A rare case of an atypical lipoma in the pyriform sinus is described with an unusual presentation and some difficult histological features. Excision was performed endoscopically, there has been no evidence of recurrence for over a year. External surgical excision is reserved in case of recurrence of the tumour.

An unusual case of cryptococcosis of the larynx is described in a non-immunocompromised patient. To our knowledge this is the second reported case in the literature.

Myxoid tumours have the essential common feature, that they are difficult to remove radically because of their gelatinous consistency. Only one previous report describes a myxoid tumour—a myxoma—located to the temporal bone. This paper presents two such tumours in the temporal bone, a myxoma and an extraskeletal myxoid chondrosarcoma. The clinical and histological features of these tumours and the operative treatment are described and discussed.

We report two cases of poorly differentiated mucoepidermoid carcinoma of the larynx which both remain well after surgical management. The first underwent a radical neck dissection for recurrent disease following radiotherapy and the second a total laryngectomy with elective post-operative radiotherapy.

Although well differentiated (‘low grade’) mucoepidermoid tumours of the larynx may respond to radiotherapy surgical management is generally recommended for all grades of such tumours especially for poorly differentiated (‘high grade’) tumours. Elective post-operative radiotherapy is often advocated for high grade tumours; radical neck dissection is generally undertaken only in the presence of lymphadenopathy, although elective radical neck dissection has been proposed for high grade tumours. These cases emphasise the value of comprehensive surgical management for this condition.

Such laryngeal tumours are difficult to diagnose histologically from biopsy and are often initially reported as squamous cell carcinoma.

The authors describe an unusual case of a primary chondroid chordoma arising from the base of petrous temporal bone. The patient, a young male, presented with a left sided jugular foramen syndrome. The CT findings of a tumour arising from the base of the left petrous temporal bone were confirmed at infratemporal exploration. The clinical and histopathological and immunohistochemical differences between classical (typical) chordoma and its chondroid variant are highlighted. The rarity of primary chordomas at this site is stressed.

A 64-year-old man with right aural discharge presented complaining of progressive deafness. Other otological symptoms were absent and specifically there was no seventh nerve paresis. A right aural polyp was identified and biopsied. Histology showed the polyp to be a schwannoma.

Subsequent temporal bone computed tomography showed expansion of the distal facial canal. At operation, the schwannoma filled the middle ear cleft and extended from the genu to the region of the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb.

Facial paresis is the usual presenting feature of a facial schwannoma, while deafness, ageusia and reduced lacrimation are variable, dependent upon the site of the lesion. The absence of facial palsy as a presenting feature is very rare and this case illustrates the need for histological examination of all abnormal aural material.

‘Factitious illness’ is a recently classified group of diseases characterized by repeated purposeful simulation of physical or mental illness in order to obtain medical or psychiatric treatment. ‘Münchausen Syndrome’ is a classical example of this group.

The case reported is a 26-year-old Caucasian male who presented with recurrent facial swelling between December 1978 and November 1987. His true condition eluded diagnosis for so long because he presented repeatedly with overt clinical signs which appeared severe enough to justify the symptoms claimed.

A case report of a patient with carcinoma of the rectum with metastasis to the tongue clinically mimicking a primary tongue neoplasm is described. The patient presented with an ulcer in the tongue three years after undergoing an anterior resection for a Dukes C carcinoma of the rectum. Other asymptomatic metastatic lesions were discovered only after the histology report suggested that the tongue ulcer biopsy was metastatic in origin. Metastatic tumour to the tongue is extremely rare and often occurs at a late stage, when there is disseminated disease. We are not aware of any reported case of tongue metastasis from carcinoma of the rectum.

Primary cholesteatoma has been described in a number of sites within the temporal bone. We report an unusual case of primary cholesteatoma, confined to the mastoid, presenting with a Bezold's abscess of the anterior cervical triangle, in an otherwise asymptomatic elderly man with normal hearing.

In neonates, acquired subglottic stenosis (SGS) is the most serious long term complication of endotracheal intubation. In this case report, we describe the pathological changes in the larynx of a child who died two years after successful treatment, involving corrective surgery, for neonatally acquired SGS. Stenosis, due to dense fibrous connective tissue, was still present at death. However, there was evidence that there had been growth of the laryngeal cartilages. Disruption of the laryngeal cartilages was present anteriorly due to the antecedent surgery but major cricoid cartilage injury secondary to intubation was not seen. The crico-arytenoid joints demonstrated ankylosis and to this was attributed the abnormal quality of voice noted in the child at follow-up. The pathological changes are considered in relation to the pathology of endotracheal intubation and pathogenesis of acquired subglottic stenosis.

A case is described, of a patient who sustained a spontaneous perforation of the cervical oesophagus in association with a ongenital oesophageal web.

The case of a 64-year-old man who presented with severe left sided facial pain and cyanosis of the left ear, preauricular region and tongue is described. Digital subtraction angiography confirmed complete occlusion of the left external carotid artery. The patient was anticoagulated and his symptoms resolved over the following month, presumably due to improvement of collateral blood supply to the ischaemic areas. The literature on the clinical manifestations of external carotid ischaemia is reviewed and the relationship between facial pain, internal and external carotid atherosclerosis is emphasised.

A case is described in which a transpalatal, transpharyngeal approach was used for access to a cyst of the petrous apex.

Although its indications are limited, in selected patients this conservative procedure has advantages over the more invasive lateral routes.

Neurological complications are rare after central venous cannulation. We report a case of right vocal cord paralysis after internal jugular vein cannulation. The mechanism of neural injury is discussed.

We report a case of combined severe subglottic and lower tracheobronchial stenoses after an inhalation burn injury. The patient was successfully treated by the insertion of a bifurcated silicone rubber stent. The proximal limb of the silicone tube was used to stent the subglottic stenosis after it had been resected, a treatment option not previously reported. It is speculated that the diffuse airway damage resulted from a combination of thermal injury, mechanical trauma and infection. The relatively late symptomatic presentation of the lower tracheal stricture is stressed and the treatment options discussed.

Fibrous histiocytoma is uncommon in the head and neck region and rare in the larynx. Its behaviour is unpredictable.

A case is reported in a 54-year-old male which was treated conservatively initially and which recurred several times over a seven year period. During that time the appearances of the lesion changed from those of a densely collagenous, cytologically benign tumour to those of a richly cellular and potentially malignant neoplasm. Laryngectomy was eventually undertaken.

Left recurrent laryngeal nerve runs a long intrathoracic course in close relationship to the aortic arch and adjacent heart structures and, hence, is liable to be injured by diseases affecting the heart and its great vessels.

We report a case of Ebstein's anomaly causing left recurrent laryngeal nerve paralysis in a neonate. To our knowledge, this is the first reported case of vocal cord paralysis associated with this condition.

A rare case of an intrahyoid thyroglossal duct cyst in a 63-year-old woman is reported. The pertinent literature is discussed.