Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.

The COVID-19 pandemic has caused unprecedented disruption to the routine operations of healthcare services across the world. As the potential duration of the pandemic remains uncertain, the need to develop strategies to continue urgent elective services has received increasing attention. A solution adopted in the Kent, Sussex and Surrey area of England has been to create COVID-19-protected cancer hubs. The Queen Victoria Hospital is the designated hub for head and neck cancer services in the area. We report on the evolution of the head and neck cancer care pathway and standard operating protocols put in place and how these have combined both national guidelines and local problem solving. It is hoped that our experience can help guide other centres as they re-establish head and neck cancer services during the ongoing pandemic.

Melanotic Neuroectodermal Tumour of Infancy (MNTI) are particularly rare and although predominantly benign, are infiltrative and locally aggressive. Presenting in the first year of life, prompt diagnosis and effective management are critical in minimising morbidity and the risk of recurrence. A retrospective review of eleven MNTI managed at Great Ormond Street Hospital (GOSH) from 2000 to 2017 was undertaken. Eight tumours presented in the maxilla, two in the skull and one in the mandible. The primary modality of treatment was surgery in ten cases with one patient receiving neoadjuvant chemotherapy. In spite of microscopically incomplete resection in seven cases, only three recurred. Overall, there was a local recurrence rate of 27% with no distant metastases noted. Disease free survival was 100% with a follow up ranging from 0.75-17 years (median 5). Taking our results in conjunction with the available literature, there is a role for conservative initial surgery of MNTI and this should be coupled with delayed reconstruction and intensive short term follow up. We propose an adapted treatment algorithm that aims to balance the risk of recurrence and malignant change with surgical morbidity in an infant population.

A study was carried out to determine the influence of telemedicine on management of facial lacerations in children. Proforma was designed, and information was collected retrospectively over a 4-month period. Of the 2524 telemedicine referrals, 27% (693/2524) were pediatric referrals. One hundred forty-five of these were children with facial lacerations, of which only 98 were admitted for possible surgical management. During the same period, a further 45 children were admitted to the pediatric ward through verbal referral. The average age of the children admitted was 4.85 years and male-to-female ratio was 2:1. Lacerations to the lips (42%) were the most common site of injury, and the majority sustained the injury as a result of a mechanical fall (42%). Among the telemedicine group, 86% had surgery, whereas in the nontelemedicine group it was 82%. On average, 2 to 3 photographs accompanied the referrals, and none of the patients who were treated conservatively by the referring centers following telemedicine referral and discussion with Queen Victoria Hospital required a re-referral. The results from this study confirm that clinical findings together with images from telemedicine provide adequate information to make clinical decisions in children with facial lacerations.