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Chronic non-specific sialadenitis of the parotid gland is an insidious inflammatory disorder which is characterised by intermittent, often painful, swelling of the gland. The disease tends to progress and may lead to the formation of a fibrous mass. The purpose of this paper is to review our experience in the surgical management of patients with chronic non-specific parotid sialadenitis. In a consecutive series of 100 patients treated for benign parotid disease, 19 were found to have chronic non-specific sialadenitis; 10 were male and 9 female. Mean age was 46 years and the mean duration of symptoms was 4.6 years. Sialography was performed in two-thirds of the patients and 17 patients were treated by superficial parotidectomy. Thirteen patients developed temporary facial nerve weakness and three Frey's syndrome. Three patients complained of temporary paraesthesia of the cheek, and two developed painful neuroma of the greater auricular nerve. Although there were two cases of infection of the parotid duct remnant, no recurrence of deep lobe sialadenitis or fistula formation was noted. Histologically, 3 lesions showed mild chronic sialadenitis, the rest had widespread involvement of the gland, and prolonged duration of symptoms was associated with extensive and severe involvement of the gland. Superficial parotidectomy has a very high success rate, with minimal long-term complications, and should be offered early in established cases, to reduce unnecessary morbidity.

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Over an 18-year period, 147 patients with malignant tumours involving the maxillary complex were treated in a combined head and neck clinic, of whom 50 underwent surgery. There were 33 males and 17 females, the mean age was 57 years (range 11-87 years). The most common clinical presentations were either painful facial swelling, infraorbital anaesthesia, palatal ulceration or nasal obstruction. Preoperative investigations included EUA, biopsy and either CT or MRI scans. Of the 50 tumours, 62% were squamous cell carcinomas. Surgery consisted of either partial or total maxillectomy including craniofacial resection in nine patients. Reconstruction was by either split skin grafting or by free tissue transfer when the cranial contents had been exposed. Adjuvant radiotherapy was given in 82% of the patients. The mean follow-up was 5 years and 59% of patients are alive and disease free. The 5-year local control rate was 67%; it was greatly influenced by histological evidence of nerve invasion, local recurrence being the major cause of death. It was concluded that adequate surgical clearance, followed by planned postoperative radiotherapy, is the most effective treatment for malignant disease of the maxillary complex.

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We present an 8-year experience with the Würzburg noncompression titanium miniplate system for the rigid fixation of the mandible during elective head and neck cancer surgery in a consecutive series of 100 patients. One half of the miniplates were used to fix mandibulotomies undertaken for surgical access. The remaining half were in patients undergoing reconstruction of segmental mandibular defects, the vast majority (92%) with vascularised bone grafts. One to four variously shaped miniplates were used per patient (mean = 1.5), plate size ranging from 4 to 40 holes. Fifteen patients (15%) developed complications which included 3 mandibular osteoradionecrosis, 8 broken, 5 infected, and 4 exposed plates. Three of the eight fractured plates were associated with nonunion. In this study, the main advantages of titanium miniplate fixation, namely case of application, decreased fixation time and malleability, were accompanied by a level of morbidity which, while comparing well with alternatives, may necessitate a reappraisal of this technique of fixation.

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Malignant parotid tumours are uncommon and present a significant management challenge. Fifty-one such patients (25 male, 26 female, median age 64 years) operated on in the Newcastle Plastic Surgery Unit between 1983 and 1994 were retrospectively evaluated. Preoperative investigations included FNA cytology (n = 20), and for staging CT and/or MRI scans (n = 21). Of the 35 primary tumours 32 were epithelial and three lymphomatous. Metastatic tumours were squamous cell carcinoma (7), melanoma (6), renal cell carcinoma (2) and sebaceous carcinoma (1). FNA cytology correctly diagnosed malignancy with an 88% sensitivity (false negatives = 2). A total or radical parotidectomy was required in 60% of patients, the rest undergoing superficial parotidectomy. In continuity neck dissection was undertaken in 23 (45%) cases. Postparotidectomy reconstruction included 10 free, 3 myocutaneous, and 4 local transposition/rotation flaps. Thirty-seven patients (73%) received postoperative radiotherapy. Seventy-two per cent of patients are alive after a mean follow-up of 42 months. The crude 5- and 10-year survival rates were 68% and 49% respectively while the loco-regional control rate (Kaplan-Meier method) at 10 years was 79%. Fifteen patients (30%) have permanent facial palsy. It is concluded that radical surgery with appropriate reconstruction followed by planned postoperative adjuvant radiotherapy gives effective control of malignant parotid tumours.

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Retraction of the upper eyelid associated with shortening of the levator mechanism occurs most commonly in association with Graves' disease but occasionally arises as a complication of blepharoplasty or other surgical procedures. A new technique of a castellated type aponeurotomy of the levator aponeurosis is carried out to lengthen the levator. This procedure appears to give a predictable, stable and symmetrical result.

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OBJECTIVE: To assess retrospectively the outcome and morbidity of Iridium-192 brachytherapy in the treatment of oral cancers. DESIGN: Retrospective audit of cases treated between 1981 and 1991. SETTING: Newcastle upon Tyne, England. SUBJECTS: 73 patients with oral cancer treated with Iridium-192. MAIN OUTCOME MEASURES: Local control, crude and cause specific survival, and local morbidity. RESULTS: Seventy four cases of squamous cell carcinoma of the oral cavity were treated using interstitial Iridium-192. The disease specific 5-year survival rates were 69% for T1, 67% for T2, and 0% for T3 tumours. Mortality from recurrent cancer was 20%, and from intercurrent disease was 28%. The incidence of major radiation induced morbidity was 11%, and the local control rate was 81% for T1, 69% for T2, and 50% for T3 tumours. CONCLUSION: Interstitial radiotherapy remains a viable and valuable mode of treatment for a small proportion of patients presenting with early (T1 and T2) oral cancers.

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Dermal eccrine cylindroma, or turban tumour, is a rare benign tumour of the eccrine sweat glands. Despite its histologically benign behaviour, the disease process is distressing for the patients. We present our experience of this condition, with a review of the literature, and recommend a treatment protocol for the disease.

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The safety of tissue expansion of the latissimus dorsi musculocutaneous flap is confirmed and the advantage of expansion of this flap before transfer illustrated.

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A review of out-patient treatment of tattoos with trichloracetic acid has been undertaken. Six hundred and seventy patients have been treated during the 6-year period between 1979 and 1984. The simple and inexpensive technique is described and the results presented.

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A nasolabial island flap on the facial artery and anterior facial vein is described. This is a useful modification of the classic nasolabial flap for repair of defects in the floor of the mouth. The flap can be led directly into the floor of the mouth, and the pedicle can be passed deep or superficial to the mandible as required. This obviates the use of bulky carrier skin passing over the alveolus and allows all the nasolabial skin to be available for reconstruction of the defect.

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A pudendal fasciocutaneous flap is described. Its use to correct both the skin shortage in the penoscrotal area occasionally found with hypospadias and secondary contracture following hypospadias repair is discussed.

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A case is presented of the development of acne vulgaris in the skin island of a latissimus dorsi musculocutaneous flap used for breast reconstruction. The patient had acne scarring of the back but had had no active acne for twenty-five years. The latissimus dorsi musculocutaneous island flap is commonly used in breast reconstruction. The development of acne in association with skin flaps has not been described before and we speculate as to its cause.

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In a series of 20 consecutive cases of mandibular reconstruction by simple bone grafting, 14 cases had a satisfactory outcome. The technique is relatively quick and simple. If the more complicated, lengthier procedures of vascularised bone grafting are used, it should be demonstrated with tetracycline labelling or early technetium 99M phosphate scanning that these grafts are contributing to immediate and active healing and are not just "taking" as simple bone grafts.

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