Multiple synchronous and metachronous neoplasms of the parotid gland: The Chichester experience

Parotid neoplasms are usually solitary and multiple tumours occurring in an individual are uncommon. The incidence and implications of multiple synchronous and metachronous tumours remains relatively unknown. We reviewed the case notes of 606 patients who had parotidectomies for neoplastic lesions over a 30 year period and identified 30 patients (5%) with multiple primary tumours. There were 24 patients with synchronous tumours and 6 with metachronous tumours. Sixteen of the synchronous tumours (67%) were ipsilateral, whereas all six metachronous tumours were contralateral. Preoperative examination was effective at detecting bilateral tumours but poor at detecting multiple ipsilateral tumours. Multiple tumours were likely to be of the same histology (n=24, 80%) and Warthin's was by far the most common multiple tumour. Ipsilateral tumours of differing histological types and identical tumours other than Wartin's were uncommon. All but one patient had superficial parotidectomies and there were no recurrences.

Changing frequency of parotid gland neoplasms--analysis of 560 tumours treated in a district general hospital

An analysis of all parotidectomies performed for neoplastic lesions in the maxillofacial unit at a district general hospital during a 26-year period between 1974-1999 was undertaken. The details analysed were age, sex, histology and temporal variations in the frequency of specific tumour types during the study period. A total of 538 parotidectomies performed on 529 patients in whom 560 tumours were present, formed the basis of this study. Marked variations were present in the age and sex distribution and relative frequency of specific tumour types in this study, when compared to previous reports. There were also differences in the age and sex distribution of pleomorphic adenoma and adenolymphoma (P <0.0001) in this study. The relative frequency of benign tumours and adenolymphoma increased, whereas that of pleomorphic adenoma decreased during the study period. In addition, there was a statistically significant decrease in the relative frequency of pleomorphic adenoma (P <0.0001) and an increase in adenolymphoma (P <0.0001) when comparisons were made with previous studies. This study from a defined population may be more representative of the true proportion of specific tumours in this population. The potential implications of the results on the investigation and treatment of parotid neoplasms is highlighted.

Nitric oxide synthase expression is downregulated in basal cell carcinoma of the head and neck

The small molecule nitric oxide (NO) has many actions, most of which are poorly understood. Recently, NO and related compounds have been implicated in skin damage caused by ultraviolet light although their exact role is not clear. We undertook an immuno histochemical study to assess the expression of type II NO synthase (NOS2) and type III (NOS3) in basal cell carcinomas (BCCs) of the head and neck. In all 48 cases studied, NOS2 was found in the basal cell layer of the skin at the tumour margin but it w as significantly reduced in the tumour epithelial cells (P=0.001). NOS3 was localized to the endothelium of the blood vessels in both skin and tumour in all cases, and it was not seen in the tumour epithelial cells. The results suggest that expression of NOS is down-regulated in basal cell carcinomas.

Outbreak of cutaneous larva migrans in a group of travellers

We describe an outbreak of cutaneous larva migrans (CLM) in a group of 140 holidaymakers to a resort in Barbados and the index case. methods A two-page questionnaire was mailed to holidaymakers and 90% responded. results 25.4% of respondents developed a rash consistent with CLM. Risk factors for developing the illness were younger age and less frequent use of protective footwear while walking to the beach. Patients had difficulty in obtaining a correct diagnosis during their initial medical consultation and in obtaining medication from pharmacies. Efficacious treatments were oral and topical thiabendazole. conclusions CLM can occur in a large proportion of people exposed to contaminated soil or sand. Protective footwear is effective in reducing infection. Thiabendazole is an efficacious treatment.

Persistent drooling: treatment by bilateral submandibular duct transposition and simultaneous sublingual gland excision

Persistent drooling in a neurologically impaired patient is often multifactorial and various treatment modalities have been employed to overcome this distressing condition. This study analysed the outcome after bilateral submandibular duct transposition and simultaneous sublingual gland excision in 20 patients with persistent drooling treated between January 1989 and July 1994. Twelve were male and eight were female and were aged 5 years to 40 years. The outcome was considered much better/excellent in 11 cases (55%), better/good in eight cases (40%), no significant improvement in one case (5%) and none were considered worse after the procedure, in the 'early' postoperative period. Long-term results, judged by an 18-point questionnaire sent to the carers after an average duration of 3.2 years post-operatively, were available for 19 patients. In all, 16 carers (84%) felt the drooling had significantly reduced, and three carers (16%) felt that there was no improvement. The three patients who were considered not to have improved were all found to have made a 'good' improvement in the early post-operative period. The morbidity associated with the procedure was of a mild and transient nature and there was a complete absence of ranula formation in our series. The procedure was well accepted by the carers, who were also willing to recommend the procedure to others with a similar problem.

Orthognathic surgery for the treatment of chronic self-mutilation of the lips

Self-mutilation by lip chewing is an uncommon problem, but may result in severe mutilation, infection and loss of tissue, with associated scarring. Many modalities of treatment have been proposed in the literature with variable success and morbidity to the patient. Alternative techniques involving orthognathic surgery to create an anterior open bite are described which may result in cessation of self-mutilation. A case is presented with a 13-year follow-up, the anterior open bite is still present, and no recurrence of self-mutilation.

Temporomandibular joint eminence augmentation by down-fracture and inter-positional cartilage graft. A new surgical technique

A new surgical technique for the treatment of recurrent temporomandibular joint subluxation or dislocation is described. Following a horizontal osteotomy and down-fracture of the articular eminence an inter-positional bovine cartilage xenograft is inserted in order to augment the vertical height of the eminence. The procedure combines simplicity with minimal post-operative morbidity. The increase in eminence height is both predictable and stable.

Acute suppurative parotitis: a forgotten cause of upper airway obstruction

A patient had threatened upper airway obstruction as a result of bilateral acute suppurative parotitis. Because of the rarity of this condition in recent times, accurate diagnosis was delayed and fiber-optic intubation in the intensive care unit was required to safeguard the airway. Management is described with reference to the surgical anatomy and previously reported cases.

Dental anomalies in fucosidosis

Dental anomalies have not previously been recorded in patients with fucosidosis. A new case of this rare disorder is reported, in which a number of variations in both number and morphology of the primary and secondary dentition occur.

Hypercalcaemia and the synthesis of interleukin-1 by an ameloblastoma

A case of hypercalcaemia secondary to a long-standing solitary ameloblastoma is presented with evidence to suggest that the raised plasma calcium was the result of the secretion of interleukin-1 and a parathyroid hormone-like substances by the tumour. The aetiology of humoral hypercalcaemia of malignancy is discussed in relation to the role played by these substances.

Idiopathic thrombocytopenic purpura presenting with infraorbital nerve paraesthesia

A case of severe chronic idiopathic thrombocytopenic purpura is reported which presented with infra-orbital paraesthesia and haemorrhagic bullae of the oral mucosa.

Prophylaxis for the international traveller

Travellers should know as much as possible about the quality of food and drink in the areas of travel, and be prepared with safety measures if necessary. Routine immunization should be up to date; cholera and yellow fever vaccinations are required for travel to certain areas. Such prophylaxis should be sought, ideally, several months before departure. Resurgences of malaria are occurring in areas where the disease had previously been controlled, making prophylaxis essential for travel to endemic areas. Other mild disorders may be treated with medication appropriate to the type of travel and area. Patients may appreciate cautionary advice about behavior, to lessen the likelihood of physical or social harm.