Fifteen patients with perilymphatic fistulae were evaluated. Of these patients, three had CSF leaks in addition to the perilymphatic fistulae. Eight patients had fistulae of one or both windows; two had fistulae confined to the lateral semicircular canal; and two had combined fistulae of both round window and lateral semicircular canals. All improved dramatically following surgical repair.

In the following study, we have shown that perilymphatic fistulae can occur in the lateral semicircular canal, and we suggest exploration of this area when indicated.

In this retrospective study of parotid tumours. 57 patients with pleomorphic adenomas were treated with superficial parotidectomy and 33 patients with limited excision. The follow-up period has been 4–14 years. When the operation was superficial parotidectomy, recurrences occurred in 8.7 per cent compared to 6 per cent in cases of limited excision. Side-effects such as permanent weakness of the facial nerve or postoperative gustatory sweating were also more common when superficial parotidectomy was performed. The post-operative results observed suggest that limited excision under magnification is more favourable than superficial parotidectomy in the treatment of pleomorphic adenomas.

A review was performed of the treatment of 92 patients with acute epiglottitis with special reference to the different procedures employed in children and adults. Intubation was performed in 74 per cent of the children but in only six per cent of the adults. More than half of the children were initially observed only, but of these 58 per cent eventually needed intubation. No deaths occurred. We present our management protocol as well as a survey of the routine management of acute epiglottitis in children in the five Scandinavian countries. The number of initially observed patients ranged from nil per cent in Iceland to 35 per cent in Finland. When an artifical airway is needed, 92–100 per cent of the patients are intubated, 0-8 per cent tracheostomized, and 0-5 per cent one or the other, as a standard procedure. Tracheostomy is performed in departments where the facilities do not permit sufficient observation of patients treated by intubation.

Summary Initial combination drug regimen containing cisplatin in patients with stage III and IV head and neck cancer produced a high percentage of clinical response. This trial was initiated to assess the role of multimodality treatment (chemotherapy plus radiotherapy) versus chemotherapy alone. Ninety-six patients entered into this study; 80 patients were evaluable at time of analysis (Table I). Patients were randomized between chemotherapy and radiotherapy (group I) and chemotherapy alone (group II). The chemotherapy administered consisted of cisplatin, bleomycin and methotrexate and was given in 2 cycles over 35 days. Local radiotherapy followed. In group II 3 cycles of chemotherapy were given without radiotherapy. The overall tumour response after chemotherapy rose up to 75 per cent. After radiotherapy in group II the response rate sank to 59 per cent. In both regimes the remission duration was very short. Patients receiving only two cycles of chemotherapy do not have a statistically shorter survival than patients, who were treated by chemotherapy plus radiotherapy, or by a 3rd cycle of chemotherapy.

Eleven children with infantile autism or autistic-like conditions were examined with oculomotor tests and with auditory brainstem response audiometry. Measurements of voluntary, horizontal non-predictable saccades showed that the eye motor function was abnormal in six (55 per cent) of the eleven patients. The saccades were hypometric in all six instances and the saccadic velocity was reduced in four instances. The abnormalities observed are consistent with brain dysfunction, in most cases probably indicating ponto-cerebellar involvement. In five instances ABR was found to be abnormal which indicates brainstem dysfunction. Oculomotor dysfunction and/or ABR abnormality was observed in eight (73 per cent) of the patients studied.

Swelling in the parotid region is often the presenting sign of a tumour of salivary gland origin. However, the possibility of disease involving adjacent structures must always be considered. Three cases are presented where pathology of the mandibular ramus presented as swelling in the parotid region. A clinical diagnosis of a parotid tumour was made, parotidectomy scheduled, and in two cases carried out before the correct diagnosis was reached. Difficulties of differential diagnosis are discussed, and imaging techniques reviewed. The value of plain radiographs of the adjacent hard tissues is emphasised. Careful interpretation should be based on a sound understanding of pathology of the jaws.

Voice rehabilitation in the laryngectomy patient has been a major goal of reconstructive laryngeal surgery. 36 patients underwent laryngectomy with the creation of a phonatory neoglottis as outlined by Staffieri. In 13 patients good voice rehabilitation was achieved. In 23 patients who failed to develop voice production, altered swallowing function was the major problem.

Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines.

The dissection of cervical lymphatics for cancer after radiotherapy imposes a special need to ensure good healing of skin flaps with good access and acceptable aesthetic results. Adaptability of incisions for extended surgery is also desirable.

Although it is felt that the adoption of the basic MacFee incision pattern fulfils these criteria, the author has for years employed curved modifications of the two horizontal incision lines. This develops a waisted skin bridge which in freely mobile and gives better access to the deep structures.

The technique is contrasted with other approaches and described in detail. It complies with the safe principle of join-free linear incisions and is practical for regular use.

The parotid gland is added to the list of parenchymal organs, notably the pancreas, in which osteoclast-like cells appear as constituent cells in their neoplasms. The cells' role in the neoplasms is a reactive one or, more rarely, as an integral element in an osteoclast-type giant cell neoplasm or so-called osteoclastoma. Distinctive in histological appearance, the osteoclast-type giant cell neoplasm is a malignant lesion that, to date, has been described only in the pancreas and parotid glands. This report presents examples of each type of giant cell lesion in the parotid gland.

Acute epiglottitis in adults is a potentially fatal but self-limiting disease of increasing incidence world-wide.

Forty-two patients, seen consecutively over a four year period at the ENT Department, Singapore General Hospital were reviewed retrospectively.

A strong male predominance with a peak age incidence in the sixth decade was noted. A severe sore throat and dysphagia with disproportionate signs of oropharyngeal inflammation was the main presenting picture. Only three patients had stridor on presentation. Vigilant monitoring of the airway with empirical high-dosh intravenous amicillin, cloxacillin and steroids resulted in a dramatic clinical improvement in most patients and none developed stridor after admission. The yield from throat swabs and blood cultures were low. Two patients developed complications, a Ludwigs angina and an epiglottic abscess. Recurrent epiglottistis was a problem in one patient.

There was low morbidity and no mortality on the management regime outlined.

Surgical management includes the initial evaluation, tracheostomy and subsequent monitoring of the child requiring surgical reconstruction, although most of this presentation concerns reconstructive techniques and results. Previous presentations have dealt with the initial endoscopic and radiological evaluation of children who present with stridor due to acquired subglottic stenosis: this includes microlaryngoscopy and bronchoscopy in order to determine the anatomical and functional situation in the larynx and tracheobronchial tree. Mr. Bull has discussed the techniques involved and Dr. Facer the anaesthetic aspects.