A case of a cerebellopontine angle lipoma is presented with a typical clinical, audiometric and radiological features of an acoustic neuroma. The correct pre-operative diagnosis was elusive even with the aid of magnetic resonance imaging.

Osteoma is the commonest benign tumour of the paranasal sinuses (Handousa, 1952). A case of a large osteoma removed from the frontal and ethmoid sinuses is presented. Histopathological examination of this tumour revealed evidence of bony remodelling similar to that seen in Pagets' disease which has not been previously reported. The pathological significance of this finding is discussed.

Munchausen syndrome by proxy (MSBP) is a rare condition in which a parent or guardian fabricates an illness in a child either by inducing physical signs or prevaricating. A case presenting as recurrent episodes of infant apnoea is reported. A high index of suspicion is required for the diagnosis and, therefore, the otolaryngologist must be familiar with the condition if the life of the infant is to be protected and potentially harmful unnecessary investigations are to beavoided.

Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin.

A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally.

For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.

Aspergillus sp. are the most common contaminants of the paranasal sinuses with the maxillary sinus as the site most frequently involved. Fungal sphenoid sinusitis can be a life-threatening situation, thus aggressive therapy is indicated. The treatment is primarily surgical. The transnasal endoscopic technique offers excellent visualization and an atraumatic approach to the sphenoid sinus. Surgical exteriorization and aeration of the involved sinus, without using antifungal chemotherapeutic agents is curative. A rare case of sphenoid sinus aspergiUosis which was successfully treated by transnasal endoscopic sphenoidotomy is reported.

A case is reported in which a patient presented, 18 months after initial injury, with a progressive proptosis of the left eye. X-rays did not reveal a foreign body but a fracture of the lateral orbital wall and an area of soft tissue density were seen on the CT scan. Exploration of the orbit revealed a 2 cm wooden fragment in the floor of the orbit.

Although intrusions of glass fragments into the frontal sinuses are not uncommon in traffic accidents, a case with a tooth in the frontal sinus has never been reported. We report a patient with traumatic inclusion of an incisor tooth in the contralateral frontal sinus. Radiographic investigations demonstrated the tooth in the frontal sinus though no skin damage was recognized on the upper face. The usefulness of CT scan in localizing the missing tooth after facial trauma and its route of entry into the contralateral frontal sinus is discussed.

Localized amyloidosis of the larynx is usually described as a non-bleeding lesion. We report a patient with localized laryngeal amyloidosis who developed a massive upper respiratory tract haemorrhage and died. This potentially fatal complication of localized amyloidosis of the larynx merits recognition as the disease could be controlled in most instances by surgical excision of the amyloid deposit.

The aspiration of contrast medium during the investigation of swallowing disorders is a well recognized hazard. It is therefore essential that the contrast medium administered is non-irritant to the lungs. A case is presented to illustrate the problems associated with the aspiration of a relatively non-irritant contrast medium.

Haemangiopericytoma is a rare, soft tissue, tumour with unpredictable biological behaviour. A case of haemangiopericytoma of the parotid salivary gland is reported. The clinical, surgical and histological features are described.

A polypoid, pedunculated tumour of the left palatine tonsil was incidentally detected in a 42-year-old female. It was composed of mature fat and was covered by a nonkeratinizing squamous epithelium with an underlying rim of fibrous tissue. The literature on tonsillar lipoma is reviewed and the differential diagnosis of polypoid lesions of the tonsil is discussed.

Chordomas are rare tumours which arise from notochordal remnants. A primary cervical chordoma of extranotochordal origin, sparing osseous structures, was excised by a bilateral neck dissection. The patient was disease-free two and a half years later.

The melanotic neuroectodermal tumour of infancy is a rare, pigmented neoplasm that most frequently arises from the anterior maxillary alveolar ridge. It presents in the first few months of life, and usually follows a benign course. A classical case is presented and the clinical, radiological and pathological characteristics are discussed. The importance of early conservative surgical excision is emphasized with, in general, a good prognosis.

This tumour, which many otolaryngologists may not be familiar with, should be included in the differential diagnosis of head and neck neoplasms in infants and young children.

Bay-leaf as a foreign body causing oesophageal obstruction has rarely been reported. We presenttwo such cases, and review their management.

Laryngeal papillomatosis is the commonest benign tumour affecting the larynx. Two forms are found i.e. juvenile onset and adult onset. Typically the juvenile onset form has a greater rate of recurrence and often remits with the onset of puberty (Corbitt et al., 1988). The human papilloma virus (HPV) is the causative agent (Abramson et al., 1987; Corbitt et al., 1988), specifically types HPV6 and 11. Attempts have been made to correlate the clinical behaviour of these two modes with the viral serotype and other aetiological factors such as smoking and hormonal factors (Abramson et al., 1987; Rimmel et al., 1992). Studies, however have shown that there is considerable variation in behaviour (Steinberg et al., 1983; Corbitt et al., 1988; Crissman et al., 1988). It is widely accepted that the disease ‘burns’ itself out, particularly with respect to the juvenile form. It is interesting and unusual therefore when the disease reappears after many years of remission. The following case report illustrates this point.

Peritonsillar or parapharyngeal abscess is not at all a rare disease. Usually the abscess is recognized as the underlying consequence of acute tonsillitis. However, the abscess may be caused by an internal fistula related to the second pharyngeal pouch. Presented here are the clinical, radiological and pathological aspects of an internal fistula with a parapharyngeal abscess related to the second pharyngeal pouch.

Ectopic ‘hamartomatous’ thymoma is a rare benign neoplasm. These tumours are found in the neck and are thought to be part of a spectrum of ectopic cervical thymic neoplasia. The clinical and histological features are discussed and the literature is reviewed. An attempt is made to explain in embryological terms why such lesions appear to occur more commonly on the left side.

Retrospective review of all patients with recurrent laryngeal nerve palsy seen at a comprehensive cancer centre over a 30 month period has revealed three patients with this diagnosis apparently related to massive venous thrombosis. All three patients had an underlying diagnosis of malignancy (two colon, one breast) and an indwelling central venous access device with its tip in the superior vena cava. Direct laryngoscopy was otherwise normal in all patients, and two had normal CT scans of the neck and mediastinum. This third patient had mediastinal adenopathy, but this was unchanged from the previous nine months. Although two patients expired shortly after this presentation, the other patient lived for one year and his palsy resolved with the resolution of his superior vena cava syndrome. Mediastinal inflammation secondary to the thrombophlebitis may be the direct cause of this unusual presentation.

Two cases of osteomyelitis of the cervical spine complicating tracheo-oesophageal puncture are reported. There was considerable delay between onset of symptoms and diagnosis in both cases due to pre-existing cervical arthritis. Previous radiotherapy was felt to be a contributory factor in both cases.

A case is reported of oat cell carcinoma of the lung presenting with unusual sites of metastasis to the orofacial region. Distant metastases are common in oat cell carcinoma but a literature review did not reveal any reports of metastases either to the hard palate or to medial canthus of the eye.