Cystic Squamous Cell Carcinomas of the Jaws: Twelve Cases Highlighting Histopathological Pitfalls.

Cystic squamous cell carcinomas (SCCs) of the jaws, including carcinoma cuniculatum, are rare, slow growing, and relentlessly invasive. The aim of this article is to present 12 cases, 4 of which were designated as carcinoma cuniculatum on the basis of deeply endophytic, anastomosing channels of cystic stratified squamous epithelium and keratin microabscesses. The other 8 were also cystic, but more heterogeneous morphologically and were diagnosed as well differentiated SCCs. Six patients were female, 6 were male (mean age = 74.0 years, range = 50-94 years). Six tumors affected the mandible, 6 the maxillary alveolus with or without extension into the hard palate. All patients underwent primary resection with neck dissection and were staged as T4a N0 M0. In 4 patients, diagnosis was delayed as a result of superficial biopsies and/or confusing histopathology. Cystic SCCs of the jaws can be difficult to diagnose and clinicoradiological correlation is essential. Long-term follow-up is mandatory.

Diagnosis and Treatment of Primary Headache Disorders in Older Adults.

OBJECTIVES: To provide a unique perspective on geriatric headache and a number of novel treatment options that are not well known outside of the headache literature. DESIGN: Review of the most current and relevant headache literature for practitioners specializing in geriatric care. RESULTS: Evaluation and management of headache disorders in older adults requires an understanding of the underlying pathophysiology and how it relates to age-related physiological changes. To treat headache disorders in general, the appropriate diagnosis must first be established, and treatment of headaches in elderly adults poses unique challenges, including potential polypharmacy, medical comorbidities, and physiological changes associated with aging. CONCLUSION: The purpose of this review is to provide a guide to and perspective on the challenges inherent in treating headaches in older adults. J Am Geriatr Soc 66:2408-2416, 2018.

Aberrant common carotid artery -- a surprise for the unwary.

An aberrant common carotid artery is a rare anatomical anomaly. We report a case of an aberrant carotid artery running across the trachea in a patient undergoing total thyroidectomy. This rare anomaly may make a tracheostomy, a particularly hazardous procedure.

Survey of maxillofacial 'out of hours' operating in the United Kingdom.

This survey looks at 'out of hours' maxillofacial operating in the United Kingdom during September 2006 and was sent out to all the maxillofacial consultants in the United Kingdom. Most respondents consider out of hours as '2200-0759'; however many hospitals now routinely work extended lists up to 2200 h. Since nearly 65% of respondents had no dedicated trauma list, the provision of theatre flexibility with prioritized trauma slots which would be used for other purposes depending upon the immediate departmental needs appears to be a viable compromise for the foreseeable future.

The effect of the new "24 hour alcohol licensing law" on the incidence of facial trauma in London.

On 24 November 2005 the new 2003 Licensing Act was implemented. It permits licensed premises to close at different times under English and Welsh law, rather than at 2300h as under the previous law. The aim of this study was to assess whether head and neck trauma secondary to alcohol-associated assaults had increased, decreased, or stayed the same since the introduction of the act. Data were collected from the Accident and Emergency Department, University College Hospital, attendance databases for two six-month periods: 24 November 2004 to 30 April 2005, and 24 November 2005 to 30 April 2006. There were 1102 attendances for head and neck trauma secondary to alcohol-associated assaults during the six months before the introduction of the 2003 Licensing Act and 730 such attendances during the similar period after the introduction of the law, with fewer cases in each corresponding month during the later period. There were more cases at weekends than on weekdays during both periods. There were fewer cases but more at weekends in 2005-6 than in 2004-5 (423, 58% compared with 584, 53%, respectively). Neither rainfall nor temperature had any influence on the results. The 2003 licensing Act seems to have reduced the number of attendances at the A&E department for head and neck trauma secondary to alcohol associated assaults.

Understanding the causes and prevention of menstrual migraine: the role of estrogen.

Menstruation increases the risk of migraine in susceptible women. In a subpopulation of women with menstrual migraine, headaches occurring in association with onset of menses may be more severe and of longer duration than headaches experienced by the same woman at other times of her menstrual cycle. Although menstrual migraines share many clinical characteristics of other types of migraines, their occurrence is predictable provided that the patient has regular menstrual cycles. Therefore, short-term prevention regimens can be considered for women whose headaches are not adequately managed with acute therapies.

Metastasising clear cell odontogenic carcinoma: a case report and review of the literature.

Primary odontogenic carcinomas are rare and examples which have metastasised are even more uncommon. We describe the first reported case of a clear cell odontogenic carcinoma which metastasised to distant bones, namely the 5th lumbar vertebra and hip, 3 years after initial diagnosis. The initial incisional biopsy was thought to represent a calcifying epithelial odontogenic tumour, but in the subsequent resection the tumour showed a prominent clear cell component admixed with squamous cells showing peripheral palisading, widespread infiltration and necrosis indicating a malignant neoplasm. Radiologically guided biopsy revealed a metastatic lesion in L5 vertebrae and left hip, confirmed by immunohistochemistry. The metastatic lesion had similar appearances to the first biopsy, and diagnosis was confirmed by comparison of histological features, immunohistochemistry and exclusion of a second primary lesion by clinical examination and imaging. The diagnosis of clear cell odontogenic carcinoma is a difficult one to make. The behaviour of these tumours is unpredictable. This case confirms that clear cell odontogenic carcinomas have the potential for distant metastasis and require long-term follow up.