A unique, previously undescribed case of iatrogenic perforation of a pharyngeal pouch which resulted in pharyngo-oesophageal fistulation is described. The correct management of such complications is discussed.

The case of a massive benign thyroid goitre extending from the arch of aorta to the nasopharynx presenting with acute aerodigestive obstruction is reported. The management of the case is discussed and also a review of the relevant literature.

Fistulae between major vessels in the head and neck are uncommon. In both civilian and wartime reports, the total number of traumatic arterio–venous fistulae in head and neck region account for less than four per cent of all arterial injuries. Fourteen cases of congenital communication between the external carotid artery and external or internal jugular vein have been reported. We report and discuss the management of a case of ruptured carotico–jugular fistula secondary to infection which presented as acute upper airway obstruction. This appears to be the first description of such a case in the literature.

A double-blind, controlled study to assess the accuracy of interpretation of lateral soft tissue radiographs of 60 patients with suspected foreign body impaction in the oro/hypopharynx was carried out by 18 respondents from three different specialities. All the patients had endoscopy carried out and foreign bodies were present in 25. Of these, foreign bodies were diagnosed on the radiograph in only 38.3 per cent. False-positive diagnoses were made in a mean of 26.3 per cent of those patients who did not have a foreign body.

This case report demonstrates the value of CT in the investigation of facial palsy due to tuberculous mastoiditis. This is the best imaging modality available for identifying features suggestive of tuberculosis, the disease extent, presence of complications and demonstration of anatomy prior to surgery.

Carcinoma ex-pleomorphic adenoma is exceedingly rare in sites other than the major salivary glands and the oral cavity. We present the first two histopathologically documented examples to occur in the nasal cavity.

From the Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.

Osteoblastoma is a benign bone lesion that mainly affects the long bones and rarely the temporal bones. Very few cases have been reported in the literature. This paper reviews the literature, discusses the differential diagnosis, clinical presentation, and CT scan findings of such a condition and details our experience with a young patient who had a temporal bone (mastoid process) osteoblastoma.

A case of supraglottic laryngeal squamous cell carcinoma with sebaceous differentiation in a 68-year-old Caucasian male is described. A right cervical lymph node metastasis, excised during the laryngectomy operation, consisted exclusively of squamous cells. Despite intensive post-operative chemotherapy. the patient developed metastatic foci in the left cervical area and left pulmonary hilus and died seven months later. This is the second case report of a laryngeal squamous cell carcinoma with sebaceous differentiation in the literature.

Lipomas of the larynx and hypopharynx are uncommon mesenchymal neoplasms. This report discusses the clinical and pathological features of three cases of laryngeal and hypopharyngeal lipomas. Two of the cases occurred in females and one in a male. The ages of the patients were 28, 51 and 51 years respectively. Two of the cases involved the supraglottic larynx (left arytenoid and left vestibular fold); the third involved the pyriform sinus. Symptoms included airway obstruction. dysphagia, throat discomfort, a sensation of excessive secretions in the throat and an increase in snoring. The complaints occurred over periods ranging from several months to one year in duration. Clinically, a polypoid lesion described as yellow in appearance was seen. Histologically. the tumours were composed of mature adipocytes without evidence of pleomorphism, lipoblasts or infiltrative growth. Surgery was the treatment of choice and included simple but complete excision in two of the cases. In these two cases, surgery proved curative with follow-up periods of 11 and seven years, respectively. In one case. the initial tumour was removed in pieces. This lesion recurred 15 years after the initial resection and was totally excised at that time. This patient has been free of tumour for more than five years.

The occurrence of plasma cell granuloma of the larynx appears to be unusual. Review of the literature revealed only two previously reported cases. We present an additional case of plasma cell granuloma of the larynx. The diagnosis was made by histological and immunohistochemical examinations. The tumour was successfully treated by radiation therapy.

A patient complaining of pain and noise on turning her neck was diagnosed as having a large greater cornua of the hyoid bone. Excision of the greater cornua relieved the symptoms.

A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed intially as a chondroma is presented. The tumour reurred twice after limited surgical resections. Total laryngectomy was inecvitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosacroma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of consecutive surgical managaement of low grade tumours as they are slow growing and metastates are infequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected.

Histologicalgrading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.

The obliteration of the frontal sinus via an osteoplastic approach is performed with the aim of achieving a permanent ‘switching off’ by final and conclusive clearing out. For this, freshly harvested abdominal fat has shown itself to be the best clinically. It is possible to demonstrate the vitality of fat transplanted into the frontal sinus without an operation i.e. by a macroscopical and histological examination using magnetic resonance imaging (MRI). The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T.S.II, Philips Medicine Systems, Eindhoven, Netherlands) with a quadrature (square) head spool. We produced T1-weighted spin echo images (TR: 450–550 ms; TE: 20–25 ms), T2-weighted fast spin echo images or in double-echo technique in transverse orientation (Turbo SE or TR: 2000–2500 ms; TE: 50–90 ms) and short tau inversion recovery (STIR) sequences for fat suppression (TJ: 140 ms; TR: 1400 ms; TE: 30 ms). The fat implanted into the frontal sinus of 11 patients aged 22–65 years, having undergone an osteoplastic frontal sinus operation with obliteration, was examined post-operatively by MRI. Objectives were the time-dependent distribution of portions of vital fatty or connective tissue, the eventual development of necroses or cysts as well as recurrences, inflammatory complications or re-epithelization of the frontal sinus four to 24 months postoperatively. In only six out of 11 cases was vital fatty tissue found. Fatty necrosis occurred five times, whereas in four cases a transformation into granulation tissue and in one case into connective tissue could be seen. All 11 patients were complaint-free. Long-term observations are needed to see if differences in the recurrence rate of frontal sinus disease are dependent on whether the implanted fat remains vital or necrosed and transformed.

Cranial fasciitis is a rare variant of nodular fasciitis. It is a benign condition with features resembling sarcoma, seen principally in young males. It involves the skull bones and grows at a rapid pace. Accurate diagnosis and surgical excision is the key to management. Prognosis is good with recurrence rare. By 1992, 17 cases had been reported in the literature. The present case is the first reported in pakinstan.It presented as post auricular mass.

The case of an atypical carcinoid tumour of the larynx is described in a 65-year-old man. Thisrare tumour may present diagnostic difficulties, but the diagnosis should be considered in a patient presenting with symptoms of local or referred pain and an apparently small, non-ulcerating supraglottic tumour. Immunocytochemistry has an important role in establishing the diagnosis. A very unusual feature of this case was positive staining for S-100 protein by sustentacular cells. Atypical carcinoid tumours do not respond well to radiotherapy so the primary treatment should be surgical resection.

Polypoidal squamous cell carcinomas, with a sarcomatous stroma, in the upper aerodigestive tract are very rare but well described tumours. They are associated with a multifario?sjiomenclature because of different opinions regarding their histology and histogenesis. The main issue is whether the stroma component is a true sarcoma or a benign reactive lesion.

In order to draw the attention of otolaryngologists and pathologists to the characteristic features of this rare tumour, two cases originating from the oropharynx are presented. Both tumours were pedunculated and polypoidal, and their bulk consisted of a bizarre sarcoma-like stroma covered with granulation tissue. In some areas of the surface, however, atypical squamous cell epithelium with foci of invasive carcinoma was found. In the vicinity of the latter both tumours contained areas of adenocarcinoma. After surgical excision followed by radiation therapy, there was no recurrence after two and five years, respectively.

The histological and immunohistochemical findings support the assumption that these two tumours are carcinosarcomas. Adenocarcinomatous elements in this type of tumour have to our kowledge been reported only twice previously and have never been observed in the pharynx.

The authors report a case of an unusual inflammatory reaction in a thyroglossal cyst. It consisted of broad papillary intraluminal projections covered by histiocytes and occasional multinucleate giant cells. This benign process should not be confused with a true papillary neoplasm, a rare complication of a thyroglossal cyst.