Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Although the annual incidence of Wegener's granulomatosis in the general population is not known, most European and American studies revealed an incidence in the range of one for every 250,000 of the population. The estimated total population of Bahrain as of June 1997 is 586,110; here we report the first diagnosed case of Wegener's granulomatosis in Bahrain.

Our patient presented with epistaxis, and from the clinical features, the very high ESR, the operative, histopathological and the radiological findings, and a high index of suspicion we could confirm the diagnosis along with the appropriate immunological test (positive cANCA). Standard treatment with cytotoxic agents and corticosteroids has been used. On follow-up the patient has shown a progressive improvement in her clinical and laboratory parameters.

We report an unusual case of internal jugular vein thrombosis in a 57-year-old female, with the recently discovered factor V Leiden (FVR506Q) mutation. The molecular basis of this mutation is described, and the importance of screening for hereditary venous thrombotic states is emphasized.

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology – Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autoiogous fat in one patient in whom this material was used for injection laryngoplasty.

We encountered a 59-year-old man with angiomyoma of the retropharyngeal space. He had been referred to our hospital because of a six-month history of a sensation of a narrowed pharynx. A smooth-surfaced tumour arising from the posterior wall in the hypopharynx was observed by indirect laryngoscopy. Radiographical imaging revealed a solitary tumour with homogenous contents in the retropharyngeal space. The tumour was successfully removed via a lateral pharyngotomy approach under general anaesthesia. Histopathologically, the tumour was composed of numerous veins with thick muscular walls. To the best of our knowledge, this is the first report of an angiomyoma arising in the retropharyngeal space.

Intramuscular haemangiomas are uncommon tumours of the head and neck, occurring mainly in adults and usually located in the region of the masseter muscle and parotid gland. We report the case of a child with an intramuscular haemangioma over the left maxilla, which caused some diagnostic confusion in view of its atypical location combined with the unusual age and inflammatory mode of presentation.

This case highlights a potentially disabling complication of intermittent claudication inthe region of the masseter muscles on mastication, following bilateral external carotid artery ligation for epistaxis. Although there have been few reports of this complication this may be a reflection of the fact that the operation is rarely performed, and not because the complication is rare. Its potentially disabling nature, and its possible common occurrence after this procedure make awareness of it by surgeons who may carry out this procedure important.

Choroid metastasis of primary nasopharyngeal carcinoma is an infrequent event. Here, we report a case of nasopharyngeal carcinoma with metastases to the choroid successfully treated by external beam radiotherapy.

We present a rare case of a giant intra-parotid calculus in a 64-year-old man with recurrent parotitis. The literature is also reviewed.

Tuberculosis, and non-tuberculous mycobacterial infections are becoming more common thus it is more likely that otolaryngologists will encounter these conditions. We describe an otherwise well patient, with symptoms and signs from chronic uvular inflammation, who proved to have a primary mycobacterial infection. This is an unique presentation in the literature and reminds clinicians of the need, where uncertainty exists in diagnosis, to consider mycobacterial infections.

Tumour metastases to the tonsil are rare and are usually due to spread from malignant melanoma and carcinomas of the breast, lung, kidney or stomach. We describe the clinical and histological findings of a tonsillar metastasis from a malignant pulmonary carcinoid tumour, an occurrence not previously reported.

Benign chondroma affecting the soft tissues is uncommon. This tumour is particularly rare in the neck. We present the first case of soft tissue chondroma arising in the parapharyngeal space of a 20-year-old man with a two-year history of a gradual sensation of a swelling in the pharynx with increasing snoring. The CT and pathological features of this lesion will be discussed. We suggest that a peroral approach should be considered for benign parapharyngeal tumour which has been demonstrated on imaging to be in the anterior parapharyngeal space, especially for tumours that are medial to the pterygoid muscles even though the tumour is a large one.

The present report documents the successful outcome in three patients with a unilateral recurrent laryngeal nerve paralysis managed with an intracordal injection of autologous fat who ultimately experienced a complete recovery of function. Such data demonstrates the safety of intracordal autologous fat injection in patients who ultimately recover function.

An 86-year-old man was referred by his family physicianto our clinic because of sudden onset aphonia immediately after a Japanese-style bath. On examination, the only abnormality was aphonia, with an otherwise normal physical examination. However, we found vocal fold oedema on laryngeal fibrescopy. For treatment, he was immediately given 30 mg prednisolone intravenously. Twelve hours after injection the oedema had completely disappeared and his aphonia had resolved. The patient was healthy for three months after returning home. However, at the beginning of a cold winter night he again complained of sudden onset hoarseness, after taking a Japanese-style bath.

Japanese-style baths are completely different from Western-style baths. There is a temperature difference of almost 30°C between the inside and outside of a bath; the transition may represent a type of physical exercise in elderly and exhausted individuals. This difference could cause a cold or heat-induced allergic reaction. We strongly recommend a laryngeal study in case of sudden onset aphonia.

A 20-year-old male presented with a small stab wound to the neck and with haemodynamic signs of significant haemorrhage, but no signs of local bleeding. On exploration, an intact vagus nerve and internal jugular vein were found, but the common carotid artery was not immediately apparent. Careful dissection confirmed a completely transected common carotid artery with the two ends contracted and retracted. A primary repair was performed and post-operatively the patient recovered completely and had no neurological deficit.

Pigmented villonodular synovitis, a benign but locally destructive fibrohistiocytic proliferative lesion involving tendon sheaths, bursae and diarthrodial joints, is distinctly rare in the temporomandibular joint. We report one such case occurring in a 42-year-old housewife who presented with a progressively enlarging right zygomatic mass for six months. On exploration, an orange-brown firm mass, 5 × 3 × 2 cm, was seen adherent to the lateral aspect of the capsule of the right temporomandibular joint, and eroding into the inferior aspect of the right temporal bone and part of the mandibular condyle. The mass was completely excised. Pathological examination showed features typical of those of pigmented villonodular synovitis and the lesion was entirely extra-articular in location. The patient remained well with no evidence of local recurrence two years after operation. Review of the literature and careful analysis of the clinicopathological features showed that the vast majority of the reported cases of pigmented villonodular synovitis of the temporomandibular joint belonged to the extraarticular variant, which is associated with a more aggressive local infiltrative behaviour and higher rate of local recurrence than the localized type. The recommended treatment for this condition is therefore wide local excision, aiming to remove the lesion as completely as possible without producing severe disability for the patient.

We present a case of well-differentiated liposarcoma of the hypopharynx in a 51-year-old male, with a review of the literature of this very rare condition.

Lipoma is the commonest soft-tissue tumour arising anywhere in the body, but its occurrence in the nasopharynx is extremely rare. Only four cases in adults have been previously reported in the English literature. We describe a 63-year-old woman with a nasopharyngeal mass that was removed transorally and verified histopathologically as chondrolipoma, that is a lipoma with chondroid metaplasia.

Obstructing tumours of the upper airways have been demonstrated to alter the flow volume loop of pulmonary function testing. These alterations could be clues to the nature and location of the obstruction. This report describes a case of a pedunculated squamous cell carcinoma arising in the pharynx whose flow volume loop showed a saw tooth pattern which reflected the location and structure of the tumour.

Upper airway obstruction is an uncommon but recognized complication of infectious mononucleosis. The management depends upon the degree of airway compromise. In the case described, severe airway obstruction was treated by securing the airway with awake fibre-optic endoscopic intubation and then proceeding to tonsillectomy. Bilateral inferiorly loculated quinsies were encountered unexpectedly and drained. This is the first report of ‘bilateral’ quinsies, associated with infectious mononucleosis and severe airway obstruction. The association, pathogenesis and significance of this finding are also discussed.

We report a case of an impacted foreign body in the tonsil presenting as recurrent unilateral tonsillitis. A completely embedded foreign body should be considered in cases of recurrent unilateral tonsillitis.