T. Aldridge

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.

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.

Posterior auricular nerve found anterior to the cartilage of the external auditory meatus—a previously unreported variant

We describe a previously unreported anatomical variant of the posterior auricular nerve found during parotidectomy, and discuss its clinical implications.

Use of Surgicel(®) and cyanoacrylate glue to seal iatrogenic rupture of cysts and tumours during surgery.

l t s paraffin block) and was not visible on sections. In summary, this simple and effective technique minimises further spillage after iatrogenic damage during operation. e describe a novel technique using cyanoacrylate tissue lue with a Surgicel® (Ethicon, UK) scaffold to seal iatroenic rupture of cysts and tumours during surgery, thereby inimising spillage. Cyanoacrylate preparations have been used in surgery for ore than 50 years, and tissue glue has been widely used in ifferent surgical applications. It is easy to apply and can save onsiderable time and effort. It polymerises within seconds fter contact with proteinaceous surfaces to form strong and exible bonds. Cyanoacrylate and other adhesives used in ral and maxillofacial surgery have been reviewed recently.1 e have used cyanoacrylate glue successfully to seal leaks rom the thoracic duct during neck dissection.2 Branchial cysts, thyroglossal cysts, and lymphatic malforations have thin walls that easily perforate during operation ausing them to leak (Fig. 1).3 While this may not be too detriental and can facilitate excision, they are generally easier to emove if there is some residual internal volume. In our expeience, once an unplanned leak is encountered, placement of purse-string suture often exacerbates the matter. Rupture f tumours such as pleomorphic adenoma during operation an lead to serious morbidity because of the possible need or further treatment. Any technique that can reduce these otentially serious sequelae should be considered a valuable djunct to meticulous and safe surgical practice. We have developed a technique using several drops of ® yanoacrylate tissue glue (Histoacryl , TissueSeal, Ann rbor, USA) to seal small tears in these lesions. In our arly experience we found that the glue easily sheared off

Epstein-Barr-virus-related mucocutaneous ulceration that mimics oral squamous cell carcinoma: the importance of recognising this new condition

We report a case and present a literature search of the relatively newly reported condition of Epstein Barr Virus (EBV)-related mucocutaneous ulceration. EBV-related mucocutaneous ulcers clinically present as oral squamous cell carcinoma (OSCC) in immunocompromised elderly patients but usually resolve by stopping or modifying the medication. As the two conditions can present in a similar way, and the management of each is totally different, this case highlights the importance of recognising this condition at an early stage.

Short communications published online in the British Journal of Oral and Maxillofacial Surgery during 2010–2011

The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.