Spontaneous oral ulceration with bone sequestration: its relevance in current clinical practice.

Oral ulceration associated with bony exposure and sequestration is uncommon and often related to well-recognised conditions. In a small group of patients no obvious aetiological factors can be elucidated, and various terminologies have been utilised to describe these lesions. We report six cases of spontaneous oral ulceration with bone sequestration as a specific entity and review the pertinent literature. We retrospectively reviewed patients presenting in the period 2013-2018. Data collected included demographic details, relevant medical, drug, and radiotherapy history; presentation, investigations, management, and outcome. Six patients with an age range of 49-65 years were identified with spontaneous oral ulceration with bone sequestration in the study period. All were males, and none had any relevant history. Five lesions occurred over the mylohyoid ridge and one was related to a lingual mandibular torus. The most common presentation was a painful ulcer with exposed bone, which had been present for 6 - 12 weeks. Occlusal radiographs demonstrated focal rarefaction in two patients. All were managed conservatively and by removal of the loose sequestrum. Healing occurred successfully in all cases, and this was earlier when the loose sequestrum was removed. Spontaneous oral ulceration with bone sequestration is a distinct lesion that most often presents over the prominence of the mylohyoid ridge. It is currently an uncommon entity (0.02%), but this could well be due to a lack of recognition and under-reporting. It should be considered as a diagnosis only when other causes have been excluded. Lesions heal successfully with conservative management and surgical intervention, and this occurs earlier following removal of the loose sequestrum.

Parotid neoplasms in children: experience of diagnosis and management in a district general hospital.

Parotid neoplasms are uncommon in children and the available literature is predominantly from specialized centres. This paper highlights our experience at a district general hospital, in the diagnosis and management of parotid neoplasms in children. The case records of all parotidectomies performed in a 26-year period between 1974-1999 were scrutinized and patients aged 18 years and below identified. The demographic data, histology, presentation, investigations, treatment, outcomes and complications were analysed. 545 parotidectomies were performed in 536 patients, in whom 569 neoplasms were diagnosed. Only 12 patients aged 18 and under were identified (2.2%). The relative frequency of individual tumours differed markedly from that in adults. 75% of the tumours were benign. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common tumours. A painless mass was the most frequent clinical presentation and CT sialogram was the most common investigation. Parotidectomy with preservation of the facial nerve was performed in all cases, and adjuvant radiotherapy employed in the case of malignant tumours. All patients were alive and well at the time of last follow up. Transient facial nerve palsy and hypertrophic scars were the most common complications.