An Unusual Presentation of Stafne Bone Cyst.

Stafne bone cyst is a rare mandibular defect. It is a developmental abnormality that commonly presents as a small, well demarcated, and asymptomatic radiolucency seen at the angle of the mandible below the mandibular canal. There are usually no clinical signs nor symptoms. Diagnosis is commonly by plain X-ray, but use of more accurate imaging such as MRI is required in atypical cases. This case study reports an unusual presentation of Stafne bone cyst in the ramus of the mandible in a young man and reviews the relevant literature.

Virtual panendoscopy--a new tool to help evaluating oral cancer.

Virtual panendoscopy (VP) is a new, non-invasive diagnostic technique available to assess luminal structures. It involves the use of the data obtained from scanning of patients using multidetector CT scanners. The data is manipulated using a software programme to generate 3D models with fly through capability to examine various anatomical tubes. Its use has been studied in colonoscopy and bronchoscopy. However its use in head and neck cancer assessment has not been extensively studied. Therefore this diagnostic tool was used to stage 10 consecutive head and neck cancer patients. The ability of this tool in staging and identification of synchronous primary was assessed. The findings from the VP were also compared with the findings of nasendoscopy. In our pilot study, the virtual panendoscopy has been a useful tool in the assessment of the upper aero digestive tract. Although it has not picked up synchronous primaries, good quality assessment of lumen and the mucosal wall was done in areas not accessed by nasendoscope. It is most useful in areas not accessed by nasendoscope i.e. trachea, bronchus etc. The outcome, its usefulness and shortcomings are discussed.

How to do a safe tracheostomy.

A new technique of surgical tracheostomy is described. Prior to performing the tracheostomy, the endotracheal tube (ETT) is advanced further down the trachea so that the end of the tube is positioned just above the carina. Using the flexible endoscope within the ETT the positioning can be done with precision. This manoeuvre avoids the cuff of the ETT being perforated as it is well below the site of the tracheal window. Following the creation of an opening in the trachea, the patient continues to have a definitive airway. In this controlled environment, time is taken to obtain haemostasis at the tracheostomy site, place a rescue stitch and also suction above the cuff of the ETT. A study was carried out in a series of 15 patients by recording various measurements during the procedure to confirm the accuracy of this technique.

Rare presentation of Mycobacterium avium-intracellulare infection.

Mycobacterium avium-intracellulare causes clinical disease mainly in immunocompromised patients with long-standing pulmonary disease, the symptoms of which are identical to those of pulmonary tuberculosis. In patients with AIDS the infection is typically disseminated. Extrapulmonary infection by M. avium-intracellulare is seen in children aged 1-5 years as cervicofacial lymphadenitis. Other extrapulmonary sites are less common and include musculoskeletal, maxillary sinus, mastoid, breast, small bowel, genitourinary tract and cornea. Such infection of the hard palate is rare. We present an unusual case of infection of the palate by M. avium-intracellulare in a 53-year-old diabetic man. To our knowledge, this infection presenting as a palatal lump in a patient without HIV or pre-existing lung disease has not been previously reported.

Craniofacial surgery for orbital malformations.

Paediatric craniofacial surgery is a highly specialised field requiring a multidisciplinary team input. Orbital and ocular involvement is relatively common in craniofacial patients. This is more in syndromic patients. In nonsyndromic patients, orbital involvement is common in frontal plagiocephaly and trigonocephaly. The management of these conditions requires close working between the craniofacial surgeon and ophthalmologist. An outline of the management of these deformities is discussed.

Intraoperative ultrasound imaging to aid abscess drainage--a technical note.

Diagnostic ultrasound is used widely to identify the presence of fluid collections preoperatively. Although its role in other parts of the body is well established, this report describes the technique of using diagnostic ultrasound intraoperatively to aid drainage of a large fascial space abscess in the head and neck. Following previously inadequate drainage of a large superficial abscess from a blindly placed drain, a second procedure was carried out, using ultrasound imaging to locate the persisting abscess. Furthermore, ultrasound demonstrated the adequacy of drainage and helped the surgeon to position the drain in the correct tissue space. We consider that intraoperative use of ultrasound has a role as a guidance tool to drain superficial fascial space abscesses in the head and neck region.

Chronic eosinophilic pneumonia associated with T-cell lymphoma.

A case of a woman presenting with a parotid swelling is described. She had chronic eosinophilic pneumonia (CEP) for approximately 2 years prior to presentation. After further investigation she had biopsy of her parotid, which proved to be T-cell lymphoma. This is a rare association, the diagnosis and the management of this condition is discussed.