This case report illustrates the value of intravenous digital subtraction angiography (DSA) in cases of penetrating neck injury. The debate continues between a policy of mandatory exploration of all penetrating neck wounds versus one of selective exploration with observation of the remainder. The argument for the former policy is that vascular trauma can occur without clinical signs. Whichever policy is followed a DSA provides invaluable information in strengthening the decision either not to operate or if operating which operation to perform and which approach to use. DSA is a quick, simple and safe investigation that can be carried out at any time of day or night.

Peanut inhalation in the right main bronchus of a 15-month-old boy was diagnosed using a T1-weighted image produced by magnetic reasonance imaging (MRI) because of the high fat content of the peanut. The T1-weighted MRI image may also be useful in diagnosing other kinds of aspirated nuts with high lipid content as well as peanuts. This method does not involve any X-ray exposure.

A prospective study of 150 CT scans showed that the right ethmoidal roof was lower than the left in 8.6 per cent of cases. The reverse situation, i.e. the right higher than the left, was observed in only 1.2 per cent of cases. This finding could account for the higher reported incidence of endocranial complications associated with right ethmoidectomy. Coronal CT scans allowing comparison of the right and left ethmoidal roofs should always be made before undertaking intranasal ethmoidectomy

We report on the case of a young woman, presenting with a left lateral neck lump, which turned out to be a bony callus originating from the thyroid cartilage; similar but smaller lesions were found on the same side in the hyoid and cricoid cartilages. The CT, MRI and pathological findings are described.

Metastases to the larynx from distant primaries are rare. We report a case of a pulmonary epidermoid carcinoma metastatic to the larynx that simulated a primary cancer. A review of the literature showed nine previously reported cases of pulmonary metastases to the larynx—only two of them were epidermoid carcinomas.

Treatment of a secondary lesion in the larynx is justified only when other organs have not been affected. The diagnostic and therapeutic considerations of this condition are discussed.

Metastatic carcinoma involving the temporal bone is extremely rare. A case is reported with an unusual presentation – recurrent episodes of acute mastoiditis. Mastoid exploration and biopsy established the diagnosis. We believe this to be the first reported case to present in this manner.

Kimura's disease is a chronic inflammatory disease which often presents as a tumour-like swelling in the head and neck region with or without lymphadenopathy. Most cases have been described predominantly in Chinese and Japanese people. The lesion is benign, but it may easily be mistaken for a malignant tumour. Kimura's disease has been confused with angiolymphoid hyperplasia with eosinophilia (ALHE), from which it probably should be distinguished as a separate entity. The diagnosis may be suggested by a fine needle aspirate, but is established by a biopsy. The treatment of choice is surgical removal.

A case of Kimura's disease in a Caucasian male of 12 years' duration is presented together with a brief review of the literature.

A 64-year-old Qatari female, with a one-year history of right otorrhoea and deafness, had a reddish-white mass projecting into the right ear canal, through the tympanic membrane, that proved histopathologically to be a paraganglioma. Computerized tomography (CT) of the temporal bones showed extensive destruction of the right mastoid bone, the posterior ear canal wall, and the sinus plate, with total disruption of the ossicles, simulating a malignant tumour, which is unusual for a middle ear paraganglioma.

Pleomorphic adenoma is the most common tumour to arise in the parotid gland. Diagnosis becomes difficult when such a tumour undergoes degeneration and presents with unusual findings. This can lead to erroneous decisions concerning treatment. We present two patients with pleomorphic adenoma of the parotid gland with cystic degeneration, describe the pathological findings and discuss some pitfalls in diagnosis and treatment. Both patients recovered uneventfully after surgery.

We report a case of a partly ossified thyroglossal cyst in close proximity to the hyoid bone and discuss the possible embryological significance of this. Thyroglossal cysts occurring within the hyoid bone or deep to the hyoid periosteum support previous suggestions that the thyroglossal tract can sometimes be trapped within the developing hyoid bone.

Extracranial carotid artery aneurysms are rare, but are occasionally recognized as causing dysphagia. These aneurysms generally occur at or above the bifurcation. Here we present what we believe is a unique case: a common carotid artery aneurysm compressing the upper oesophagus, and mimicking the obstruction of a post-cricoid carcinoma.

A case of carcinoma of the lung with a metastasis on the tongue is presented. The case is of interest because, although primary carcinomas of the tongue are fairly common accounting for 50 per cent of all oral carcinomas, metastatic tumour represents only one per cent of all malignant tumours of the oral cavity and of these only 0.2 per cent metastasize to the tongue.

Primary nasal, paranasal, oral and pharyngeal (NPOP) lymphoma, thought to be a distinct entity among childhood lymphomas, may present with a wide variety of common ENT symptoms such as nasal obstruction, rhinorrhoea, epistaxis or sinusitis. The diagnosis may only be recognized when the disease results in symptoms such as visual loss, facial paraesthesia or lymphadenopathy, or systemic symptoms, such as fatigue, bone pain or abdominal pain

Full radiological assessment plays a vital part in making the diagnosis and planning treatment. Computerized tomography (CT) gives excellent bony detail but magnetic resonance imaging (MRI) using T2-weighted images, allows differentiation of mucosal thickening and retained sinus secretions from the tumour. Extension into the surrounding spaces and the cranial fossa is best assessed by coronal and sagittal T2 images.

MRI is the best technique for follow-up because no radiation is involved and better soft tissue delineation improves the distinguishing of tumour from fibrosis.

An 82-year-old male presented with a two-month history of hoarseness. A 2 cm pedunculated lesion was removed from the base of his epiglottis. Microscopy showed a polypoid atypical spindle cell lesion. Multiple levels failed to reveal an invasive squamous cell carcinoma. On the basis of haematozylin and eosin stained sections the main differential diagnosis was a pseudosarcoma with an overlying dysplastic squamous mucosa or infiltrating spindle cell carcinoma. Immunohistochemistry showed positive staining for vimentin but no convincing staining with antibodies to cytokeratin and EMA. Ultrastructural analysis also failed to reveal epithelial characteristics. Ploidy analysis by static cytophotometry of the spindle cell proliferation revealed an aneuploid stem line with a DNA index of 1.67. On the basis of this the process was felt unlikely to be reactive and a diagnosis of a spindle cell squamous carcinoma was made. This diagnosis was subsequently supported by a clinical recurrence of the nodule at a six-month follow-up.

This report describes a 59-year-old black man who had an acinic cell carcinoma with associated malignant spindle cell transformation in the parotid gland. To the best of our knowledge, a similar lesion in the salivary gland has not been previously reported.

Bilateral pneumothorax may occur after emergency tracheotomy, if a significant upper airway obstruction with a large negative intrathoracic pressure exists.

Sjogren's syndrome is an autoimmune disease characterized by exocrine gland destruction and manifested by parotid, submandibular and lacrimal gland infection. We report a case with recurrent severe parotid gland infections. The sialographic and CT findings are presented.

Metastatic carcinoma of the palatine tonsil is rare, with only 92 cases reported in the world literature. We report a case of tonsillar metastasis from the colon. This is an unusual case not only because it is the first case report of tonsillar metastasis from this site but also because the tonsillar secondary is the first sign of the primary disease.

Rhabdomyomas of the larynx are rare tumours. In the literature to date 18 cases have been reported. They usually present with slowly progressive symptoms typical of their benign nature. We present a case that has many atypical features for an ‘adult’ type rhabdomyoma and discuss the relevant associated literature.

Inflammatory pseudotumours or plasma cell granulomas are space-occupying, rounded masses appearing in various locations usually as an aftermath of recurrent infections.

Recurrent pain and mass have been the most common presentations (Durst et al., 1977). These have been confused with tumours but radical surgical treatment is unnecessary, in the absence of life-threatening complications. The prognosis is excellent after excision. The nature and pathogenesis of the inflammatory pseudotumours, their presentation as fever and anaemia in some cases, are unknown.

This report is probably the first case of a plasma cell granuloma involving the maxillary sinus causing focal erosion of the orbital wall, simulating a malignant tumour clinically.