Managing the risk from children's travel cups.

INTRODUCTION: UK national newspapers have reported cases of children (and adults) who have got their tongue trapped in a Disney travel mug lid, causing extreme distress to the patients, their parents and ED staff. Potential risks include oral endotracheal intubation necessitating emergency tracheostomy to secure the airway, tongue necrosis and dental trauma. Although Disney has withdrawn their original mug from the global market, the same dangers can occur with other internationally available brands. Our aim was to design, test and present an alternative lid. METHODS AND MATERIALS: We designed an alternative lid to fit onto the original Disney mug; our addition of two parallel bars prevented tongue protrusion into the lid. Prototypes of the original and new lids were three-dimensional printed for testing. A tongue substitute was developed and a representative 0.2 bar suction force was generated. The bottle was mounted in a material test machine, attached to the load cell fixture. Four samples each for the existing and new design were tested. The data were analysed by a custom Matlab script to extract the maximum force required to remove the tongues from the cup. RESULTS: The new design resulted in a significant (p=0.0286, Mann-Whitney U) reduction in pullout force. For the existing design, the median pullout force was 4.64 N (minimum 3.86 N, maximum 4.91 N), while it was 2.37 N (minimum 2.20 N, maximum 2.53 N) for the new design. Trauma to the materials used with the original lid design was evident but not observed with our design. CONCLUSION: Our lid appears to offer a safer design that can avoid injuries. However, absolute safety remains unproved, as testing did not account for other body parts which may get trapped in the lid, nor did we test a range of tongue substitute sizes, and laboratory testing only was completed.

Oral focal mucinosis of the palate: a rare disease entity.

Oral focal mucinosis (OFM) is an extremely rare, benign oral soft tissue condition; less than 10 documented cases have been reported in the literature in patients under 18 years old. OFM has an unknown aetiology and predominantly presents in the fourth and fifth decades. The pathogenesis of OFM may be due to fibroblast overproduction of hyaluronic acid. Clinically, it remains almost impossible to diagnose definitively, due to its lack of pathognomonic features, therefore such lesions may have multiple differential diagnoses and histological analysis is essential to confirm OFM. We present an unusual presentation of OFM in a 14-year-old female patient. Following excision, focal myxoid degeneration of the connective tissue was apparent. This case highlights this rare condition for consideration in differential diagnosis of clinically similar lesions.

Lymphatic malformations of the head and neck-current concepts in management.

Lymphatic malformations of the head and neck, also known as lymphangiomas or cystic hygromas, are a diverse group of lesions. They can be small and superficial or large and extensive, and management can be a challenge. Surgically they can be difficult to remove completely because of their poorly defined borders and the potential for damaging neighbouring structures. We review the dilemmas posed in diagnosis and treatment, and discuss the contemporary management of these interesting entities including sclerotherapy, which is gaining popularity.