An 80-year-old man was seen in the clinic with a two month history of pain, bleeding and deafness in his left ear; accompanied by a left facial palsy. Six months earlier, anaplastic carcinoma of the bladder had been diagnosed and treated with radiotherapy. On examination there was a mass in his left external auditory canal and VII, VIII, IX and X left cranial nerve palsies. Histology of a biopsy was identical with his original bladder tumour. He received a course of palliative radiotherapy but died shortly after. Post-mortem demonstrated the left temporal bone metastasis extending into the middle and posterior cranial fossae. There was no evidence of residual bladder tumour, or other primary tumour. Temporal bone metastases are probably more common than generally thought. Presentations like this may become more common as cancer therapy improves, with patients surviving longer and presenting later with metastatic disease.

A patient is described with two primary malignant melanomas which developed during consecutive pregnancies four years apart. The first melanoma was of the cutaneous nodular type located on the arm. The second, of the superficial spreading type, was located in the oral mucosa near the right tonsil. The influence of pregnancy on the development and outcome of malignant melanomas is discussed, and the risk of a subsequent pregnancy is emphasised.

This evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.

Middle ear adenomas are rare epithelial tumours. Reports indicate that neuroendocrine (carcinoid) tumours may also occur at this site, often in association with an adenomatous component. The clinico-pathological findings (including C.T. scan appearances) of such a ‘mixed’ neoplasm are presented together with a brief review of the few previously described cases. The importance of immuno-histochemistry and electron microscopy for accurate pathological diagnosis of these neoplasms is confirmed.

Oropharyngeal reconstruction especially after surgery for medially located lesions of moderate dimensions presents a challenge. The risk of using well vascularized, but insensitive tissues close to the airway has led to the development of several measures to overcome the difficulties involved. The transposition of masseter muscle which has been put forward in recent years provides successful primary closure with preservation of function.

Wegener's granulomatosis may present with deafness or other aural symptoms. This report describes two patients with histological evidence of Wegener's granulomatosis who developed reversible sensorineural hearing loss during the course of their illness. The first patient showed complete recovery of a sensorineural hearing loss averaging 50 dB after ten months treatment with cyclophosphamide and high-dose prednisolone. The second patient, who was on maintenance haemodialysis, achieved a 40 dB improvement in sensorineural hearing loss within two weeks of adding cyclophosphamide to pre-existing corticosteroid therapy. These findings suggest that the prognosis of sensorineural hearing loss in Wegener's granulomatosis can be improved with suppression of the vasculitic process by early treatment with combined cytotoxic-immunosuppressive therapy

Reported is a child who at the age of 18 months had presented with a left retinoblastoma. The lesion had involved the optic nerve (Stage IV), and was successfully treated by enucleation and radiotherapy. The radiation field did not include the mandible or the submandibular triangle. He was followed up until he left the area aged 11 years. He represented aged 12 years with a progressive swelling of the left submandibular gland. Histology of the surgically excised submandibular gland revealed a mucoepidermoid carcinoma of the submandibular gland. This case highlights the need for continual surveillance in survivors of retinoblastoma, as second primary tumours occur both within and outside of previous radiation fields. The clinical association between retinoblastoma and mucoepidermoid carcinoma of the submandibular gland has not been previously reported.

Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the presence of copious mucopurulent secretions in the trachea. It is an uncommon condition that requires prompt diagnosis and intensive medical therapy if significant morbidity and mortality are to be avoided.

Since the condition was first described in 1979 approximately one hundred cases have been reported. In this paper we present four children with bacterial tracheitis to add to the current literature. Interestingly, one child was admitted on two separate occasions with the disease, an event not previously recorded. All patients underwent endoscopy which revealed findings typical of bacterial tracheitis in each case. None required tracheostomy though three required nasotracheal intubation. Post-endoscopy all were managed in the Intensive Care Unit. There were no fatalities or significant morbidity. The average duration of hospitalization was seven days.

Serum 5-nucleotidase levels have been estimated in a group of 50 patients with head and neck cancer. The mean value was significantly higher in patients compared to the controls. In patients with non-malignant growths, the activity was comparable with the controls. The increase was higher in patients with proliferative lesions than those with ulcerative growths. Enzyme activity was found to be increased with the advancement in the stage of cancer. The rise was comparatively higher in patients with cervical metastasis. After radiotherapy, a gradual and significant reduction of serum 5-nucleotidase activity was observed.

Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty.

SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure.

Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.

Three cases of inter-sterno-costo-clavicular ossification (ISCCO) associated with chronic tonsillitis are reported. Two cases had additional symptoms of pustulosis palmaris et plantaris (PPP). All the patients underwent tonsillectomy. The histological changes of the palatine tonsils of case 1 and case 2 were characterized by so-called focal small lacunar ulcers and periarteriolar fibrosis (onion-skin lesion). Some multinucleated giant cells were observed in case 2. Following tonsillectomy, symptoms in the clavicular region and the PPP improved. It is possible to consider that ISCCO is caused by focal tonsillar infection.

We present a case of the Wildervanck (cervico-oculo-acoustic) syndrome exhibiting congenital deafness, Klippel-Feil anomaly and lateral rectus palsy with enophthalmos. Audiometry indicated a predominantly conductive loss which, because of masking difficulties, was assumed to be bilateral: an erroneous assumption supported by results of conventional petrous bone tomography which failed to demonstrate any abnormality of the inner ears. Computed tomography (CT), however, revealed a severe Mondini dysplasia of one ear, a condition which must be assumed to be associated with severe sensorineural hearing loss. Reconstructive middle ear surgery for the conductive loss on the other side was therefore contraindicated.

Metastatic tumours of the paranasal sinuses from primary lesions of the urogenital tract are rare, with about 50 cases so far being reported in the literature. The most frequent primary lesions is a renal carcinoma. We have experienced a case of paransal sinus malignancy. There were no symptoms of urinary tract carcinoma preceding those in the paranasal sinuses. This case was later revealed at autopsy to be a metastasis from a diverticulum of the urinary bladder.

Tumours of the laryngeal ventricle and saccule are rare and difficult to diagnose endoscopically. We present a case in which the tumour remained confined within the saccule, and describe how the problem of obtaining a positive biopsy was overcome.

Antibodies to specific human immunodeficiency virus (HIV) polypeptides are important laboratory markers of HIV infection. We have used an antibody to the major structural gag protein p24 of HIV-1 virus to immunochemically localize this capsid antigen in lymphoid cells from seven of eight patients at risk for HIV infection and who presented with parotid lymphadenopathy and lymphoepithelial cysts of the parotid gland. A clinicopathological assessment of these two manifestations as they relate to HIV infection is also presented.

A definite diagnosis of neuroendocrine carcinoma of the skin is seldom made on initial histological examination; the tumour is usually reported as a poorly differentiated or anaplastic carcinoma. By applying electron microscopy and immunohistochemistry, a correct diagnosis can be made. The ultrastructural examination shows dense-core membrane-bound granules, intermediate perinuclear filaments and desmosome-like junctions. Immunohistochemistry reveals positive staining for neuron-specific enolase and keratin, the latter in a characteristic paranuclear distribution. Confronted with an unusual clinical picture or indefinite histological diagnosis, tissue specimens should be secured for the above mentioned ancillary procedures.

Aspergillus infection of the nose and sinuses has been recognized for nearly 100 years but a variant, allergic aspergillus sinusitis, has recently been recognized. This non-invasive form causes chronic sinusitis characterized by thick green inspissated mucus in which eosinophils and Charcot-Leyden crystals are found. Fungal hyphae are scanty and are indentified with special stains. Consequently the diagnosis may frequently be overlooked. It has many similarities with allergic broncho-pulmonary aspergillosis and is treated by surgical debridement and aeration with or without cortico steroids, either topical or systemic.

We treated a 28-year-old woman with initial symptoms of hoarseness. At biopsy, atypical lymphoid cells infiltrate was observed in the submucosa of the larynx and polymorphic reticulosis was diagnosed. Immunohistochemical examination of the laryngeal material obtained at autopsy revealed a strong reaction of lymphoid cells to the monoclonal antibody to human T lymphocytes. The possibility that polymorphic reticulosis is a transitional form of peripheral T cell lymphoma was confirmed.

Adenoidectomy performed for ‘glue ear’ accounts for many of the admissions for surgery in childhood. In spite of this there are no objective guidelines to enable the clinician to select those cases in whom a definite benefit is likely, or in whom such procedures might best be avoided. A total of 147 children with established bilateral glue ear randomized to adenoidectomy (A) or no pharyngeal surgery (NS) treatment groups were examined for clearance of effusion in an unoperated ear after one year. Outcome was analysed with respect to the pre-operative Radiographic Palatal Airway size in three groups in relation to mean measurements obtained from matched populations of normal children and those with established disease. Those with small airways had significantly increased clearance following A when compared with NS between the ages of 3–7 years. Adenoidectomy should probably not be performed in those children with large airway measurements, although the outcome may ultimately be related to the age at which surgery is performed.