The most commonly used incision for parotidectomies is the modified Blair incision. We have successfully used an alternative incision which allows good exposure, and leaves no neck scar.

Between 1 March 1989 and 1 August 1991, 18 parotidectomies were performed using a modified facelift incision. Fifteen parotidectomies were done for similar indications during the same period using a modified Blair incision. The mean age in both groups of patients was 40.3 years. The pathology and incidence of complications was similar in the two groups. The difference in mean (±SD) time of surgery between the two groups was not statistically significant: 3.14 ±0.75 hours in patients with a modified facelift incision and 3.25 ±1.27 hours in patients with a modified Blair incision (p<20.1).

The modified facelift incision is an alternative approach to parotidectomy for selected patients. It provides adequate exposure, even for a total parotidectomy and mastoidectomy and it results in improved patient satisfaction without additional risk of complications.

Malignant external otitis is classically associated with insulin-dependent diabetes mellitus probably due to generalized systemic immunodeficiency (Mowet and Baum, 1971). A unique case of malignant external otitis associated with Waldenstrom's macroglobulinaemia is presented.

A prospective study was designed to compare the effects on voice capacities after either suspension microlaryngoscopic surgery or indirect microlaryngostroboscopic surgery. Patients where the clinical diagnosis 'dysphonia due to a benign lesion of the vocal fold' was made, and who could be operated in either way, entered the study. Post-operative voice evaluation was performed on 21 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The long-term voice results following indirect microlaryngostroboscopic surgery and suspension microlaryngoscopic surgery demonstrate a statistically significant improvement for the maximum intensity, maximum dynamic intensity range, dynamic intensity range at habitual speaking pitch, and melodic pitch range. In selected cases indirect microlaryngostroboscopic surgery offers a very good functional result.

This study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

A study of 20 cases of gastric tube transposition following total laryngopharyngoesophagectomy during an eight-year period is presented. The site of the tumour was: hypopharynx in 13 cases (12 pyriform sinus, 1 postcricoid); and cervical oesophagus in seven cases. There were nine (45 per cent) Stage III lesions and 11 (55 per cent) Stage IV lesions (UICC, 1987).

Post-operative morbidity rate was 15 per cent. Hospital mortality rate was 10 per cent (cause of death was myocardial infarction). Anastomotic fistula rate was five per cent. Excluding hospital mortality, the three year actuarial survival rate was 35 per cent for the whole series and 53 per cent for patients with hypopharyngeal cancer. The actuarial survival rate for patients with oesophageal cancer at one and two years was 41 and zero per cent respectively.

The transposition of a tubed stomach provided successful swallowing in two-thirds of the patients for a period of more than a year and these patients developed good neoesophageal speech.

Two patients with labyrinthine fistulae following chronic otitis media are presented. Anaerobic bacteria, especially Bacteroides spp. and Bacteroides fragilis were recognized as important pathogens in the disease.

A series of 59 patients of all ages with recurrent respiratory papillomatosis (RRP) treated over an 18-year period is presented. A number of these patients were initially diagnosed in childhood but required treatment throughout adult life. The frequency of laser treatment was not related to either disease duration or age at onset. In 28 patients, the HPV type was identified, showing that HPV type 11 was more common in children and ran a more protracted clinical course. The requirement for tracheostomy in this series was small, whereas the incidence of malignant change in adult patients was significant

Deafness is known to be associated with certain autoimmune disorders. This article describes a hitherto unreported possible association between pyoderma gangrenosum and progressive bilateral sensorineural deafness.

The ability of a target-controlled propofol infusion system to provide sedation for patients undergoing assessment of the upper airway during snoring is presented. This technique provides the desired sedation level for induction of snoring and is short acting and readily controllable. We advocate its use in sedation nasal endoscopy.

Abstract The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The ‘Allan Johnson’ modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.

This paper compares the physical parameters of the newer Groningen low resistance and Provox indwelling laryngectomy prostheses with the established and original Groningen device.

In vitro pressure/flow profiles were determined, using specially designed apparatus, in 44 standard Groningen high resistance (GHR), 37 Groningen low resistance (GLR) and 19 Provox tracheo-oesophageal prostheses prior to insertion. GHR valves had significantly higher forward opening pressures than both the newer valves and the GHR was significantly higher than the Provox (p<0.01: Mann-Whitney U-test). The mean forward resistance of GHR was significantly higher than that of both; the Provox valve was significantly lower than that of GLR (p<0.0001: Mann-Whitney U-test). This may be of relevance with respect to patient acceptability, voice quality and effective duration of valve action.

The implementation of audit in most hospital departments in the UK has been instigated by the guidelines set out by the Royal Colleges. This paper aims to demonstrate the results of regular subregional audit meetings in the ENT departments involving three District Hospitals in East Anglia. We report the effects of audit meetings in improving the management of epistaxis, whereby a protocol for treatment and discharge was established, the duration of the nasal pack left in situ was reduced, and the material of the pack was changed.

Chlamydia pneumoniae has been implicated as a cause of tonsillitis and pharyngitis, but the incidence has varied from one to 19 per cent in various studies. We investigated 51 patients admitted to University College Hospital, Galway, with severe tonsillitis. Throat swabs were examined for evidence of Chlamydia pneumoniae using a direct monoclonal antibody test. Blood was taken for serology from 45 patients. A further specimen was taken at six weeks. A control group of 32 blood bank sera was used. Mean hospital stay was three days (one to eight). Five patients (10 per cent) were monospot positive. Chlamydia pneumoniae was identified by direct immunofluorescence on a tonsillar swab from one patient who did not seroconvert. IgG antibody was identified in 13 cases (29 per cent) and in seven of the control group (22 per cent). No serological evidence of recent infection was found. Chlamydia pneumoniae was not found to be a cause of severe acute tonsillitis in our study group.

Primary tracheal tumours are extremely rare and present with widely variant clinical and histological features. Treatment methods vary considerably, and few studies have sought to provide adequate guidelines. A retrospective analysis was carried out of all patients treated in our unit between 1965 and 1990. Our experience deals almost exclusively with high tracheal tumours involving the adjacent subglottic region. Squamous carcinoma (SCC) and adenoid cystic carcinoma (ACC) were the commonest subtypes, and presented with dyspnoea and hoarseness as the most frequent symptoms. ACCs occurred commonly in young individuals, presented insidiously, and ran a long, and often, unpredictable course. Endoscopic evaluation revealed the majority of the lesions to be bulky and obstructive in nature. Primary surgery with adjuvant radical radiotherapy, when indicated, appeared to provide optimal results. Debulking surgery followed by radiotherapy provided effective and lasting control in two cases of ACC. Other malignant subtypes behaved aggressively and progressed uncontrolled.

For many years it has been recognized that seemingly benign neck cysts may contain carcinoma. The true incidence is unknown. This paper investigated nine out of 270 patients presenting with a neck mass — which proved to contain a squamous carcinoma. Records (from a 30-year period) of over 3400 patients with squamous carcinoma of the head and neck, were examined. The histology slides were reviewed, the number of cystic lesions was noted and also the clinical outcome. Out of the 270 patients nine presented with a cystic lesion and these were studied. Six cystic lesions were originally diagnosed as branchial cysts although the youngest age was 39 years. All patients underwent a simple excision.

In six cases the tonsil was the primary site, in one the primary was in the base of tongue and in two the primary remained occult. One-third of the patients had died of their disease by the time this report was written and the maximum follow-up time for the remaining patients was 18 months. Therefore 16 per cent of branchial cysts in this series represented metastases from squamous cell carcinoma.

At the Royal Liverpool University Hospital only 25 patients had branchial cysts excised between 1988 and 1993: out of these only four contained squamous carcinoma.

In patients over 40 years of age panendoscopy and ipsilateral tonsillectomy is mandatory prior to cyst excision.

Eighteen patients with bony defects of the mandible had the mandible reconstructed using conventional nonvascularized bone grafts from the iliac crest. After surgery they received radiotherapy for cancer in the oropharynx or oral cavity. This study was carried out over a 10-year period. All patients were followed-up both for their tumour growth and the results of their reconstruction. Four to 10 years after surgery 55.5 per cent were alive and well. Full dental rehabilitation was achieved in 33 percent and 12.5 percent were without dental rehabilitation.

We examined a very unusual patient who developed peripheral facial palsy with chickenpox. A survey of the English literature revealed that eight such patients had been reported, but the period between the appearance of the vesicles of varicella and the facial nerve palsy ranged from five days before to 16 days after the eruption development. We presume that the route of infection was neurogenous in patients who had palsy after the appearance of the eruptions, but haematogenous in patients who had palsy before the appearance of vesicles. The two patients whose infection route was presumed to be haematogenous, had a poor prognosis.

Cricket is a national sport in some countries and can be potentially hazardous. We report an incident of a cricket ball impact to the chin, which resulted in posterior dislocation of both temporomandibular joints and bilateral mixed deafness. There appear to be no similar case reports in the literature.

Since 1976, in our department, the external perichondrium of the ala of the thyroid cartilage of the nondiseased side has been successfully applied in repairing endolaryngeal defects and reconstructing the laryngeal wall in 22 cases. The post-operative result was good in the most cases.

Abnormal sensitivity to environmental sounds is a short-term feature often observed following insertion of grommets. Here we describe a child with this symptom who was found to have Williams syndrome, a condition in which hyperacusis is observed in 95 per cent of patients.