Localisation of a cerebrospinal fluid fistula in the nasal region is difficult. Lack of a suitable roentgen contrast medium for intrathecal use has earlier restricted theutility of cisternography. Metrizamide cisternography and CT have recently proved to be well tolerated and effective in revealing CSF fistulae. A case report of operatively treated CSF rhinorrhea recurring after three years is presented. With the help of CT metrizamide cisternography, the fistula could finally be localised in the sphenoidal sinus. The re-operation confirmed this finding. The technique of cisternography is described.

Otorhinolaryngological manifestations of 13 patients with von Recklinghausen's disease appearing at Lagos University Teaching Hospital over a five-year period have been studied. Among patients with ENT manifestations of the disease, the most common general features exhibited were cutaneous neurofibromas (100 per cent), headache (69.23 per cent) and pruritus (46.15 per cent). But the head and neck findings included external meatal canal stenosis (30.77 per cent), conductive deafness (30.77 per cent), nasal discharge (30.77 per cent), cranial nerve involvement (30.77 per cent) and disfigurement of the soft tissues of the face (30.77 per cent). Involvement of pinna (23.31 per cent), rhinolalia aperta (15.38 per cent), mental retardation (15.38 per cent) and pharyngeal swelling (7.69 per cent) also featured. Clinically detectable bilateral acoustic neurofibromas in adults or astrocytomas in children were not found in this series. Involvement of the frontoparietal bone (7.65 per cent) presented with skull bossing which had to be differentiated from that due to sickle cell disease in the African. There was also a singular case of phrenic nerve involvement. However, malignancy occurred in one (7.69 per cent) of these patients. Thus, it is important always to follow-up these patients closely so as to detect malignant transformation in time.

The authors have treated a 61-year-old woman with neurilemmoma of the larynx. The tumour was located in the submucosal region of the arytenoid on the right side of the larynx. Surgical resection of the tumour had to be done by external neck excision instead of endoscopically.

A case is described in which upper airway obstruction was successfully treated using cri-cothyroidotomy in association with high frequency jet ventilation. This procedure allowed time for the patient to be transferred to the operating theatre for formal tracheostomy under optimal conditions. It is suggested that the Portex ‘Mini-trach’ kit, though primarily designed for tracheobronchial toilet, can be used to provide a satisfactory and safe airway during the resuscitation of an obstructed patient, particularly if jet ventilation is available.

The fourth example of an acinic cell carcinoma arising in the sinonasal tract is presented. Because of its unusual and atypical histologic appearance, correct diagnosis required electron microscopic analysis and the demonstration of intracellular amylase by immunohistochemical stains.