16. Callaham M. Prophylactic antibiotics in common dog bite wounds: a controlled study. Ann Emerg Med 1980;9:410-4.
17. Dire DJ. Cat bite wounds: risk factors for infection. Ann Emerg Med 1991;20:973-9. Erratum in: Ann Emerg Med 1992;21:1008.
18. Dire DJ, Hogan DE, Walker JS. Prophylactic oral antibiotics for low- risk dog bite wounds. Pediatr Emerg Care 1992;8:194-9.
19. Smith PF, Meadowcroft AM, May DB. Treating mammalian bite wounds. J Clin Pharm Ther 2000;25:85-99.
20. Matter HC. Sentinella Arbeitsgemeinschaft. The epidemiology of bite and scratch injuries by vertebrate animals in Switzerland. Eur J Epi- demiol 1998;14:483-90.
21. Ebinger T, Rösch M, Katzmaier P, Wachter NJ, Merk S, Mentzel M. Infected animal bite injuries of the extremities. Chirurgia 2002;73:601-6.
22. Burt JD, Burns AJ, Muzaffar AR, Byrd HS, Hobar PC, Beran SJ, et al. Total soft-tissue reconstruction of the middle and lower face with multiple simultaneous free flaps in a pediatric patient. Plast Reconstr Surg 2000;105:2440-7.
23. Lengele BG, Testelin S, Bayet B, Devauchelle B. Total lower lip func- tional reconstruction with a prefabricated gracilis muscle free flap. Int J Oral Maxillofac Surg 2004;33:396-401.
INTERESTING CASE: Metastatic adrenal adenocarcinoma of the mandible
A 44-year-old man, presented with an 8-week history of anaesthesia of the lower lip and a 7 cm x 5 cm enlarging mass over the left angle of the mandible. He had had a suprarenal cortical adenocarcinoma removed 9 years previously. Orthopantomography showed a lytic lesion of the left ramus (Fig. 1).
L
Examination of a biopsy specimen and immuno-histochemistry confirmed that it was a metastatic deposit from the adrenal tumour (Fig. 2). He was given palliative radiotherapy and chemotherapy.
It is the haematopoietic areas in the mandible that favour secondary deposits. The adrenals are the most common primary site in the first decade of life, and it is usually neuroblastomas that metastasise to the jaw. Our patient presented with a secondary from an adenocarcinoma of the adrenal gland, which has not to our knowledge been reported previously.
V. Rachapalli M. Blanco-Guzman G.M. Jones A. Oriolowo