Waseem Jerjes

Florid cemento-osseous dysplasia in a young Indian woman. A case report

We present a rare case of florid cemento-osseous dysplasia (FCOD) occurring in a 27-year-old Indian woman. She presented with three lesions, two of them symmetrical, at the posterior region of the mandible. Another lesion appeared nine months later, symmetrical to the existing third lesion. This confirmed the diagnosis of florid cemento-osseous dysplasia as being symmetrical asymptomatic bone lesions occurring in the jaw. The diagnosis was made radiographically depending on a series of radiographs, as biopsy is contraindicated. No treatment was required as the lesions were asymptomatic, causing no problem to the patient. The patient continues to be reviewed annually. The case is rare in its unusual combination of the disease itself (FCOD), age (27 years) and race (Indian). Clinical and radiological features are presented.

Experience in third molar surgery: an update

Background The relationship between a surgeons experience and the incidence of postoperative complications after third molar surgery is assessed in this prospective clinical study. Previous reports have shown this to be one the most influential factors on surgical outcome.Method In this study, 3,236 patients underwent surgical removal of impacted third molars. All patients included in the study were reviewed and the various postoperative complications were recorded and statistically compared to the surgeons grade. Patients demographics and pre-operative radiographic findings were also noted.Results The surgical procedures were performed by seven specialists and 12 residents. In the group of patients treated by the residents, the incidence of postoperative complications was found to be significant with regards to trismus, infection, alveolar osteitis and paraesthesia of the lingual and inferior alveolar nerves. In the group of patients treated by specialists, the incidence of postoperative bleeding was found to be statistically significant.Conclusion There is without doubt a relationship between the surgeons experience and the postoperative complication in third molar surgery. The impact of the findings from this study upon the profession, education and research is as yet unrealised. The ethical and moral implications of our findings are discussed.

Upper-lip laser frenectomy without infiltrated anaesthesia in a paediatric patient: a case report

Labial frenectomy is a common surgical procedure in the field of oral surgery. Labial frenectomy is a procedure usually done for orthodontic reasons. The role of laser surgery in the oral cavity is well established. The use of diode laser frenectomy without infiltrated anaesthesia is currently under investigation. Needle-less oral surgery, without infiltrated anaesthesia, is a novel situation in paediatrics with paramount importance.

The direct effects of stored blood products may worsen prognosis of cancer patients; shall we transfuse or not? An explanation of the adverse oncological consequences of blood product transfusion with a testable hypothesis driven experimental research protocol

Francis and colleagues reported an association between blood transfusion and worsened cancer prognosis. Since then there has been much debate over whether there is in fact such an association. We propose a possible mechanism which could explain much of the conflicting clinical and experimental evidence, and which can be readily tested experimentally. It is suggested that the extracellular accumulation of bioactive factors in blood transfusion products can directly and indirectly cause tumour growth and hence a worsening of prognosis. This theory can be applied both in vitro and in vivo. Two separate UK studies have shown that perioperative blood transfusion is associated with worsened prognosis in head and neck squamous cell cancer patients. Furthermore, pilot experiments have shown that as blood ages, endothelial growth factors are leached from the metabolically compromised red cell. We believe that we have provided a rationale to explain the conflicting findings of research to date in this area. That red cells should store endothelial reparative growth factors would seem logical, as would the release of any factors as the metabolic processes of the anucleate red cell decline over time. As a result, leuco-depletion should be promoted and blood transfusion should be avoided if possible.

How we do it: a method of neck dissection for histopathological analysis

BackgroundDissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers.We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity.MethodsWhen dissected, each level is excised between lymph nodes groups and put into a separate pot of formalin taking care to avoid rupture of any obvious pathological nodes.ResultsThis makes for a simpler dissection as the surgeon progresses, as a larger more cumbersome specimen is avoided and manipulation of involved nodes is actually reduced with a reduced risk of tumour spillage.ConclusionWe feel that our technique provides several advantages for the histopathologist as well as the surgeon. As the dissection of the specimen into the relevant levels has already been performed, time is saved in orientating and then dissecting the specimen. Accuracy of dissection is also improved and each piece of tissue is a more manageable size for processing and analysis.This technique may also have several surgical advantages when compared with the commonly practiced techniques e.g. with reducing in-vivo specimen manipulation, hence reducing the risk of inadvertent injury to important structures and tumour spillage.

Rheumatoid nodule of the thyrohyoid membrane: a case report

BackgroundRheumatoid nodules are common extra-articular findings occurring in 20% of rheumatoid arthritis patients. They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the bodyCase presentationWe present the case of a 62-year-old male who presented with a midline neck mass. Clinically it moved on swallowing and tongue protrusion-suggesting attachment to the thyrohyoid membrane. Ultrasound examination revealed a cystic lesion in the absence of cervical lymphadenopathy in a non-smoker. The neck was explored and histological examination of the excised lesion which was attached to the thyrohyoid membrane revealed a rheumatoid nodule.ConclusionA rheumatoid nodule of the thyrohyoid membrane is very rare. The triple diagnostic scheme of clinical examination supplemented with ultrasound and guided fine needle aspiration for neck lumps remains valid in most cases. If excision is indicated we feel it should be performed in such a manner that the scar tract could easily be encompassed in a neck dissection excision should definitive histological examination be adverse. We suggest that when dealing with patients with established rheumatoid arthritis one should consider a rheumatoid nodule as a differential diagnosis for any swelling on the patient whether it be subcutaneous or deep.

Interrogation of skin pathology using elastic scattering spectroscopy

In this study, facial skin lesions acquired from 73 patients were subjected to in vivo elastic scattering spectroscopy. Lesions were then surgically resected. The majority of the lesions were classified into four categories: basal cell carcinoma, seborrhic keratosis, fibroepithelial polyp and intradermal nevi. Results Results showed that ESS can differentiate between normal and pathological skin conditions as well as benign and malignant skin conditions.

Diagnosis of head & neck malignancy using fluorescence spectroscopy and imaging

Fluorescence diagnostic methods usually pick up a mixed bag of signals from endogenous fluorophores such as tryptophan, collagen, elastin, NADH and FAD. As some of these show a tumour specific distribution, this can be exploited to distinguish tissues in vivo. The fluorescence contrast is even slightly enhanced by using exogenously applied fluorescent markers or their precursors (e.g., 5-aminolevulinic acid induced Protoporphyrin IX). Even though the sensitivity to detect malignant lesions seems to be improved by combining fluorescence diagnostic methods with normal inspection according to the literature and to our own experience, the methods are rather unspecific as chronic inflammations cause results similar to neoplastic disease.

Cystic hygroma treated with ultrasound guided interstitial photodynamic therapy: Case study

A cystic hygroma, or hygroma cysticum coli, was first described by Wernher in 1843 as a benign harmatoma of the lymphatic system [1]. They are most commonly known to affect the posterior triangle of the neck (70—80% of cases); however, the axilla, superior mediastinum and chest wall have also occasionally been involved. Although of unknown aetiology, theories suggest that they could originate from the growth arrest of primitive lymph channels. This causes the impediment of peripheral lymphatic’s resulting in the formation of fluid-filled sacs. The condition usually presents at birth or early infancy with variable size. It can be either unilocular or multilocular which in both cases transilluminate during examination. Symptoms can be severe when involving the neck giving rise to progressive airway obstruction and dysphagia and/or odynophagia. Surgical debridement or excision of small lesions has been recommended. However, large size lesions are difficult to excise due to increase risk of morbidity and disfigurement.

Cervical Lymphadenitis Due to Mycobacterium Malmoense

Nontuberculous mycobacteria are isolated from soil, dust, water, milk, eggs, vegetables, and domestic animals. They may be transmitted to humans through inhalation of particles from the air. 1-4 Nontuberculous mycobacteria were first described as pathogens of the head and neck in 1956. 5,6 Mycobacterium malmoense (MM) is a rare infection 7 and was first described in 1977 by Schroder and Juhlin. 8 This atypical mycobacterium has been isolated in increasing numbers from clinical samples next to Mycobacterium tuberculosis and the Mycobacterium avium complex. 9 Cervical lymphadenitis and lymphadenopathy are common in children and may be caused by local or systemic infection (Table 1). The most common presentation of nontuberculous mycobacterial (NTM) infection in children is cervicofacial adenitis. 10 In 2006 Thavagnanam et al 11 conducted a review of pediatric data over the last 14 years from mycobacterial laboratories in Northern Ireland. They found an upward trend in the number of cases of cervical lymphadenitis attributable to NTM infections. MM is primarily a pulmonary pathogen. 12 The main extrapulmonary disease type of MM infection is pediatric cervical lymphadenitis. 13 Most of the literature supports the view that the treatment of choice for cervical lymphadenitis due to NTM infection is surgical excision. 14 However, the complications of surgery are also well documented, and some authors advocate medical therapy, with antimicrobials, as an alternative or as an adjunct. 1 We report 2 cases of 2.5-year-old immunocompetent female patients with unilateral cervical lymphadenitis due to infection with MM. The clinical features and management are described.