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ABSTRACT: With the increasing use of hyaluronic acid-based injectable fillers for cosmetic enhancement a variety of adverse reactions are being reported in the literature. Although most adverse outcomes occur early we describe an interesting case study of a female presenting with granulomatous complications ten years postoperatively. To our knowledge this is one of the longest reported delayed reactions. For the general dental practitioner offering such treatments it is important to be fully aware of the potential risks and how they may be managed in order to consent appropriately for cosmetic procedures.
British dental journal official journal of the British Dental Association: BDJ online 04/2013; 214(7):339-40. · 1.09 Impact Factor
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ABSTRACT: The surgical management of advanced cervical metastases with carotid artery involvement in patients with primary squamous cell carcinoma of the head and neck can be difficult. The authors retrospectively reviewed 73 patients over a 15-year period comparing the outcomes of carotid artery resection versus peeling the tumour off the carotid artery. Based on these findings, the authors suggest that in the absence of carotid wall involvement, nodal metastatic tumour should be peeled off the carotid artery where possible. This practice appears to have a lower morbidity than that associated with arterial reconstruction. Steps to minimize cerebrovascular injury are discussed.
International Journal of Oral and Maxillofacial Surgery 12/2012; · 1.51 Impact Factor
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ABSTRACT: Myxofibrosarcoma has been recently described as a distinct histological entity and commonly affects the extremities and trunk of the elderly. It is, however, rare in the head and neck (2.8%) region, and we are unaware of any reports of it presenting as a parotid mass. The epitheloid variant accounts for less than 3% of myxofibrosarcomas. We report a case of a 78/F presenting with an epitheloid myxofibrosarcoma in the parotid gland. The clinical presentation was of a parotid lump of 9-month duration, and the diagnosis was made following thorough histological assessment. We present what we believe to be the first reported case of a (epitheloid) myxofibrosarcoma affecting the parotid gland and highlight its diagnostic features and outcome of treatment.
Case reports in pathology. 01/2011; 2011:641621.
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ABSTRACT: This feasibility study evaluated whether contrast enhanced ultrasound (CEU) was able to assess free flap perfusion following free tissue transfer in the head and neck region. Thirty-six patients underwent standard clinical monitoring (SCM) and CEU postoperatively. The time taken for each technique to detect flap failure was recorded. Qualitative CEU analysis by visual assessment predicted survival in 30/30 (100%) and failure in 5/6 (83%) flaps with sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of 100, 86, 97 and 100%, respectively. Quantitative CEU measurement of blood volume (α) values within healthy perfused flaps was over 60 times higher than in failing flaps (8.25±2.82dB vs. 0.12±0.17dB, respectively, P<0.0001). If a cut-off α value of <1.5dB was used to predict future flap failure, the accuracy of the test was 100% (sensitivity, specificity, PPV, NPV). If a cut-off α value of >1.9dB indicated flap success, the PPV and NPV are 100%. Following surgery, SCM took 76 (±15) h to detect flap failure compared with 18 (±38) h with CEU (P<0.05). CEU is highly accurate in its ability to distinguish between perfused and failing flaps. The technique is quick (<10min) and capable of imaging all flap types.
International Journal of Oral and Maxillofacial Surgery 12/2010; 39(12):1211-7. · 1.51 Impact Factor
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ABSTRACT: Large maxillary defects ideally require reconstruction with a free flap. Varied classifications have been reported to describe maxillary/orbital defects. We describe our experience of free flaps in large maxillary defects using composite tissue of serratus anterior muscle and the angle of the scapula. Eleven patients (6 men and 5 women, age range 42-69 years) were studied retrospectively and the outcome was recorded. We conclude that the composite flap is versatile enough to reconstruct maxillary defects of various sizes.
British Journal of Oral and Maxillofacial Surgery 03/2010; 49(1):53-7. · 1.95 Impact Factor
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ABSTRACT: Lagophthalmos secondary to facial nerve damage can lead to corneal exposure and eventually blindness. Appropriate management depends on the severity and likely duration of recovery. Upper eyelid gold implants play an important role in the medium and long term management of this condition. The authors report their experience with 16 consecutive patients who underwent gold weight implantation of the upper eyelids for correction of paralytic lagophthalmos and describe their surgical technique. The mean age of the patients was 70 years with a male predominance (M:F=3.2:1). Radical parotidectomy (69%) was the most common reason for the intervention. The mean weight of the implant was 0.95 g. There were no intraoperative or immediate postoperative complications. One implant (6%) was extruded and one patient (6%) had residual lagophthalmos and required a heavier implant. 15 of the 16 patients were satisfied with the outcome and all had adequate lid closure at last follow up.
International Journal of Oral and Maxillofacial Surgery 05/2009; 38(6):632-6. · 1.51 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 02/2009; 47(3):241-2. · 1.95 Impact Factor
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ABSTRACT: The sensory recovery of noninnervated free flaps used in oral and oropharyngeal reconstruction is analysed retrospectively to evaluate the degree of sensory recovery in different free flaps; and to assess the influence of various clinical and surgical factors on the recovery. A total of 40 patients who underwent oral and oropharyngeal reconstruction with noninnervated radial forearm (24), jejunal (10) or gastro-omental (6) free flaps were studied for at least 12 months postoperatively. The modalities examined were light touch, sharp prick, hot and cold temperature and static two-point discrimination. All the modalities showed statistically significant recovery in all flaps (p<0.05). The degree of sensory recovery for each modality is highest in the radial forearm followed by gastro-omental and lastly jejunal flaps. The differences between radial forearm and gastro-omental/jejunal flaps are statistically significant (p<0.05) except for light touch. The differences between the later two groups of flaps did not show statistical significance (p>0.05). Sensory recovery for all modalities in all flaps was not dependent on sex, age, smoking, flap size, postoperative radiotherapy or follow-up period (p>0.05).
International Journal of Oral and Maxillofacial Surgery 06/2008; 37(9):819-23. · 1.51 Impact Factor
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Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 05/2008; 33(2):171-3. · 2.39 Impact Factor
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ABSTRACT: A malignant peripheral nerve sheath tumour, the sarcoma most common in patients with neurofibromatosis type 1, arising in the parapharyngeal space is rare. They usually arise from pre-existing neurofibromas, particularly the plexiform type. The most common presenting symptoms are an enlarging neck mass, pain, and a neurological deficit. They are aggressive tumours that carry a poor prognosis despite wide excision and adjuvant radiochemotherapy. Patients with neurofibromatosis type 1 should be investigated, including deep biopsy, if pain and enlargement of the neurofibromas or any neurological deficit develop.
British Journal of Oral and Maxillofacial Surgery 04/2008; 46(7):585-7. · 1.95 Impact Factor
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ABSTRACT: To review our experience of the treatment of primary tracheal tumours.
All medical notes of patients with primary tracheal tumours diagnosed between 1981 and 2002 were retrospectively analysed.
In this period, 80 patients were diagnosed with primary tracheal malignancy, 48 males and 32 females. The median age was 48 years. Sixty-nine patients had malignant tumours, most commonly adenoid cystic carcinoma (50.7 per cent) or squamous cell carcinoma (30.4 per cent). Fifty-five patients underwent surgery, 30 of whom also received radiotherapy. Twenty-five patients received only radiotherapy. The five-year survival rate for all malignant tumours was 30.5 per cent. The five-year survival rates for adenoid cystic carcinoma and squamous cell carcinoma were 40.2 and 24.6 per cent, respectively. Local recurrence and distant metastases developed in 21 patients (30.4 per cent).
Primary tracheal tumours are rare and mainly malignant. Surgery is the most effective treatment method. Technical advances allow for safe resection of the tumour with a safe, tension-free anastomosis.
The Journal of Laryngology & Otology 04/2008; 122(11):1235-40. · 0.60 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 04/2008; 46(2):165. · 1.95 Impact Factor
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ABSTRACT: Sarcoidosis and sarcoid-like reactions have been reported to be associated with malignancies, particularly testicular cancer and lymphoma. They occur either synchronously or metachronously, and may also occur after chemotherapy. We know of only two other case reports of granulomatous reactions in head and neck cancer. The present case highlights the association of sarcoidosis with head and neck cancer, and the importance of considering the diagnosis in patients who may have metastatic disease.
British Journal of Oral and Maxillofacial Surgery 02/2008; 46(1):59-60. · 1.95 Impact Factor
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ABSTRACT: Dyskeratosis congenita is characterised by abnormal pigmentation of skin, dystrophy of nails, and mucosal leukoplakia mainly on the tongue. Bone marrow failure, pulmonary complication, and premalignant leukoplakia of the tongue are serious complications of the disease.
British Journal of Oral and Maxillofacial Surgery 04/2007; 45(2):156-8. · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 09/2006; 44(4):325. · 1.95 Impact Factor
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ABSTRACT: Malignant fibrous histiocytoma is one of the commonest soft tissue sarcomas in adults, affecting, in order of frequency, the extremities, trunk and head and neck. We treated 131 patients with malignant fibrous histiocytoma by radical, wide, or marginal resection. Their mean age was 43 years, and there were 54 in the head and neck and 77 in the trunk and extremities. The extent of clearance of the tumour, local recurrence, and 5-year survival were studied in these two groups. In the head and neck group, local recurrences developed in 86% after marginal resection, 66% after wide resection and 27% after radical resection. The comparative figures in the trunk and extremities group were 75, 71 and 18%, respectively. The overall 5-year survival was 48% in the head and neck group and 77% in the trunk and extremities group (p=0.03). Repeat operations for recurrences of tumour offered a 'cure rate' of 23% in the head and neck group and 61% in the trunk and extremities group. Inadequate resection of the sarcoma in the head and neck was associated with a high incidence of local recurrence and a poor prognosis. Therefore, we suggest that the initial operation for sarcoma in the head and neck should be as radical as possible to reduce the chance of local recurrence and to improve the outcome.
British Journal of Oral and Maxillofacial Surgery 07/2006; 44(3):209-12. · 1.95 Impact Factor
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ABSTRACT: The shape of the eyebrow and upper eyelid are distinctive facial landmarks. In cosmetic and reconstructive operations, maintenance of the anatomical relations of these landmarks ensures a pleasing postoperative appearance. The measurements differ, however, among different ethnic groups. We studied the position of the eyebrow and eyelids in three different racial groups, white, Indian, and Chinese. The aim of the study was to quantify the position of the eyebrow and eyelids and to find out if there were significant differences among the races.
British Journal of Oral and Maxillofacial Surgery 05/2006; 44(2):89-93. · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 03/2004; 42(1):79-80. · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 07/2003; 41(3):203. · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 07/2003; 41(3):203-4. · 1.95 Impact Factor
