Arteriovenous Malformation of the Jaws: a Black Hole for the GDP ­ A Case Report.

We report a case of a mandibular arteriovenous malformation in a 3-year-old child, who attended our department, and have carried out a literature review. Clinical relevance: Arteriovenous malformation (AVM) is a rare condition but clinicians need to be aware of it as this lesion can have potentially life-threatening complications due to massive haemorrhage.

A facial swelling with multiple discharging sinuses: a diagnostic conundrum.

BACKGROUND: Many disease processes can present with facial swelling and multiple discharging sinuses. A differential diagnosis would include actinomycosis, tuberculosis and osteomyelitis, but tinea barbae is a relatively uncommon presentation. CASE REPORT: The following case report describes a 48-year-old jockey who was diagnosed with tinea barbae. It chronicles the investigations that were performed to determine the offending pathogen and the difficulty in achieving a diagnosis. DISCUSSION: The investigations and the pathophysiology of dermatophytic infections and their management in a maxillofacial/oral medicine environment are discussed.

Temporal arteritis presenting with tongue necrosis.

Spontaneous glossodynia is uncommon and glossodynia progressing to necrosis is especially rare. Although the commonest cause of lingual necrosis is giant cell arteritis, only a few cases of a new diagnosis of giant cell arteritis, clinically presenting with isolated lingual necrosis, have been reported.

Squamous cell carcinoma of the maxillary gingiva, alveolus, and hard palate: is there a need for elective neck dissection?

We retrospectively studied 17 patients with squamous cell carcinoma (SCC) of the maxillary gingiva, alveolus, and hard palate who were treated over a 7-year period (2000-2007) to investigate whether selective neck dissection is justified at an early stage. Four patients presented with metastases in the neck, and all developed early recurrence in the neck, with poor prognosis. Of the 13 patients who initially had no sign of metastases, two developed regional metastases within the first 18 months of initial treatment. Squamous cancers of the maxillary gingiva, alveolus, and hard palate should be treated aggressively, and elective neck dissection should be considered because of the high risk of occult metastases. Prospective studies are difficult because of the rarity of the tumour.

Cutaneous head and neck SCCs and risk of nodal metastasis - UK experience.

AIM: To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck. METHODS: A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis. RESULTS: One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively. CONCLUSIONS: The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

Lipomatous lesions of the parotid gland.

PURPOSE: Lipomatous lesions of the parotid gland are rare and seldom considered in the initial diagnosis of a parotid mass. We report our experience in the management of patients with lipomatous lesions affecting the parotid gland. PATIENTS AND METHODS: Retrospective analysis of all parotidectomies performed for neoplastic lesions in the maxillofacial unit between 1975 and 2003 and patients with lipomatous lesions involving the parotid gland were identified; 638 parotidectomies were performed in this period on 629 patients in which 660 neoplasms were identified. Eight patients were found to have lipomatous lesions and form the basis of this study. RESULTS: Lipomatous lesions accounted for only 1.3% of parotid tumors and occurred more frequently in males, at a ratio of 3 to 1. The most common presentation was that of a slowly enlarging, painless mass. Computed tomography scan was the most frequent imaging modality undertaken, and in 3 patients a diagnosis of a lipoma was made preoperatively. Seven patients underwent a superficial parotidectomy and 1 patient had a total conservative parotidectomy because of the deep lobe location of the mass. Five patients were found to have a focal lipoma and 3 patients had diffuse lipomatosis. There were no recurrences. Temporary facial nerve palsy and Frey's syndrome were the most frequent complications. CONCLUSION: Lipomatous lesions accounted for only 1.3% of all parotid tumors. There were no specific distinguishing clinical features in our patients, and an accurate preoperative diagnosis was made in 3 patients based on imaging investigations. A well-circumscribed lipoma was more common than diffuse lipomatosis. Superficial parotidectomy was the treatment of choice and there were no recurrences in our series.