Numb chin syndrome: a metastatic deposit in the mandible

Metastatic deposits in the mandible are discussed and a case of leiomyosarcoma arising from a testicular primary is presented. The patient presented with symptoms typical of those that would present to a general dental practitioner. The various stages involved in the diagnosis and management of the condition are discussed.

CLINICAL RELEVANCE

Intra-oral malignant secondary tumours may present to dentists with signs and symptoms similar to those of benign, cystic or infectious processes. Metastatic tumours in the oral cavity are uncommon, most commonly arising in the mandible. Owing to their relative infrequency, these tumours present a challenge in diagnosis and treatment.

Complications encountered in a prospective series of 182 patients treated surgically for mouth cancer

Outcomes of surgical treatment for patients with mouth cancer can be limited by the risk of perioperative complications. This study identifies factors that predict for complications in such patients. Between 1992 and 2000, 182 patients had surgery for mouth cancer. The patient, their medical and surgical characteristics as well as perioperative complications were identified. Univariate analysis was carried out to determine which characteristics were associated with complications. Complications occurred in 85 patients (47%). Fifty-three percent of the complications were of intermediate severity and 15.6% were major. The operative death rate was 3.2%. Factors predicting complications included pre-existing cardiovascular (p<0.01) and respiratory disease (p=0.02), alcohol consumption (p<0.01), stage of disease, nature and scale of surgery, duration of surgery (p<0.01). Tracheostomies (p<0.01, OR 3.05), poor differentiation of tumour (p<0.05) and presence of extracapsular spread were predictive of complications. Patients with more complications are at increase risk of operative death or dying with head and neck cancer (p=0.04). Complications were also analysed into those that may be related to surgical technique and medical management. 113 (37%) complications were in this category. Factors influencing complications are multifactorial. Identification of risk factors allows individualised approach should improve outcome of treatment.

Endoscopically assisted operative retrieval of parotid stones

The treatment of large parotid stones remains a problem. We describe a technique in which microendoscopy is used to locate the stone and facilitate its removal. Over a 12-month period, eight patients were treated and seven stones removed successfully. The remaining duct was obstructed by a stricture. In six instances, the parotid duct was repaired and in two ligated. The mean follow up was 10 months (range 6-18) and there have been no complications. Our initial experience suggests that microendoscopy to locate the stone and facilitate its removal is an option in the management of persistent parotid stones.

Perioperative complications and survival in patients with oral cancer

This study identifies factors that predict for outcome and complications in patients with mouth cancer. Out of a total of 276 patients, one third received radiotherapy alone and the remainder surgery (182) of which 62 also received adjuvant radiotherapy. Factors predicting an adverse outcome at a univariate level were male gender, recurrent disease, no partner, co-existing systemic disease (abdomen and respiratory), alcohol intake, non Caucasian, stage of disease, scale of surgery, decreasing differentiation of tumour, increasing hospital stay and blood loss. On multivariate analysis, female gender, reduced scale of surgery, absence of recurrence, excess alcohol consumption, increased hospital stay and duration of surgery were predictive of improved survival. Complications occurred in 85 patients (47%). Predictive variables on univariate analysis were preexisting cardio-respiratory disease, alcohol consumption, stage of disease, nature and scale of surgery. The 5 year disease specific survival was 87% for stage I, 75% for stage II, 62% for stage III and 43% for stage IV with a 3.2% operative death rate.

Fixation of a frontozygomatic fracture with a shape-memory staple

A simple method using a staple was successfully used to treat a 74-year-old lady with a fractured frontozygomatic suture.