Tumours of the parapharyngeal space are not common. The majority arise from the deep lobe of the parotid gland or neurovascular structures. We describe a case of fibromatosis, which has not previously been reported at this site.

A distinction between a peritonsillar abscess and peritonsillitis is useful clinically, as the former requires surgical drainage while the latter merely requires treatment with antibiotics. To evaluate the diagnostic implications of performing ultrasonography of the tonsils in patients with clinically diagnosed peritonsillar abscess, 27 patients underwent ultrasound examination before needle aspiration of the abscess was performed. Ultrasound was able to detect peritonsillar abscess in91 per cent of the cases (sensitivity rate), with a false negative rate of nine per cent and a false positive rate of 20 per cent. The specificity of the test was 80 per cent, and was able to differentiate abscess from peritonsillitis in 88.9 per cent. On the basis of these results we conclude that ultrasonography of the tonsils in patients thought to have peritonsillar abscess is a useful adjunct, enhancing diagnostic accuracy and reducing unnecessary surgical drainage.

A case of a single inflamed mastoid air cell is described. This was initially interpreted as a facial nerve schwannoma on MRI examination. Careful evaluation of the signal characteristics and additional findings from the high resolution CT examination helped to establish the correct diagnosis.

Internal carotid artery trauma is a rare but potentially disastrous complication of surgery to the sphenoid sinus and pituitary gland. Emergency and elective procedures to establish haemostasis are discussed.

Laryngocoele is a well known but uncommon condition in Otolaryngology. CT scanning is superior to other imaging modalities in establishing the diagnosis, delineating the anatomy and aiding in the management. A case is presented with a review of the literature

Leiomyosarcoma of the larynx is extremely rare. Histological diagnosis excluding other tumours, in particular fibrosarcoma and spindle cell carcinoma is often difficult. Immunohistochemical studies are helpful in arriving at an unambiguous diagnosis and we present a case characteristically positive for actin and desmin. The difficulties of determining treatment are discussed.

Angiosarcoma is a tumour of endothelial origin rarely found in the head and neck. A case of angiosarcoma of the pyriform sinus, treated by surgery and post-operative radiotherapy, is reported, providing a cue for discussion of the diagnostic, clinical and pathological pecularities of the tumour in the light of personal experience and the published data.

A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.

A case is presented of a laterally occurring thyroglossal cyst. In conventional teaching, thyroglossal duct remnants occupy the midline, or a position adjacent to the midline, and are found in a line marking the descent of the thyroid anlage and move upwards on protruding the tongue. Laterally presenting thyroglossal duct remnants are unusual.

Fourth branchial pouch anomalies are rarely reported. A case is described of an isolated branchial cyst which was found to contain ectopic thyroid tissue. This case, together with four others previously reported, support the theory that the thyroid gland may receive contributions from the fourth branchial pouch during development.

Clear cell carcinoma of salivary gland is a rare neoplasm. We report a third case of clear cell carcinoma arising in a pleomorphic adenoma and also in an extraparotid location. We document the immunohistochemical profile of the tumour including reactivity with a marker for the c-erbh-2 oncoprotein and suggest a myoepithelial origin for these lesions. The presence of a tetraploid stemline may account for the rapid tumour progression in this case.

We report a rare case of metastasis of a follicular carcinoma of the thyroid to the sino-nasal cavity 12 years after diagnosis and treatment of the primary malignancy and review the literature of previously reported cases.

Clinically, lipomas of the hypopharynx may be confused with other benign or even malignant lesions. Barium flow radiography allows depiction of lesions cranial to the epiglottis, but often fails to be accurate for subepiglottic lesions. CT however has allowed a certain diagnosis to be made in many cases in the past. MRI is still more accurate, and allows not only a more specific diagnosis of the lesion, but also a better depiction of the origin of the pedunculated lesion and its extension in the parapharyngeal space. This paper adds three cases to the 52 cases in the literature already described and presents the typical features of hypopharyngeal lipoma by MRI for the first time.

The case of a minor salivary gland tumour, arising from the tongue, with nodal metastasis is presented. Biopsy of the tumour and fine-needle aspiration cytology of the neck swelling showed the presence of a clear cell carcinoma with evidence of nodal metastases. A commando operation was performed and the defect was reconstructed using a local tongue flap. The literature review indicated that the neoplasm was rare and its site of occurrence rather unusual.

We present a case of secondary carcinoma of the external auditory meatus from a probable breast primary with a review of the literature.

A rare case of adenocarcinoma of the submandibular gland with positive serum measurements and tissue immunohistochemical stainings for both CEA and CA 125 is presented.

Laryngeal myxomas are rare benign mesenchymal tumours in contrast to myxomatous degeneration in laryngeal polyps which occurs frequently. A correct diagnosis of myxoma is usually not difficult to reach if the possibility of myxomatous degeneration in laryngeal polyps is excluded and strict pathological criteria are adhered to. We report a myxoma arising from the left vocal fold in a 64-year-old male who presented with a four-year history of intermittent dysphonia. Although excision was microscopically incomplete, there is no evidence of recurrence macroscopically 18 months later and the patient remains asymptomatic.