Early Orthopedic Retraction of the Premaxilla in Bilateral Complete Cleft Lip and Palate: An Innovative Approach to a Difficult Problem.

Bilateral cleft lip and palate occurs in 9.2% of cleft patients. Many approaches have been adopted to manage the protrusive premaxillary segment in patients with bilateral cleft lip and palate. Some advocate the use of intraoral appliances, occasionally combined with invasive surgery, which often requires revision at a later date. The authors describe the case of a 3-year-old child born with bilateral cleft lip and palate presenting with a protuberant premaxilla and an overjet greater than 25 mm. Prompt intervention was warranted in this case due to the potential for traumatic compromise to the dentition of the premaxillary segment and a distinct lack of social integration reported by the parents. The patient was managed with a novel, innovative approach using orthodontic traction and minimally invasive surgery. The literature has been reviewed and the patient's subsequent physiological and psychosocial development has been monitored. He has since undergone successful alveolar bone grafting.

Adenoid Cystic Carcinoma of the lacrimal gland metastasising to the liver: report of a case.

BACKGROUND: Adenoid Cystic Carcinoma of the lacrimal gland is a rare tumour. Their aggressive behaviour, with a high-risk of local recurrence, and late distant spread of the tumour even after aggressive management has been reported. Metastasis to the liver is rare and when it occurs, it is usually part of widespread metastasis, and therefore surgical treatment is seldom considered. CASE PRESENTATION: We report a rare case of an isolated liver metastasis from a lacrimal gland adenoid cystic carcinoma 20 years after resection of the primary tumour. The patient presented with right upper quadrant pain radiating to the back and shortness of breath of 3 months duration. No local recurrence was detected during a 15 year follow-up with computerized tomography (CT) of the head. Abdominal CT scan demonstrated a solitary liver tumour with no other primary source, and the bone scan was normal. The patient was treated with an extended right hemihepatectomy. The histology revealed a predominantly cribriform tumour with focal areas of basaloid type metastatic lacrimal gland adenoid cystic carcinoma. CONCLUSION: This case illustrates the unpredictable behaviour of adenoid cystic carcinoma and the need for a life long follow up for these patients after treatment. The possibility of surgical resection for liver metastasis from adenoid cystic carcinoma should always be considered.

Communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve: A prospective study of 25 neck dissections.

The great auricular nerve originates from the cervical plexus (C2, 3) and supplies sensation to the lower part of the pinna and the skin overlying the angle of the mandible. We have previously reported an unusual anatomical variant where the anterior division of the great auricular nerve passed into the submandibular triangle and was joined on its deep surface by the marginal mandibular division of the facial nerve. We now report a prospective study of 25 neck dissections in which a meticulous search for this variant resulted in the same communication between the great auricular nerve and the marginal mandibular division of the facial nerve being found in one further patient (an incidence of 2/25 patients in our series). Although communications between the transverse cervical nerve and the cervical branch of the facial nerve are well known, we have found that the marginal mandibular nerve can also be joined by the cervical plexus. This may have clinical implications during operations on the neck, particularly as stimulation of a communicating nerve of the cervical plexus might result in depression of the lip, and could potentially cause the operating surgeon to think that it was a branch of the facial nerve. We think that this finding merits a cadaveric study to evaluate the relation more fully.