Excision of a submandibular gland: a safe day case procedure?

There are considerable benefits, both for patients and hospitals, if operations are done as day case procedures. Excision of a submandibular gland is a relatively common operation and it is usual practice for surgeons to be cautious, admit the patient for an overnight stay, and leave a drain in place. To assess the amount of postoperative bleeding into the wound (and hence potential risk to the airway) we have studied prospectively the amount of drainage that occurs. Sixty consecutive patients admitted for overnight postoperative monitoring after excision of a submandibular gland had a suction drain placed as part of the procedure. Drainage was measured by departmental staff at regular intervals during the following 24h. Nearly all the patients drained 40ml or less (mean 18ml) and in all cases there was a clear decrease in the volumes drained over the first 6-8h postoperatively. Drainage then became negligible. The plateau in drainage was evident regardless of the initial volume drained. Surgeons should be confident that drainage will cease after 6-8h in most patients, and residual drainage is negligible.

Encapsuloma: a case report.

We describe what we have termed an 'encapsuloma'. To our knowledge it is the largest reported encapsulation of a prosthetic temporomandibular joint that incorporated the facial nerve.

Hyperplasia of the mandibular coronoid process: an analysis of 31 cases and a review of the literature.

PURPOSE: This study was undertaken to investigate the demographic and clinical features of mandibular coronoid hyperplasia and to assess the response to current treatments. PATIENTS AND METHOD: Case notes were studied and records made of age, sex, duration of symptoms, operative procedures, and response to treatment in all patients presenting at the Queen Victoria Hospital, East Grinstead, over a 20-year period from 1970 to 1990 with a confirmed diagnosis of mandibular coronoid hyperplasia. RESULTS: Thirty-one cases were recorded, 23 bilateral and 8 unilateral. The average age on presentation was 27.8 years for bilateral and 23.6 years for unilateral cases, with symptoms predating presentation by an average of 9 years and 6.75 years, respectively. Surgery was disappointing in terms of improving mouth opening. CONCLUSION: The results of this large series are supported by meta-analysis of the previous literature. They suggest that surgical management may be improved by a greater understanding of the pathogenesis of this condition.

Oncocytoma of the submandibular gland.

This report describes a case of oncocytoma, a rare, benign tumour which is particularly uncommon in the submandibular gland. The neoplasm was a chance finding in a gland which presented with recurrent swelling, assumed to be due to chronic sialadenitis.

Lateral open bite resulting from acute temporomandibular joint effusion.

Two cases of acute open bite, one arising from trauma to the mandible without actual fracture, and one from an acute episode of rheumatoid arthritis, are presented. The resultant malocclusions were due to a sudden increase of volume in the temporomandibular joint space with subsequent displacement of the mandibular condyle, following acute effusion.

Reconstruction of the infraorbital margin with a composite microvascular free flap.

A technique for reconstruction of the infraorbital bony rim and overlying soft tissues following ablative surgery is described using an osseofasciocutaneous radial forearm free flap. The advantages of this type of reconstruction are outlined.

Dermatofibrosarcoma protuberans of the scalp.

Dermatofibrosarcoma protuberans is an uncommon tumour of the dermis and rarely occurs on the scalp; there are few known predisposing factors. A case is described of such a tumour that occurred at the site of radiotherapy for a basal cell carcinoma. Histological characteristics, behaviour and management of dermatofibrosarcoma protuberans are discussed.

Post-endodontic pericoronitis.

Pericoronitis is defined as inflammation of the soft tissue around the crown of any partially erupted tooth. A case of pericoronitis with an unusual aetiology is described.

Odontogenic myxoma: an orthodontic presentation.

A maxillary odontogenic myxoma in a 17-year-old male was diagnosed as a result of his presenting to an orthodontist. Histological diagnosis was obtained following enucleation, and a further wide local excision performed as definitive treatment. The origin of the tumour was most likely from the follicular remnants of a previously exposed canine tooth.

Gorlin's syndrome and von Recklinghausen's disease occurring in one family.

A family is presented in which both Gorlin's Syndrome (Basal Cell Naevus Syndrome) and von Recklinghausen's neurofibromatosis have been inherited. The features and treatment of these syndromes are discussed and the management of families with these diseases is considered.

Adriamycin effects on transplasma membrane redox functions in porcine neutrophils.

Transplasma membrane electron transport, as assayed by external ferricyanide reduction, has been related to control of growth and hormone response of cells. Elicitor-stimulated transmembrane NADPH oxidase is important for bacteriocidal superoxide production by neutrophils. Since adriamycin is myelosuppressive and can stimulate superoxide production, its effects on the two redox systems of porcine neutrophil plasma membranes were compared. Adriamycin inhibits transplasma membrane ferricyanide and stimulates superoxide production activated by phorbol myristate acetate (PMA). Ferricyanide reduction in PMA-treated cells becomes resistant to inhibition by adriamycin. These results provide evidence for an independent effect of adriamycin on transmembrane ferricyanide reduction and on superoxide generation.