Background The extent of neck dissection for tongue SCC is unclear owing to the potential presence of occult level IV metastasis. We aim to assess the incidence of occult level IV nodal metastasis for tongue SCC patients treated in our centre over a 20 year period. Methods A retrospective analysis of data collected from 1999 to 2019 was performed. Patients diagnosed with oral tongue SCC treated primarily with surgery and a neck dissection fulfilled the inclusion criteria. Results A total of 124 patients were included in our study. Sixty‐one patients were N0 with no occult level IV metastasis. About 17.3% of clinically node positive patients had level IV metastasis. Length of hospital stay and complication rates were comparable for patients who received levels I–III and I–IV neck dissections. Conclusion Occult level IV metastasis in N0 tongue SCC patients are exceedingly rare, we would therefore suggest consideration for a level I–III neck dissection. In patients who are clinically node positive, a level I–IV neck dissection would be recommended.

Acute appendicitis is one of the most common causes of acute abdominal pain globally. The pathophysiology of acute appendicitis is due to occlusion of the appendiceal lumen commonly from a faecolith. Obstruction of the appendiceal lumen by ingested foreign bodies is possible albeit rare. Here, we present an extremely rare case of acute appendicitis caused by impaction of the patients tooth within the lumen of the appendix. There have been only seven reported cases of impacted teeth causing appendicitis in the literature. There are no evidence-based guidelines for the management of appendicitis caused by tooth impaction. The authors suggest operative management with appendicectomy should be considered in the first instance.

Background The natural history of incidental common bile duct stones (CBDS) is poorly understood. Current evidence is conflicting, with several studies suggesting the majority may pass spontaneously. Despite this, guidelines recommend routine removal even if asymptomatic. This study aimed to systematically review the outcomes of expectant management for CBDS detected on operative cholangiography during cholecystectomy. Methods MEDLINE, Embase and CINAHL databases were systematically searched. Participants were adult patients with CBDS identified by intraoperative cholangiography. Intervention was regarded as any perioperative effort to remove common bile duct stones, including endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic and open bile duct exploration. This was compared to observation. Outcomes of interest included rates of spontaneous stone passage, success of duct clearance and complications. Risk of bias was assessed using the ROBINS‐I tool. Results Eight studies were included. All studies were non‐randomized, heterogeneous and at serious risk of bias. In patients observed after a positive IOC, 20.9% went on to have symptomatic retained stones. In patients directed to ERCP for positive IOC, persistent CBDS were found in 50.6%. Spontaneous passage was not associated with stone size. Meta‐analysis is dominated by the results from one large database, which recommends intervention for incidental stones, despite low rates of persistent stones seen at postoperative ERCP. Conclusions Further evidence is required before a definitive recommendation on observation can be made. There is some evidence that asymptomatic stones may be safely observed. In clinical scenarios where the risks of biliary intervention are considered high, a conservative strategy could be more widely considered.