ABSTRACT Introduction Lipomas are benign soft tissue masses that typically do not cause significant health issues. Surgical removal is often performed for cosmetic reasons or, less commonly, to address complications resulting from mass effects. We present a clinical case of a woman with a giant bilateral cervical lipoma, which led to airway obstruction and required complex surgical intervention. Case Report The patient, a woman with a giant bilateral lipoma of the neck, developed nocturnal dyspnea lasting approximately 6 days due to the compressive effect of the mass on the airway. Surgical resection was planned to relieve the airway obstruction. Following the incisional biopsy and extubation, the patient experienced laryngospasm, which led to airway compromise and anoxia, resulting in a brief (2‐min) cardiovascular arrest. Prompt resuscitation was performed, and a tracheostomy was placed to secure the airway. Surgery was delayed for 3 weeks to stabilise the patient before proceeding with the resection. The lipoma's location posed significant surgical challenges due to its close relationship with critical structures, including the vascular and neural bundles of the neck, the trachea anteriorly, and the aortic arch and pulmonary apices inferiorly. The resection was completed without further complications (mass size of 6 × 15 × 17 cm, 1210 g)., and the airway compression was successfully relieved. Two days postoperatively, the tracheostomy cannula was removed without incident. Discussion Cervical lipomas with mediastinal extension are rare and may present significant surgical challenges due to their proximity to vital structures. Large masses can lead to symptoms such as dysphagia, dyspnea, and potentially life‐threatening complications. In this case, the development of nocturnal dyspnea prompted early surgical intervention, with biopsy performed to exclude malignancy. The perioperative course was complicated by post‐extubation laryngospasm and cardiac arrest, but the patient was successfully resuscitated, and the airway was secured with a tracheostomy. Bilateral cervical access was essential for safe dissection around the trachea, vascular structures, and oesophagus, allowing for complete removal of the mass. Histopathological examination confirmed the benign nature of the lipoma. Conclusion This case illustrates that large cervical lipomas, despite their benign nature, can lead to severe clinical complications if they cause significant airway compression. While surgical resection remains the treatment of choice, such cases require careful multidisciplinary planning, particularly in the perioperative period, to manage potential risks associated with the proximity of the tumour to critical anatomical structures.

The author declares no conflicts of interest.

ABSTRACT Background Odontogenic orbital cellulitis (OOC) is a rare but serious complication of dental infections, accounting for 2%–5% of all orbital cellulitis cases. It can be life‐threatening if not promptly diagnosed and managed, particularly in vulnerable populations such as pregnant women. This case report discusses the complex management of OOC with deep neck space involvement in a Gravida 5 para 4 female at 27 weeks of gestation—an exceptionally rare scenario with only isolated cases reported worldwide. Case Presentation A 28‐year‐old pregnant female presented with right periorbital swelling, pus discharge and signs of orbital involvement following extraction of the right maxillary and mandibular third molars. Clinical examination revealed orbital oedema, limited ocular movements and purulent discharge from the extraction site. MRI revealed multiple abscesses extending into the parapharyngeal, masseteric and orbital spaces. Surgical intervention under local anaesthesia involved incision and drainage of the buccal, retromolar and orbital abscesses, along with the placement of drains. Post‐operative care included IV antibiotics and multidisciplinary monitoring by maxillofacial and ophthalmology teams. Conclusion Odontogenic orbital cellulitis during pregnancy presents unique diagnostic and therapeutic challenges. Prompt recognition, appropriate imaging, surgical drainage, antibiotic therapy and multidisciplinary coordination are essential for favourable maternal and foetal outcomes.

Ulceroproliferative growths of the buccal mucosa with muscle degeneration and atrophy of the fat pad in association with oral submucous fibrosis (OSMF) can shrink the buccal space, enabling the tumour early and easy access to the skin. The subepithelial hyalinisation in OSMF spreading into the submucosal tissues, atrophy of the fat or fibrovascular tissue, diminished vascularity, and lack of oedema due to the decreased influx of inflammatory cells such as lymphocytes and plasma cells [1] can accelerate the tumour progression close to the skin in an extensive ulceroproliferative growth of the buccal mucosa despite fibrosis. OSMF is a progressive potential malignant disorder associated with areca nut, a group 1 human carcinogen [2]. It is a slowly progressive disease with fibrous bands, inflammation, and a heap of collagen matrix that fails to degrade. The shielding effect of the areca nut is associated with a better prognosis in terms of reduced incidence of nodal involvement or extracapsular invasion as the rich lymphatics in the submucosal plexus are occluded and a better grade of tumour differentiation [3]. Skin involvement (Figure 1) has a detrimental oncological outcome; it upstages the disease and can also be an independent risk factor for contralateral nodal metastasis [4]. The clinical pearl for skin involvement by a tumour is loss of skin pinchability, indicating that the tumour has breached the outermost protective layer of resistance. An ulceroproliferative growth of the buccal mucosa with atrophy of the fat pad can cause severe tenderness of the intact skin in its vicinity on palpation. This can be an ominous sign of skin involvement and warrant removal for a safe oncological margin. The buccal complex entails four layers (Figure 2): Mucosa, Buccinator Muscle, Subcutaneous tissue, and skin (in to out), and the usual distance from mucosa to the skin is around 1–1.5 cm. The reduction in fat (facial atrophy) and degeneration of the muscle fibres due to reduced blood supply, glycogen depletion, and muscle contracture [5] diminishes the protective contents of the skin. The mucosa is breached by the ulcerative growth and the muscle and subcutaneous fat shrink due to OSMF. A skin graft ideally survives on muscle, fascia, periosteum, perichondrium, tendon sheaths, perineurium, cancellous bone, and granulation tissue; these are absent in the recipient bed postfibrotomy. Skin grafts in OSMF have a high incidence of shrinkage, contraction and rejection, considering the poor vascularisation of the recipient bed. The skin, the largest organ, has a rich network of nerve fibres and nerve endings with specialised receptors. The tumour gallops across the various layers of the buccal mucosa, and the overlap of ulceroproliferative lesion and submucous fibrosis accelerates its progression to the skin via the fibrous degeneration of the connective tissue. This triggers perineural inflammation, which can be clinically elicited by tenderness on palpation. In contrast, hyalinisation of the collagen fibres beneath the epithelium with stenosis of vessels shields the lymphatic spread. The amalgamation of the subcellular events, evanescence of the fat, and contraction of the buccal space in OSMF with buccal mucosal cancers may cause skin tenderness due to perineural inflammation. It can be an early sign of skin involvement much before the onset of skin pinchability. An interesting report on how OSMF may shield primary tumours from presenting in the oral cavity but can prematurely predispose to regional metastasis has been reported [6]. However, till these can be concretely evaluated with objective markers and substantiated by trials with robust data, they remain a hypothesis albeit with clear reasoning and substantial logic. More extensive randomised controlled trials with these entities coexisting need to be followed up to give credence to our hypothesis. Retrospective data from larger registries are being systematically assessed to understand whether carcinoma in the backdrop of OSMF portends a better prognosis or upstages disease due to early skin involvement. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

ABSTRACT Background Orthognathic surgery is a surgical procedure to correct dentofacial deformities, improving function and facial aesthetics. Method This case report highlights the use of the short split sagittal osteotomy (SSSO), a modified technique proposed by Posnick, in treating a 32‐year‐old female patient presenting with retrognathia (Class II skeletal pattern) and obstructive sleep apnea. Results The patient underwent bimaxillary advancement with counterclockwise rotation and genioplasty, planned virtually via Dolphin 3D software. The surgical approach aimed to optimise occlusal function, airway space, and facial harmony while minimising potential complications. The SSSO technique, characterised by a low and short medial cut anterior to the lingula, was chosen for its advantages in reducing surgical trauma, nerve injury risk, and operative time. The patient expressed satisfaction with both functional and aesthetic results. Conclusion Literature review supports the efficacy and safety of the SSSO, citing lower rates of unfavourable splits, reduced neurosensory deficits, and reliable stability when proper fixation is applied. This case reinforces the potential of the SSSO as a viable alternative to the traditional bilateral sagittal split osteotomy (BSSO), especially in less complex mandibular corrections. Selection of surgical techniques should remain individualised, guided by patient anatomy, surgeon experience, and the specific goals of treatment.

ABSTRACT Background In 1971, the World Health Organisation concluded the term Adenomatoid Odontogenic Tumour (AOT). This tumour accounts for approximately 2%–7% of all odontogenic tumours. AOTs commonly present in the younger demographic with a 2:1 female predisposition. The maxilla is more commonly affected. AOTs are categorised into follicular, extrafollicular and peripheral variants, respectively. Patients are usually asymptomatic with evidence of expansion of the cortical bone. AOTs are slow‐growing and well‐encapsulated with enucleation and curettage being the treatment modality accepted amongst the literature. Methods A 15‐year‐old female was referred to the oral surgery department at Edinburgh Dental Institute with a 6–7‐month history of an asymptomatic swelling adjacent to tooth 22. On clinical assessment, there was a firm labial swelling adjacent to tooth 22. Radiographic assessment highlighted the presence of a unilocular radiolucency with a corticated margin distal to the root surface of tooth 22 with expansion, thinning and perforation of the buccal cortical bone. Diagnosis suggested a benign odontogenic lesion: an odontogenic keratocyst, lateral periodontal cyst or lateral radicular cyst. Results Management involved enucleation for histopathological assessment. This confirmed an intraosseous AOT with complete excision. Clinical and radiographic review highlighted complete mucosal healing with evidence of bony infiltration and no recurrence. Conclusion This case highlighted the effective management of an intraosseous AOT with enucleation and curettage.

ABSTRACT Objective The main aim is to evaluate the efficacy and safety of corticosteroid administration as adjuvant therapy in patients with odontogenic cervicofacial infections. Methods We searched five databases, grey literature and manually reviewed bibliographic references for observational studies. Outcomes included hospital length of stay, intensive care unit admission, reoperation and other postoperative complications. The risk of bias was assessed using the Newcastle‐Ottawa Scale. Meta‐analyses were not performed due to the heterogeneity of the results. Results We included four observational studies. Dexamethasone use reduced the odds of reoperation (odds ratio (OR): 0.9; 95% CI: 0.8–0.98). Additionally, higher doses of dexamethasone were associated with a shorter hospital stay (β: −0.2; 95% CI: −0.3 to −0.07). However, another study reported a longer hospital stay among patients who received corticosteroids than those who did not; p < 0.001. Furthermore, corticosteroid use was associated with lower odds of intensive care unit admission (OR: 0.51; 95% CI: 0.09–2.72); p > 0.05. The only reported adverse event was prolonged hyperglycemia (0.8%). Conclusions The adjuvant use of corticosteroids in managing patients with odontogenic cervicofacial infections has potential beneficial effects and appears safe. However, the evidence remains unclear, and further studies are needed to evaluate potential benefits and harms.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

ABSTRACTDespite the widespread use of botulinum toxin (BTX) in facial paralysis, current clinical protocols remain highly heterogeneous, lacking standardisation in dosage, muscle targeting and outcome assessment. This variability limits reproducibility and compromises patient outcomes. We highlight the need for a paradigm shift toward objective, technology‐based approaches, including electromyography and ultrasound, to guide BTX application. Furthermore, we call for rigorous randomised trials to evaluate its pharmacological effects in paralysed muscles. Scientific rigour must replace empirical practices to ensure safe and effective treatment, especially within public health systems.