Squamous cell carcinoma arising in a dentigerous cyst is a rare lesion with distinct histopathology and stringent criteria for diagnosis.(1,2) During the past century, <60 cases have been reported.(3) Of the previously documented cases, all have occurred in adults. We present the case of a squamous cell carcinoma arising in a dentigerous cyst in a 16-month-old girl. This case poses interesting questions regarding the pathophysiology of these tumors and highlights the importance of maintaining a high index of suspicion regardless of age when evaluating cystic lesions of the mandible and maxilla.

Cervical thymic cysts are extremely unusual neoplasms that only rarely produce signs and symptoms of upper airway tract compromise. Less than 7% of patients initially have dyspnea or hoarseness. We report the first known case of progressive neonatal airway obstruction secondary to a rapidly enlarging cervical thymic cyst. Because one half of these benign tumors may demonstrate mediastinal extension, computed axial tomography or B-mode ultrasonography or both is recommended prior to surgical excision. Review of the literature confirms that the majority are successfully removed via a transcervical approach without recurrence.

Aggressive medical management and surgical debridement is curative in most cases of malignant external otitis. Recently, four patients with this condition were treated at the University of California, San Francisco, who did not respond to conventional therapy. In each case, appropriate intravenous antibiotics, diabetic management, and extensive excision of involved tissue failed to eradicate the infection. Progression of the disease was evidenced by any one of the following: 1. Persistence of granulation tissue in the external auditory canal, 2. Development of cranial neuropathies during treatment, 3. Other signs or symptoms of active infection for more than two weeks after institution of therapy. Any one of these criteria was considered an indication for more radical surgical intervention. In three patients, the operative procedure consisted of a subtotal temporal bone resection to gain access to the primary focus of infection and provide adequate drainage. The common finding in each case was an abscess cavity in the soft tissues at the base of the skull. A description of the clinical course and surgical management of malignant external otitis forms the basis of this communication.

The management of salivary gland neoplasms continues to be a challenging clinical problem. Despite recent advances in histopathological classification, agreement among head and neck surgeons concerning optimum treatment is lacking. In attempts to eradicate the more malignant varieties of these tumors, surgeons have performed radical and multilating surgery. Radiation therapy has not been considered efficacious in many centers. A review of 93 maligant salivary gland tumors from 1955 to 1973 at the University of California, San Francisco, suggests that these tumors may be more radiosensitive than once thought. Radiation therapy combined with conservative surgical procedures may be as successful and perhaps more rational treatment than radical surgery alone.