that we have used n our department. The first is a custom-made foam presure relieving prosthesis (Fig. 2). We take an impression of he ear and a cast is made. The affected area is protected ith pink wax to ensure that no foam touches the lesion (all ajor undercuts are also blocked out) then a separator is prayed on and a prefabricated mould is placed on the cast. oft polyurethane self-curing foam is injected into the mould nd left to set. The fit is checked and the prosthesis given to he patient to wear at night secured with a hairnet. It can e custom made quickly and cheaply by any maxillofacial urgical laboratory.

Use of a dermal regeneration template and full-thickness skin grafts to reconstruct exposed bone in the head and neck

Soft tissue defects over bone are difficult to reconstruct and this is compounded when there is no periosteum. We present what is to our knowledge the first reported use of a dermal regeneration template (Integra®, Integra Life Sciences Corp, Plainsboro, NJ, USA) to assist in reconstruction over an exposed mandible.

Fine needle aspiration of a neck lump: a mercurial mystery

We describe an interesting case of mercury within a lymph node, which we found during routine fine needle aspiration cytology of a neck lump. We know of no similar reports and look for any suggestions from our readers as to the cause of such a finding.

The transverse mega-apophysis—An unusual neck lump

Although detection of a calcified structure in the neck may indicate an underlying infective or neoplastic process, it may also, as in this case, represent a variation of normal skeletal anatomy. The danger of such skeletal anomalies is that they may be referred for investigations such as fine needle aspiration and, when this is unsuccessful, subsequent open biopsy examination. Ultrasound is recommended as a first line investigation.

Mercury within fine needle aspiration of a neck lump

We read with interest the response to our brief article. The first point suggests a possible reason for our findngs. We can assure readers that a thorough history was taken nd at no point was there an altercation with a thermometer. lthough the patient may possess a mercury thermometer e appreciate that in the 1990s, mercury-based thermomeers were considered too risky and have largely been replaced ith electronic digital thermometers, or those based on liqids other than mercury. We briefly discussed the routes by hich mercury can enter the body and took a focused history hat failed to explain how it had happened. Another point is about the form of mercury. We proposed hat it was the methylated form because it is extremely poorly bsorbed. The substance was found within macrophages of he lymph node and was exposed to the biological process that ade it likely to become methylated. This form is also highly