Using decalcified collagen scaffolds to improve healing after transoral partial glossectomy for squamous cell carcinoma.

INTRODUCTION: Transoral partial glossectomy procedures for small squamous cell carcinomas of the anterior tongue often leave significant defects which are challenging to reconstruct. Post-operative scarring leads to adhesions, reduced tongue mobility and limitations of function. We present a series of cases where a decalcified collagen scaffold was successfully used in this challenging reconstructive setting. METHODS: After standard oncological diagnostic and workup, five patients underwent transoral partial glossectomy procedures. Decalcified collagen scaffolds were used to reconstruct the surgical defect using a standard protocol. Demographic and outcome data were collected retrospectively. RESULTS: The median length of post-operative stay was 5 days. There was no reported post-operative bleeds or infection. Histological margins were clear. Scaffolds remained in situ at 1 week, and functional recovery was apparent at 6 weeks post-procedure. DISCUSSION: These results suggest such scaffolds could be used as an adjunct to help reconstruct the anterior tongue after oncological resection. CONCLUSION: The study supports a call for further exploration and research into the use of these scaffolds as a potentially beneficial avenue for reconstructing the tongue.

A retrospective study of the influence of telemedicine in the management of pediatric facial lacerations.

A study was carried out to determine the influence of telemedicine on management of facial lacerations in children. Proforma was designed, and information was collected retrospectively over a 4-month period. Of the 2524 telemedicine referrals, 27% (693/2524) were pediatric referrals. One hundred forty-five of these were children with facial lacerations, of which only 98 were admitted for possible surgical management. During the same period, a further 45 children were admitted to the pediatric ward through verbal referral. The average age of the children admitted was 4.85 years and male-to-female ratio was 2:1. Lacerations to the lips (42%) were the most common site of injury, and the majority sustained the injury as a result of a mechanical fall (42%). Among the telemedicine group, 86% had surgery, whereas in the nontelemedicine group it was 82%. On average, 2 to 3 photographs accompanied the referrals, and none of the patients who were treated conservatively by the referring centers following telemedicine referral and discussion with Queen Victoria Hospital required a re-referral. The results from this study confirm that clinical findings together with images from telemedicine provide adequate information to make clinical decisions in children with facial lacerations.

Head and neck oncological ablation and reconstruction in the COVID-19 era - our experience to date.

The COVID-19 pandemic has caused unprecedented disruption to the routine operations of healthcare services across the world. As the potential duration of the pandemic remains uncertain, the need to develop strategies to continue urgent elective services has received increasing attention. A solution adopted in the Kent, Sussex and Surrey area of England has been to create COVID-19-protected cancer hubs. The Queen Victoria Hospital is the designated hub for head and neck cancer services in the area. We report on the evolution of the head and neck cancer care pathway and standard operating protocols put in place and how these have combined both national guidelines and local problem solving. It is hoped that our experience can help guide other centres as they re-establish head and neck cancer services during the ongoing pandemic.

Paraneoplastic cerebellar degeneration as a presentation of breast cancer - a case report and review of the literature.

Paraneoplastic cerebellar degeneration is part of a rare spectrum of neurological syndromes whereby gynaecological, lung or breast cancers present primarily with neurological manifestations. The presence of onconeural antibodies and PET scanning help in the challenging diagnosis of these conditions but despite the treatment of the primary cancer, the prognosis for the neurological symptoms is poor.

Non-complex reconstructive techniques in the management of BRONJ: a case series of patient-related outcomes.

OBJECTIVES: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognised condition that continues to be a therapeutic challenge. It can have devastating effects on patients' quality of life. The literature recommends a myriad of management strategies. This case series demonstrates a combination of resection procedures, local reconstruction options and their impact on quality of life. PATIENTS AND METHODS: This case series consisted of three patients with BRONJ following the use of bisphosphonates (BPs); for metastatic and metabolic bone diseases, none responded to conservative treatment. All patients were surgically managed by a standardised protocol combining bone resection and local reconstructive measures. RESULTS: We evaluated surgery-related change in quality of life using the "University of Washington Quality of Life Questionnaire". At 3 months, all patients were pain free but were only able to manage soft foods and one persisted in using a straw for fluids. In all cases, quality of life scores showed an overall improvement or remained unchanged. There was no evidence of BRONJ recurrence. CONCLUSION: Quality of life is an important consideration in the management of BRONJ patients. Optimal surgical resection and reconstruction may be an ideal treatment plan, but in medically compromised patients, this may not be possible. Consideration should be given to modified strategies with a potentially lower morbidity, yet still aiming to improve patients' quality of life.

The role of free flap reconstruction in paediatric caustic burns.

Ingestion of caustic soda can cause severe scarring of the oral cavity and the surrounding soft tissues. Free flap reconstruction for burns in the oral cavity has been described as a viable option in adults, but to the best of our knowledge has not been reported in children. We describe cases of successful microvascular reconstruction for burns caused by caustic soda in the oral cavity in children.

Orthognathic treatment of asymmetry: two cases of "waferless" stereotactic maxillary positioning.

We present 2 cases in which navigation-guided surgery was used to correct complex facial asymmetry. The merits and challenges of using stereotactic technology to allow "waferless" positioning of the maxilla in orthognathic surgery are illustrated by patients who were operated on without the use of acrylic wafers to achieve three-dimensional correction of the maxillary deformity. Biometric assessment was made clinically and recorded with computed tomographic (CT) scanning. The operation was planned using Voxim(®) software and the operation done with the aid of the Voxim(®) navigation system.

Calcitonin-induced osteoplastic reaction in the mandible.

We describe a case of florid osteoplastic response in the mandible to the use of calcitonin. Calcitonin has been used in the treatment of central giant cell granuloma for many years and is widely accepted. We know of no reported cases of calcitonin-related exuberant bony deposition in the jaws or the axial skeleton.