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This review aimed to examine the relationship between TP53 mutational status, as determined by genomic sequencing, and survival in squamous cell carcinoma of the head and neck. The databases Medline, Embase, Web of Science (core collection), Scopus and Cochrane Library were searched from inception to April 2021 for studies assessing P53 status and survival. Qualitative analysis was carried out using the REMARK criteria. A meta-analyses was performed and statistical analysis was carried out to test the stability and reliability of results. Twenty-five studies met the inclusion criteria, of which fifteen provided enough data for quantitative evaluation. TP53 mutation was associated with worse overall survival (HR 1.75 [95%CI 1.45–2.10], p

Highlights • Incidence of permanent IAN damage ranges from 0.35% to 8.4%. • Timely, accurate pre-operative visualisation of nerve is paramount in a safe clinical practice and reduces the risk of unnecessary litigations. • CT imaging has better sensitivity and specificity in demonstrating nerve and tooth relationships compared to plain film radiographs., Introduction The risks of third molar surgery have been well documented with damage to the inferior alveolar nerve (IAN) being one of the largest concerns. Presentation of case This case report presents an impacted third molar with associated dentigerous cyst in which the IAN is externalised and runs along the lateral surface of the mandible. Discussion This is an extremely rare anatomical variation with most IANs lying inferior and lingually to third molars. This case reiterates the limitations of standard radiographic techniques such as the orthopantomogram (OPG). Conslusion We would advocate the use of cone beam computed tomography (CBCT) in cases which have adverse plain radiographic features to allow appropriate surgical planning.

Highlights • Scalp lacerations are common injuries that can be missed in polytrauma. • A thorough secondary survey is of immense importance to avoid missed injuries. • Areas missed in the secondary survey due to contraindications should be revisited. • Examination of wounds requires cleaning and possibly the use of local anaesthetic. • Missed lesions can have significant sequelae causing increased morbidity., Introduction We present the case of an overlooked scalp laceration in an 81-year-old lady who presented with polytrauma following a fall down stairs. Complications that developed required more extensive treatment compared to what would have sufficed with early identification. Presentation of case Imaging on admission to hospital showed multiple vertebrae and rib fractures as well as a large cranial subcutaneous haematoma with no intracerebral bleed. Before the laceration was identified, the patient developed acute anaemia requiring transfusion. Continued reduction in haemoglobin levels called for a more thorough examination of the scalp. Investigation, following copious irrigation, revealed a large laceration. The presence of infection and necrotic tissue necessitated a general anaesthetic for debridement and closure. Disscussion Diagnostic errors are more common in patients presenting with multiple or severe injuries. Initial management in trauma cases should focus on more evident or life threatening injuries However, it is important that reflections and recommendations are continually made to reduce diagnostic errors, which are higher in polytraumatised patients. Various factors including haemodynamic instability and patient positioning added to the elusive nature of this wound. Adequate examination of lacerations requires thorough cleaning as coagulated blood and other material may obscure findings. This is particularly important in scalp lacerations where the overlying hair can form a barrier that is effective at hiding the wound edges. Conclusion This case highlights the importance of a thorough secondary survey; an effective examination technique would have avoided the need for extensive treatment to manage the sequelae of the missed scalp laceration.

We present the case of poor neurological recovery and subsequent death secondary to a thalamic abscess in a 53-year-old man. This patient initially presented with sudden dysarthria and left hemiparesis while driving. Neuroimaging showed a multilobular abscess involving the right thalamus with oedema extending to the basal ganglionic region and brainstem. The source of the abscess was initially unknown and it required draining multiple times while the different causes were being explored. The patient's neurological state along with intubation made for a difficult and inconclusive oral examination. It was only after neuroimaging included tooth-bearing areas that it became evident that this patient had extensive periodontal disease with multiple areas of periapical radiolucencies. The patient underwent complete dental clearance alongside repeated drainage of the abscess. Despite initial postoperative improvement, the patient never recovered from the neurological damage and died 3 weeks later.

Background: Dissection onto the facial aspect of the zygoma is necessary in several maxillofacial procedures. This carries inherent risk of damage to the vessels exiting the zygomaticofacial foramen (ZFF) on the facial aspect of the zygoma. Objectives: The aim was to compare ZFF anatomy between ethnic groups and sexes, and to determine reliable reference points for surgery. Methods: 858 zygomatic bones on dry adult skulls were used in the study. Skulls were selected from nine different geographic regions for a comparison between ethnic groups, and a comparison of anatomy between sexes was completed. Each zygoma was examined for the number of ZFF, after which a cross-line laser was used to create two consistent lines from which the ZFF was measured and mapped. Findings: There were significant differences in number and location of ZFF between ethnic groups, but not between sexes. Of all 858 sides, 1 ZFF was most commonly identified (49.8%). However, foramina number ranged from 0 to 4 per zygoma. Despite this variability over 80% of ZFF bilaterally were found within a 15 mm diameter circle centred at 5 mm anterior to the intersection of lines discussed above. Moreover, over 90% of ZFF fell beyond an arc of 5 mm from the orbital margin. Conclusion: We present a novel method of identifying a ‘ZFF zone’ within which the majority of foramina lie. This simple technique can be of use in directing osteotomy sites, local nerve blocks, and in preventing iatrogenic damage to the ZFF neurovascular bundle.

Sir, a 28-year-old male patient presented to our maxillofacial department with an iatrogenic mandibular fracture, confirmed by imaging, following removal of an impacted lower right third molar tooth.

Highlights • Silent sinus syndrome is a rare cause of hypoglobus and enophthalmos. • Clinical presentation is highly variable and non-specific. • Diagnosis and management may be multidisciplinary. • Clinicians from multiple disciplines should be familiar with presenting features., Introduction Silent sinus syndrome (SSS) is a rare disorder with protean manifestations. An absence of familiarity with ambiguous and atypical presentations may complicate diagnosis and delay management. Case presentation A 28 year old female patient presented with a chronic history of headache, post-nasal discharge and recurrent facial pain refractory to analgesics. Enophthalmos and hypoglobus progressed over a period of 2 months, and a diagnosis of SSS was confirmed via imaging. Definitive treatment was withheld given the patient’s postpartum state and improvement of symptoms. Discussion SSS typically manifests with painless and progressive, unilateral, enophthalmos and hypoglobus. Since presentation is dominated by ophthalmologic complaints, the ordinary route by which SSS is diagnosed is through ophthalmology review. The predominant complaint in our patient was chronic headaches with facial pain, and mild enophthalmos and hypoglobus were only noted 2 months later at follow-up. This represents an atypical presentation of SSS, and exemplifies the subtle and often ambiguous presenting features of this disorder. Conclusion The protean manifestations of SSS mean that patients may initially present to specialities other than ophthalmology. To ensure rapid diagnosis and appropriate management, it is important that clinicians, particularly in ophthalmology, maxillofacial surgery, and ears, nose and throat (ENT), are familiar with this obscure condition.