Silastic® (Dow-Corning) implants are used for augmentation rhinoplasty. Complications following their use usually occur within the first 24 months. We report a case in which the dorsal splint became displaced spontaneously five years after surgery.

On routine examination of a case of Waardenburg's syndrome apart from the usual features of the disorder, partial anodontia involving both the lower lateral incisors was evident.

The interesting association of partial anodontia and Waardenburg's syndrome is discussed along with relevant available literature.

We report the case of a 57-year-old patient with a presumed developmental anomaly of the medial orbital wall. The resultant protrusion of orbital contents into the ethmoidal complex was clearly demonstrated on coronal computed tomography (CT) scans of the paranasal sinuses. This anomaly presents a high risk of iatrogenic injury to the medial rectus and orbit during functional endoscopic sinus surgery and has not previously been described.

Schwannomas, arising from the Schwann cells of the nerve sheath, occur very rarely in the sino-nasal tract and histological diagnosis can, sometimes, be difficult. We describe a case of schwannoma of the sphenoidal sinus occurring in a 71-year-old man, who underwent complete excision of the tumour endoscopically. To our knowledge, this is the third case of sphenoid sinus schwannoma reported in the English literature.

This paper presents the long-term effect of restricted surgery for snoring and sleep apnoea. Patients with obstructive sleep apnoea (OSAS) (19) or heavy snoring (HS) (36) were studied prospectively for five to seven years after uvulopalatopharyngoplasty without tonsillectomy performed by regular surgical technique using local anaesthesia (LUPP). Five years after surgery, 90 per cent answered a questionnaire. All OSAS patients were offered a polysomnography, and the HS patients were offered a sleep study. Eighty per cent still showed a positive effect on daytime somnolence, and 77 per cent on snoring. Sideeffects were reported by 40 per cent; most common was choking (20 per cent) the first year. Eighteen per cent had local problems such as globus sensation. The polysomnography showed that 80 per cent were still ‘responders’ with an apnoea index (AI) reduction of >50 per cent. None of the HS patients had developed OSAS. In conclusion, LUPP in selected patients with OSAS or HS has a good long-term effect. Sideeffects are common, but diminish with time.

We present two cases of alar haematoma. This is a very rare complication of nasal trauma, and only two cases have been described previously. One case presented late and did not undergo surgical drainage and has a persistent cosmetic deformity. We recommend early surgical drainage when possible.

Tracheo-oesophageal puncture for voice restoration is a well-established technique post-laryngectomy. A number of complications can occur with the creation of a tracheo-oesophageal fistula (TOF) and in the subsequent management of the patient with an indwelling voice rehabilitation system.

This article is the first to report the use of Hylaform®, a colourless viscoelastic gel, to treat an intractable case of leakage around a Provox® 2 voice prosthesis. The procedure which required no anaesthesia resulted in no further leak around the valve to the present day, now more than four weeks post-viscoaugmentation.

Surgical emphysema is a relatively rare complication of dental surgery. Many cases go unrecognized or are misdiagnosed. Although the majority of cases resolve spontaneously, some can lead to potentially lifethreatening complications requiring emergency intervention. A case of surgical emphysema following a routine restorative dental procedure is presented. The differential diagnosis and management of this condition is discussed.

Both laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.

Positron emission tomography (PET) scanning has recently been introduced into clinical practice but its usefulness in the management of head and neck cancer is not well defined. The aim of this prospective preliminary study was to examine the clinical value of fluorodeoxyglucose (FDG) – PET in patients with head and neck cancer treated by radiotherapy with surgery in reserve by (i) relating quantitative uptake of isotope to tumour type and histological grade and (ii) comparing the imaging findings of PET and magnetic resonance imaging (MRI) in post-radiotherapy assessment of tumour response. Twenty-one patients had pre-treatment PET and MRI scans and these were repeated four and eight months after treatment if there was no clinical relapse. Pre-treatment uptake of FDG using tumour to cerebellar ratio parameters was significantly related to the histological grade of squamous cancer (p = 0.04) but not to tumour type. Discordance of post-treatment PET/MRI findings in one case indicates a possible role for PET in the early detection of tumour recurrence. Other potential uses of PET scanning in the management of head and neck cancer are discussed.

A case is reported in which an inhaled sewing needle, stuck fast in the trachea, became displaced through the tracheal wall during attempted removal via flexible bronchoscopy. The inherent risks and pitfalls of this procedure are highlighted.

A case of acute airway obstruction due to an acute retropharyngeal haematoma secondary to indirect trauma as a first presentation of metastatic prostatic adenocarcinoma is described.

It is commonly believed that external laryngoceles always penetrate the thyrohyoid membrane at the site of penetration of the neurovascular bundle. We present a case where the site of penetration was posterosuperior to this. Careful dissection of the neck of a laryngocele sac is important to prevent damage to the neurovascular bundle.

Stridor is a noisy breathing caused by compromised airway in the larynx and trachea. The causes can either be due to intrinsic or extrinsic compression. Stridor resulting from extrinsic compression due to anterior cervical osteophytes is rare.

We report an unusual case of acute stridor due to an osteophytic mass in the cervical vertebrae resulting in a mechanical upper airway obstruction. The underlying pathology was Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH). Stridor is a rare manifestation of DISH and it certainly represents the most lifethreatening one. Only a few cases have been reported in the English literature and are mainly secondary to impaired function of the vocal folds, or postcricoid ulceration and oedema. We present such a case, in that stridor was the result of direct airway obstruction by the osteophytic mass and an emergency tracheostomy had to be performed to establish an airway.

Congenital posterior laryngeal clefts are rare anomalies, being first described by Richter in 1792, and first operated upon successfully by Pettersson in 1955. Most clefts present within the first few months of life, with only a few cases being documented as presenting in adulthood. We present the case of a 50-year-old lady presenting with a previously undiagnosed posterior laryngeal cleft with an associated tracheoesophageal fistula. The defect was graded as 2 on the Benjamin and Inglis classification system of posterior laryngeal clefts. Following a literature review, we believe that our patient is the oldest to present with this congenital defect.

At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position.

At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8.

Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep.

This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.

A rare case of compartmentalized maxillary sinus mucocele 12 years after a Caidwell-Luc operation is reported. The two separate mucoceles were drained intranasally by endoscopic sinus surgery. The clinical features of this mucocele are presented and the incidence, presentation and theories on formation of post-operative mucoceles are reviewed.

Primary mucosal malignant melanoma (PMML) of the larynx continues to be a rare entity. To date, there are few cases reported in the world literature consisting of mainly isolated case reports and literature reviews.

Traditionally believed to be radioresistant, we present a case of PMML of the right vocal fold managed with right cordectomy and adjuvant radiotherapy. The patient is well without any evidence of local recurrence or metastasis three years and four months from presentation.

Tumours of smooth muscle origin are extremely rare in the upper aerodigestive tract. Immunohistochemical studies are helpful for accurate diagnosis of leiomyosarcoma. Here, we report a case of well-differentiated laryngeal leiomyosarcoma that showed rapid local growth but no metastasis. Diagnosis and treatment of leiomyosarcoma are discussed.

Development of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.