Heterotopic ossification in the submental triangle remote from the vascular pedicle after reconstruction with a fibular free flap: a previously unreported complication.

Fibular free flaps are routinely used to reconstruct segmental mandibular defects after resection. While ossification of the vascular pedicle is uncommon but well reported, to our knowledge, heterotopic ossification remote from the pedicle has not previously been described. We report a case in which this occurred. It serves as a reminder that bony, hard lumps in the neck can present years after reconstruction with a fibular flap.

Multiple simultaneous primary oral squamous cell carcinomas: a previously unreported presentation.

The simultaneous occurrence of a second oral squamous cell carcinoma, or in rare cases more, is well known, but to our knowledge, the presentation of 5 primary oral cancers at once has not previously been reported. We discuss this exceptional case and offer a possible explanation for its cause.

Innervation of the lower third of the sternocleidomastoid muscle by the ansa cervicalis through the C1 descendens hypoglossal branch: a previously unreported anatomical variant.

We describe a previously unreported anatomical variant (found during a routine neck dissection) in which the lower third of the sternocleidomastoid was innervated by the C1 branch of the ansa cervicalis (descendens hypoglossi).

High division of the spinal accessory nerve and communication with a C2 branch of the cervical plexus: a previously unreported anatomical variant.

Anatomical variations of the spinal accessory nerve are well known. We describe a previously unreported variant in which the nerve divided high in level II after crossing the internal jugular vein and before entering the sternomastoid muscle. Both branches were joined by a communication from the C2 cervical root. We discuss the clinical implications of this finding.

Communication of the transverse cervical nerve with the marginal mandibular nerve: a previously unreported anatomical variant.

Communications between the transverse cervical nerve (C2 and 3) and the cervical branch of the facial nerve have been reported. We describe a case in which the transverse cervical nerve joined the marginal mandibular branch of the facial nerve. It was found during a selective neck dissection and to our knowledge is the first report of such a communication. We discuss the clinical relevance particularly in relation to confusion with the marginal mandibular branch of the facial nerve when operating in the submandibular region.

A simple technique to control the hair and enhance draping for major head and neck surgery.

We describe a simple technique to control the hair before conventional draping for serious operations to the head and neck to minimise the need for hair washing after long procedures.

The contemporary management of chyle leak following cervical thoracic duct damage.

The considerable anatomical variation of the thin walled cervical thoracic duct predisposes it to inadvertent damage during neck dissection. If this is not recognised at the time of surgery, a chyle leak can result in potentially serious complications as well as delaying the patient's discharge from hospital. This article summarises the basic anatomy of the terminal thoracic duct in the neck and discusses the pathophysiology of a chyle leak. We present the latest ideas for managing this problem when it is identified at the time of surgery, and review the diagnosis and contemporary management options available for dealing with this difficult problem when it is found to occur post-operatively.

Review of salivary papers published in the British Journal of Oral & Maxillofacial Surgery during 2009-2010.

The management of salivary gland disease forms an appreciable part of the work undertaken by our specialty. Fast-track and one-stop clinics for head and neck lumps allow for early diagnosis of salivary gland tumours in most units, and for the sharing of cases between our ear, nose and throat (ENT) colleagues. The emphasis on benign salivary gland disease is very much on outcome after operation, and there have been improvements in surgical technique, particularly in relation to minimal dissection of salivary adenomas and sialendoscopy. This article continues a series of reviews, which aim to provide readers with a quick overview and update of recent publications in the British Journal of Oral and Maxillofacial Surgery (BJOMS) within a particular subspecialty.

A synopsis of technical notes published in the British Journal of Oral and Maxillofacial Surgery in 2009/2010.

Technical notes form an important part of the British Journal of Oral and Maxillofacial Surgery (BJOMS). Many ideas are novel and some change practice. During 2009-2010, 39 technical notes were published in the journal, and they covered the whole remit of the specialty. In this article we briefly review and summarise these articles, and highlight the salient points.

Use of N-butyl-2-cyanoacrylate tissue glue in thoracic duct injury during neck dissection surgery.

Although thoracic duct injury is an uncommon complication of neck dissection, it can have a significant physiological and immunological impact on the patient's recovery as well as having more serious effects. We report a novel technique of using cyanoacrylate tissue glue for managing thoracic duct damage when this is noted at the time of neck dissection surgery. We have used this technique in four patients with no post-operative chyle leak or added complications.

Eagle's syndrome after fracture of the elongated styloid process.

A case is reported of a patient presenting to clinic after a sudden spontaneous 'cracking' sensation in the jugulo-digastric region. This proved, following clinical and radiological investigation, to be a fractured elongated styloid process(ESP). This extraordinary presentation of Eagle's syndrome has not previously been published.

Anterior cranial fossa dermoid cyst: case report.

We report a case of an intracranial mass that presented with proptosis and diplopia, and proved to be a dermoid cyst. Resection was successful and there had been no recurrence after 5 years.