England lock Charlie Ewels red carded just 82 seconds in at Twickenham

The pre-match headlines ahead of England and Ireland's Six Nations Round 4 match revolved around the availability of Maro Itoje, yet his second row partner took just over a minute to steal the show in Twickenham.

England suffered a major blow inside two minutes when Ewels was shown a red card having clattered into Ireland vice-captain Ryan.

Ryan was left bloodied and forced off the field for assessment after Ewels ploughed into him, causing head on head contact.

Iain Henderson replaced Ryan, with Sexton kicking the resultant penalty to put the visitors 3-0 ahead.

The Irish swiftly made the most of their numerical advantage as James Lowe scored the opening try of the afternoon.

Neat interplay from Dan Sheehan and Josh Van Der Flier released Lowe on the left flank and he capitalised on plenty of space to charge over unchallenged.

Sexton was off target with the conversion, leaving Ireland 8-0 in front.

England were given a reprieve when a Caelan Doris try was chalked off due to a knock-on from Garry Ringrose in the build-up.

The hosts then suffered a further setback, with flanker Tom Curry limping off injured to be replaced by Dombrandt.

England fly-half Marcus Smith kicked a penalty to put the hosts on the scoreboard at 8-3 down just before the midway point of the first half.

Meanwhile, Ireland lock Ryan failed his head injury assessment, leaving Ulster captain Henderson to continue in his place.

Itoje was passed fit to start England’s Guinness Six Nations showdown with Ireland.

The influential lock was doubtful after missing Friday’s captain’s run due to illness but has recovered to continue alongside Charlie Ewels for a crunch clash which will result in the losing team being eliminated from title contention.

England head coach Eddie Jones, who has declared Ireland “red-hot favourites” for the Twickenham contest, has made three alterations to his starting XV following the round-three win over Wales.

Hooker Jamie George has been recalled in place of the injured Luke Cowan-Dickie, while Alex Dombrandt has dropped to the bench following a bout of coronavirus to be replaced by Sam Simmonds at number eight, while Joe Marchant is preferred to Elliot Daly at outside centre.

Ireland head coach Andy Farrell has made six changes, including the return of captain Johnny Sexton.

Fly-half Sexton, who this week announced he will retire following next year’s World Cup, has been restored alongside James Ryan, Bundee Aki, Andrew Conway and Hugo Keenan, while Cian Healy has taken the place of injured prop Andrew Porter.