Few studies examine techniques of surgical resection for scalp malignancies to ensure clear margins. We present a case series utilizing outer cortex removal in patients without evidence of bony or pericranial invasion. A retrospective casenote review is presented of three cases treated in a tertiary Head and Neck Cancer Centre. An outer table removal approach was utilized based on the absence of bony involvement either on pre-operative imaging or from intra-operative findings. All cases underwent an outer table drilldown procedure. Tumour histology included high grade carcinoma of unknown origin, malignant cylindroma and squamous cell carcinoma. Complete excisions with adequate deep margins were achieved in 100% cases. Overall disease-free survival was 66.6% and local control rate was 100%. This technique allows a high degree of local control, notably at the deep margin. There is little morbidity and it avoids the complications associated with full thickness calvarial resection.

For an avulsed tooth with closed apices, it is recommended that the tooth undergoes elective root canal treatment. We however present in this case report a 73-year-old Afro-Caribbean lady, with an asymptomatic, untreated, self-replanted lower left canine which suffered an avulsion 45 years ago. The patient reported no loss of function. This case illustrates the potentially positive outcome of a replanted, non-root-treated, avulsed closed-apex tooth while highlighting the significance of patient-related factors.

Patients presenting to the emergency department with facial lacerations are commonplace and often sutured by a junior trainee. Cicatricial ectropion can occur after trauma, surgery and actinic/other dermatological conditions. It can make the eye dry, irritated and vulnerable to infection and water excessively. A 71-year-old man presented to the emergency department after falling off his bike. He had lacerations on his right forehead and right lower eyelid, amongst other injuries. His lacerations were sutured in the emergency department but 2 months later, he presented with scar contracture and was diagnosed with cicatricial ectropion of lower eyelid. This case highlights the risk of ectropion after closure of lacerations which involve the eyelid. Ectropion and how to reduce the risk involved surgically are discussed in this case report. Both diagnosing and operating clinicians should be aware of these risks and inform the patient appropriately.

No abstract

Dear madam, A 69-year-old female presented with a 5-6 month history of on and off pain on the right side of her face and tongue. She reported a history of a fall on her face at work 4 years prior. Her medical history included chronic fatigue syndrome, arrhythmia and chronic kidney disease which she was taking propranolol, duloxetine and omeprazole for. She is a non-smoker.On examination, there was tenderness over the right masseter and clicking of the right TMJ joint. The patient had good mouth opening, dental occlusion and an orthopantomogram showed no abnormalities.The initial diagnosis was right temporomandibular myofascial pain and conservative management was implemented.In a review 9 months later, she reported no improvements and a bite raising appliance was planned. She later presented at the Emergency Department and was diagnosed with possible trigeminal neuralgia which she was prescribed carbamazepine for. This did not help with the pain. It was later elicited that her family history included death of her 70-year-old mother due to brain tumour, two cousins born with brain tumours which led to blindness and a granddaughter born with 'something similar'.Subsequent to a complain of difficulty with word selection and worsened short-term memory, a computerised tomography (CT) scan (Fig. 1) of the head was requested. An extra-axial well-defined duralbased 2.1x1.7cm lesion in the left frontal lobe region in keeping with a meningioma was reported. Pain due to a tumour in the frontal lobe may be explained by the trigeminovascular system of the brain 1 . The patient is currently under the neurosurgical team for management.The management of temporomandibular joint (TMJ) disease is at present not fully understood and there are many associated controversies 2 . This is complicated by other possibilities of pain in that region such as trigeminal neuralgia, giant cell arteritis and meningiomas.