Serryth Colbert

Lymphatic malformations of the head and neck—current concepts in management

Lymphatic malformations of the head and neck, also known as lymphangiomas or cystic hygromas, are a diverse group of lesions. They can be small and superficial or large and extensive, and management can be a challenge. Surgically they can be difficult to remove completely because of their poorly defined borders and the potential for damaging neighbouring structures. We review the dilemmas posed in diagnosis and treatment, and discuss the contemporary management of these interesting entities including sclerotherapy, which is gaining popularity.

Performing to a world class standard under pressure—Can we learn lessons from the Olympians?

With the 2012 Olympics being held in London, we explored pre-requisites for success in sport, and the comparative efficacy of employing these when performing under intense pressure in the clinical setting. We asked members of the Great Britain Olympic rowing team and OMFS surgeons to complete a validated questionnaire on how they performed under pressure. 89 questionnaires were completed by 43 surgeons and 46 rowers (81% response). We compared the results in terms of mental toughness and technical skill. The importance of training to be a winner was evident in athletes. While emphasising the multidimensional nature of talent, we recognise the essential role of psychology in the ability of individuals to fulfil their sporting potential. We discuss the possible implications for surgeons.

Experience of head and neck theatre staff and attitudes to human factors using an aviation-based analysis and classification system—a pilot survey

The role that human factors have in contributing to air crashes is well known and is included as an essential part of training. Awareness of human factors in surgery is increasingly being recognised but surprisingly few papers have come from head and neck specialties. We circulated a questionnaire on human factors based on an aviation model to 140 head and neck medical and ancillary staff who work in operating theatres in 3 large UK hospitals. Most positive responses were found in the consultant group followed by trainee doctors and support staff. A significant difference was found in the subcategories of Unsafe Supervision (p=0.002) and Preconditions to Unsafe Acts (p=0.001). This work will help to identify multi-system deficiencies that can be corrected, and highlights aspects that may yield the greatest reduction in surgical errors.

Supraclavicular metastases from distant primaries: what is the role of the head and neck surgeon?

Suspicious malignant supraclavicular lymphadenopathy provides a challenge for diagnosis and treatment. The wide variety of primary tumours that metastasise to this region should alert the clinician to look beyond the head and neck, particularly if it is the only site in the neck with suspected disease. As metastatic spread to these nodes from primaries not in the head and neck often indicates wide spread disease, neck dissection is controversial. In this article we review the lymphatic anatomy and discuss the investigation of supraclavicular lymphadenopathy. We discuss the evidence for the management of the neck in patients with subclavicular primary cancers (excluding lymphoma and melanoma) and the role of neck dissection.

Reducing the risk of retained throat packs after surgery.

• absorb any blood, other bodily or external fluids or other material that may seep into the back of the patient’s throat and enter the oesophagus or lungs during surgery in the mouth (oral surgery) • to seal the area around the tracheal tube during provision of general anaesthesia and the surgical procedure, and thus prevent leakage of gases • stabilise the tracheal tube or a supraglottic airway device and thus prevent its displacement during the surgical procedure.

Squamous cell carcinoma arising in dentigerous cysts.

We present two cases of squamous cell carcinoma (SCC) arising in dentigerous cysts. Malignant transformation in dentigerous cysts is rare giving rise to diagnostic difficulties. We propose imaging at an early stage to reduce delays in diagnosis.

Odontogenic skin sinus: A commonly overlooked skin presentation

Facial skin lesions present routinely to clinic and are largely dermatological in origin. Odontogenic infections are an unusual cause of facial lesion and are well-described in the dental literature; however they are regularly overlooked and mismanaged, often to considerable aesthetic detriment. We present such a case and highlight important avoidable pitfalls.

How do I manage an acute injury to the facial nerve

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options.

Role of drinking water copper in pathogenesis of oral submucous fibrosis: a prospective case control study

Although oral submucous fibrosis (OSMF) is thought to be multifactorial in origin, the chewing of areca nut is thought to be the main cause. Alkaloids and tannins in areca nut are responsible for fibrosis, but recent evidence has suggested that copper ions are also an important mediator, and in a small pilot study we recently found that OSMF was significantly associated with a raised concentration of copper in drinking water. We have further investigated this association in a heterogeneous population in Hyderabad-Karnataka, India, a region with a high incidence of the condition. We evaluated 3 groups, each of 100 patients: those with OSMF who chewed gutkha, those who chewed gutkha but did not have OSMF, and healthy controls who did not chew gutkha. The difference between the groups in the mean concentration of copper in water measured by atomic absorption spectrometry was significant (p<0.001). There were also significant differences between the groups in mean concentrations of serum copper, salivary copper, and ceruloplasmin (p<0.001). Our results confirm that copper in drinking water contributes to the pathogenesis of OSMF, but ingestion of copper is unlikely to be the sole cause.

A review of trauma and trauma-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2010-2011.

This review summarises all trauma and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2010 to December 2011. In total 45 articles were published, of which 42% (19) were full-length articles. These articles primarily focused on the management of mandibular condyle and orbital fractures, with several papers discussing maxillofacial surgery by the British military. There were no articles discussing midfacial fractures or massive facial trauma. The remaining papers included short communications, technical notes, and letters; and provided discussion of interesting cases, new surgical techniques and fracture classifications. The number of trauma papers published in BJOMS appears to be less than other sub-specialties such as head and neck oncology. The number of prospective and randomised studies remains low, highlighting a need to foster further research within maxillofacial trauma.