Tonsillar haemorrhage is a rare complication of infectious mononucleosis. We present a case of life-threatening tonsillar haemorrhage secondary to infectious mononucleosis in a young man whose predominant symptoms at presentation were haematemesis and melaena. The origin of the haemorrhage was not obvious until the patient was examined under anaesthesia. The bleeding was controlled by emergency tonsillectomy.

We report on a patient with an intramedullary lesion who showed only symptoms of so-called vestibular neuronitis. From the neurological aspects and MRI findings, the lesion was thought to be localized to the vestibular nerve in the pons. Cerebrospinal fluid testing and MRI findings suggested a diagnosis of multiple sclerosis (MS), although the clinical features were not compatible with MS. This case may shed some light on the aetiology of vestibular neuronitis.

A rare case of a salivary megalith with a sialo-cutaneous and a sialo-oral fistula in an elderly man is presented. A brief review of the literature is made.

Three cases of penetrating sinus injuries due to air gun pellets are presexnted in order to illustrate the potentially serious consequences of air gun injuries. Primary surgery was performed in all cases.

The clinical presentation, methods of accurate pre-operative localization and surgery are discussed.

Benign tumours of the tonsils are rare. Only a few cases of tonsillar lipoma have been previously reported. The case of a pedunculated polypoid lipoma of the palatine tonsil in a 44-year-old Japanese woman is presented. The ‘polyp’ was excised and an histopathological examination was carried out. The ‘polyp’ contained dilated lymphatics in the dense fibrous connective tissue beneath the overlying mucosal epithelium and below the mature fat tissue with intervening strands of fibrous tissue.

A rare case of a squamous cell carcinoma of the left pyriform fossa is presented. It was found as a pedunculated polypoidal mass in a 17-year-old Hindu girl. A review of literature is included.

Paralysis of the tongue due to isolated bilateral hypoglossal nerve palsy is a rare occurrence. Due to a trauma the cause in our case may have been a traction injury to both hypoglossal nerves at the base of skull. In some cases a contributing factor may be malformation of the skull base. Most cases have a good prognosis for recovery.

A 67-year-old man with an enlarged left tonsil underwent a tonsillectomy for the suspicion of malignancy. He had had a dental extraction six months earlier. Clinical and histopathological investigations established the diagnosis of primary tonsillar tuberculosis.

Osteogenic sarcoma involving the sphenoid bone is an extremely rare condition. The rarity of the disease and the close proximity of the sphenoid bone to the various important intracranial structures poses a real challenge in diagnosis and surgical management of these lesions. An extended lateral craniofacial resection by a multidisciplinary approach was carried out in one such case to attempt en bloc resection. This case is presented and also a review of the relevant literature.

We report a case of proven thyroid medullary carcinoma, metastatic to the temporal bone. Review of the otolaryngology literature demonstrates that this is the first such report. The patient presented with symptoms, physical examination, and imaging studies suggestive of a glomus jugulare tumour. The pre-operative diagnosis of metastatic thyroid medullary carcinoma, however, was made, based on a history of medullary carcinoma of the thyroid with previous metastases as well as an elevation in calcitonin levels. Histological examination of the surgical specimen confirmed the diagnosis.

A rare case of benign teratoma arising in the submandibular gland is presented.

A case of carcinoma ex pleomorphic adenoma arising in the soft palate is reported. The tumour presented had enlarged gradually over 10 years and finally occupied the oral cavity. The patient was admitted to our hospital due to disturbance of her speech and swallowing, and a sudden haemorrhage from the tumour. The initial pathological diagnosis by open biopsy was benign pleomorphic adenoma. After total resection, histological examination revealed that the tumour was composed partly of benign pleomorphic adenoma and partly of an adenocarcinomatous component. The carcinoma cells with prominent nucleoli were spheroid or polygonal in shape, and frequently formed ductal structures with areas of necrosis. Mitoses were also found. These findings showed that this tumour was a secondary carcinoma which had developed in a preexisting pleomorphic adenoma.

We present a case of superficial siderosis (SS) of the central nervous system (CNS) with an unruptured intracranial aneurysm to illustrate that the commonly encountered unexplainable progressive sensorineural hearing loss (SNHL) can be an important sign for the early awareness of this rare disorder. The literature on SS is reviewed and the pathogenesis of SS is discussed.

Oedema, fibrosis, and stenosis of the hypopharynx and the oesophageal inlet are described in a few publications as a complication of post-laryngectomy irradiation treatment.

In this paper a case of laryngeal carcinoma, treated exclusively by irradiation, where severe laryngeal and hypopharyngeal stenosis with complete occlusion of the oesophageal inlet were manifested as a late complication is described. We have found no similar case described in the English literature.

Candida epiglottitis has been reported in immunocompromised patients, but in only one paediatric patient with human immunodeficiency virus. We present possibly the first reported case of Candida infection of the epiglottis in an adult with human immunodeficiency virus treated with oral fluconazole. We review the symptoms, diagnosis. and management of the published cases of Candida epiglottitis in patients without the human immunodeficiency virus. Laryngoscopy and culture are diagnostic.

Pneumoperitoneum as a result of pneumomediastinum has been described already. Amongst the causes pneumoperitoneum due to a complication of adenotonsillectomy, has not previously been described.

We describe a five-year-old girl with tension pneumoperitoneum with respiratory and circulatory insufficiency half an hour after adenotonsillectomy. Removal of the intra-abdominal air witha 14 gauge needle restored normal respiration and circulation.

We present a patient with a lipoma of the deep lobe of the parotid gland. Despite the common occurrence of this tumour in other regions of the body, we believe that this is only the second report in the literature of a lipoma in this location. We believe that these tumours are easily dealt with by simple enucleation, and that superficial parotidectomy should be reserved for tumours deep to the facial nerve.

This report describes a 47-year-old male who had an occult papillary carcinoma of the thyroid present as a nodal involvement of the parapharyngeal space, in the retrostyloid compartment. To the best of our knowledge, this is an extremely rare condition.

Schwannoma of the posterior pharyngeal wall, in a 36-year-old male patient is presented demonstrating the asymptomatic nature of the tumour (which is peculiar to schwannomas). The tumour gradually increased in size, destroyed the body of the third cervical vertebra but remained asymptomatic. The patient only presented to hospital when the tumour obstructed the airway, because of its large size.

A 62-year-old male with a myoepithelioma of the right parotid gland was treated with surgical excision followed by adjuvant radiation therapy. Prior to the completion of radiation therapy, the patient developed progressive disease at local, regional, and distant metastatic sites. Combined modality treatment with radiation and chemotherapy resulted in a significant but transient shrinkage of the tumours at all sites. The patient succumbed to metastatic disease 212 days following the diagnostic biopsy. This case illustrates several of the distinctive clinical and pathological characteristics of this rare tumour.