Unusually sited lower third molar.

We present the case of a 60-year-old woman who presented to our unit with left-sided facial swelling, pain and trismus. Initially managed as a parotitis by a different specialty, an ultrasound subsequently showed a collection deep to the parotid associated with an ectopic wisdom tooth within the mandibular posterior ramus/condyle and the patient was referred to our department. After treating the acute infection, the wisdom tooth was surgically removed. Our case highlights the importance of the clinician maintaining an open mind to differential diagnoses and details a technique for surgical removal of a tooth with difficult access.

Metastatic squamous cell carcinoma in the neck presenting with Horner syndrome - a cause of the condition not previously described.

Horner syndrome, a combination of pupillary miosis, ptosis and facial anhidrosis, results from damage to the oculosympathetic nerve pathways. It can occur anywhere from the hypothalamus to the eye, but to our knowledge, metastatic disease to a node in the neck from a mucosal squamous cell carcinoma (SCC) of the head and neck has not previously been reported as a primary cause in humans. It is surprising that it does not present more often given the frequency of metastatic disease in the neck. We discuss how it may have occurred, and highlight the importance of a thorough examination and investigation of the head and neck in patients who present with unusual neurological signs.

The deep circumflex iliac artery perforator flap (DCIAP)--a reconstructive option for the large composite oro-mandibular cutaneous defect.

The deep circumflex iliac artery (DCIA) flap is often used for mandibular reconstruction but it is bulky and causes additional donor-site morbidity because of the inclusion of an "obligatory internal oblique muscle". Large composite segmental mandibular resections that consist of floor of mouth, subtotal tongue, and adjacent facial skin are a challenge in terms of reconstruction. They often require 2 free flaps or a free scapular flap and both have disadvantages. The deep circumflex iliac artery perforator (DCIAP) flap with a cutaneous component overcomes the disadvantages. We describe reconstructions with DCIAP flaps in 3 patients with large mandibular composite segmental defects. We report our experience of the flap and discuss some of the difficulties we encountered and the points we learned perioperatively.