Background: Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third part of the duodenum between the superior mesenteric artery and the aorta. Owing to its non-specific gastrointestinal symptoms, diagnosis is frequently delayed, leading to significant morbidity including malnutrition and electrolyte disturbances. Methods: We report a case series of two adolescent female patients with underlying neurodevelopmental and psychiatric comorbidities who presented with progressive post-prandial vomiting, early satiety, and significant weight loss. Both patients underwent extensive initial investigations, including upper gastrointestinal endoscopy and abdominal imaging, which failed to identify a cause. Subsequent computed tomography (CT) angiography demonstrated reduced aorto-mesenteric angles (17° and 21°, respectively) and a decreased aorto-mesenteric distance of 6 mm, consistent with SMA syndrome. Initial management involved nutritional optimisation with nasojejunal feeding. Results: Despite conservative management, both patients experienced persistent symptoms and ongoing weight loss, necessitating surgical intervention. Each patient underwent laparoscopic duodenojejunostomy with limited small bowel resection. There were no intraoperative or postoperative complications. Postoperatively, one patient experienced complete resolution of vomiting with gradual nutritional recovery. The second patient demonstrated significant weight gain, improved energy levels, and radiological normalisation of the aorto-mesenteric angle. Both patients continue under outpatient follow-up. Conclusion: SMA syndrome should be considered in young patients presenting with unexplained post-prandial gastrointestinal symptoms and weight loss, particularly following rapid weight reduction. CT angiography plays a central role in diagnosis. While conservative management remains first-line, laparoscopic duodenojejunostomy is a safe and effective treatment option for patients who fail nutritional rehabilitation.

Background: Paediatric facial fractures are uncommon but clinically important injuries with potential long-term effects on facial growth, dental occlusion, and function. Management differs from adults due to distinct anatomy, fracture patterns, and biological remodelling capacity. Purpose: To review the evidence and core principles guiding assessment and management of paediatric facial fractures, highlighting key differences from adult injury patterns. Methodology: A narrative review of the literature was performed focusing on epidemiology, anatomical considerations, imaging strategies, fracture patterns, and operative and non-operative management. Key recommendations from established trauma and maxillofacial guidelines were synthesised to identify best practice and common clinical pitfalls. Results: Facial fractures occur less frequently in children, with falls representing the predominant mechanism in younger age groups. Paediatric facial bones are thinner and more elastic, resulting in higher rates of greenstick and minimally displaced fractures. Computed tomography with three-dimensional reconstruction remains the imaging modality of choice, although careful clinical correlation is required to guide management. Non-operative treatment is appropriate in many cases due to the high remodelling potential of the paediatric facial skeleton. When surgery is indicated, preservation of growth centres, minimal fixation, and judicious implant selection are essential. Conclusion: Paediatric facial fractures require a tailored approach prioritising growth preservation and long-term functional outcomes. Recognition of the differences between paediatric and adult facial trauma supports safer decision-making and reduces the risk of iatrogenic harm.

Introduction Mucosal melanoma of the head and neck is a rare and aggressive malignancy associated with delayed diagnosis and poor prognosis. Oropharyngeal involvement is uncommon and may be asymptomatic or detected incidentally, creating diagnostic and management challenges. Methods A case of incidentally detected oropharyngeal mucosal melanoma is presented, alongside a focused review of the literature examining patterns of presentation, staging strategies, and current surgical management principles for mucosal melanoma of the upper aerodigestive tract. Case and Results A middle-aged male was referred with an incidentally identified pigmented lesion of the uvula. The lesion was asymptomatic and not associated with cervical lymphadenopathy. Histopathological analysis confirmed mucosal melanoma. Staging investigations demonstrated no evidence of regional or distant metastatic disease. Following multidisciplinary discussion, the patient underwent wide local excision, with subsequent re-excision required to achieve clear margins. Postoperative recovery was uncomplicated. Early surveillance imaging demonstrated no evidence of local recurrence or metastatic disease. Discussion The literature demonstrates that oropharyngeal mucosal melanomas are frequently diagnosed at an advanced stage due to their occult location and lack of early symptoms. Complete surgical excision with clear margins remains the cornerstone of treatment, although margin width is often limited by anatomic and functional constraints. The role of elective neck dissection and adjuvant therapy remains uncertain, reinforcing the need for individualised, multidisciplinary decision-making. Conclusion Incidental detection of oropharyngeal mucosal melanoma can permit timely surgical management and favourable early outcomes. Vigilant head and neck examination and evidence-informed multidisciplinary care are essential in managing these rare tumours.