Re: Thompson M, Adlam DM. Syndrome of inappropriate anti-diuretic hormone secretion associated with oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2002; 40: 216–219

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that resolution usually occurs within 2 weeks.4 Our experience with an admittedly small group is that continuing paraesthesia has persisted for between 6 and 18 months in this group. It is our impression that cases of lingual nerve paraesthesia after inferior alveolar/lingual nerve block usually resolves after about 2 weeks. In view of our recent experience over the last 10 months, we would like to ascertain if our observation is isolated or coincidental, or if it is mirrored across the United Kingdom. Yours faithfully S. P. van Eeden FRCS(Ed), FFDRCSI Specialist Registrar M. F. Patel Consultant Department of Oral and Maxillofacial Surgery Royal Berkshire Hospital Reading, Berkshire RG1 5AN, UK REFERENCES 1. Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmokinet 1997; 33: 417. 2. Simon MA, Vree TB, Gielen MJ, Booij MH. Comparison of the effects and disposition kinetics of articaine and lidocaine in 20 patients undergoing intravenous regional anaesthesia during day case surgery. Pharm World Sci 1998; 20: 88. 3. Malamed SF, Gagnon S, Leblanc D, Articaine hydrochloride: a study of the safety of a new amide local anaesthetic . J Am Dent Assoc 2001; 132: 177. 4. Septodont web site: http://www.septodont.co.uk/articaineuk/ prescribing/spc1hundred.html. doi:10.1016/S0266-4356(02)00222-X, available online at http://www.idealibrary.com on

Re: Thompson M, Adlam DM. Syndrome of inappropriate anti-diuretic hormone secretion associated with oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2002; 40: 216–219 We were fascinated to read the report of the syndrome of inappropriate anti-diuretic hormone secretion in relationship to one patient with oral squamous cell carcinoma. We had a similar case in a patient that we reported in 2001.1 While we did not highlight in the title or the abstract the fact that one patient had SIADH, one of the two patients that we reported had proven metastatic oral squamous cell carcinoma in the pituitary which was the cause of SIADH. Interestingly, the patient that Thompson and Adlam report had been known to have a T4 tumour for 18 months prior to presentation. In our paper, we postulated that the long period between the development of the oral symptoms and the presentation for treatment was a risk factor for cerebral metastases. The reason for drawing this to the attention of your readers is that a pituitary deposit of metastatic oral squamous cell carcinoma would be an addition to the mechanisms proposed in the pathophysiology of SIADH in malignancy that were listed by Thompson and Adlam. P.S.G.F. Hardee BDS, MBBS, FDS, FRCS Consultant Oral and Maxillofacial Surgeon I.L. Hutchison Consultant Oral and Maxillofacial Surgeon

Department of Oral and Maxillofacial Surgery Barts & The London NHS Trust, The Royal London Hospital 3rd Floor Alexandra House Whitechapel E1 1BB London, UK REFERENCE 1. Hardee PSGF, Hutchison IL. Intracranial Metastases from Oral Squamous Cell Carcinoma. Br J Oral Maxillofac Surg 2001; 39: 282–285. doi:10.1016/S0266-4356(02)00220-6, available online at http://www.idealibrary.com on

Re: Lloyd CJ, Penfold CN. Insertion of percutaneous endoscopic gastrostomy tubes by a maxillofacial surgical team in patients with oropharyngeal cancer. Br J Oral Maxillofac Surg 2002; 40(2): 122–124 Sir, I read the paper of Drs Lloyd and Penfold, suggesting that percutaneous endoscopic gastrotomy (PEG) tubes can safely be inserted by maxillofacial surgeons. I feel obliged to add a critical comment to this article. PEG feeding is accepted worldwide as a routine procedure in oral cancer patients, and is generally associated with low morbidity. In our institution it has been routinely used since 1994. Insertion is done by our gastroenterologists, who upon insertion perform a gastroesophagoscopy to exclude any associated problems. Despite being a generally safe procedure, we have had two major intraabdominal complications requiring several surgical interventions and a prolonged hospital stay. I would be interested to know the reaction of medical insurance companies to such an incident when the initial procedure had been performed by somebody not normally assigned to undertake such procedures. I have no doubt that Drs Lloyd and Penfold are able to perform the insertion of a PEG. But I definitely think that we should leave it to specialists who are accordingly trained. We do not make ourselves friends in the hospital by starting to acquire procedures which have nothing to do with our core business. I also think that the endoscopy, which is part of the procedure, is more professionally done by gastroenterologists than by maxillofacial surgeons in general. With kind regards, Sincerely yours, B. Hammer MD, DMD Clinic for Reconstructive Surgery Kantonsspital Basel Basel CH-4031, Switzerland doi:10.1016/S0266-4356(02)00219-X, available online at http://www.idealibrary.com on

Re: Postoperative sore throat after routine oral surgery. Br J Oral and Maxillofac Surg 2002; 40: 60–63 Sir, It is interesting that this study shows that the postoperative sore throat should not be too readily related to the use of a pharyngeal