The purpose of this study was to assess the presence of dendritic cell phenotypic antigens in the cervical lymph nodes of patients with hypopharyngeal and laryngeal carcinoma, and to assess the significance of such antigens in the tumour immune reaction.

Immunohistochemical staining of cervical lymph nodes was performed using antibodies against cell surface markers such as S-100 protein and cluster of differentiation 1a and 83 glycoproteins. Two hundred and seventy-four cervical lymph nodes obtained at surgery from 37 patients with hypopharyngeal carcinoma and 31 patients with laryngeal carcinoma were thus evaluated.

The number of dendritic cells positive for each phenotypic antigen was significantly greater in non-metastatic lymph nodes than in metastatic lymph nodes. In the metastatic lymph nodes, cluster of differentiation 1a glycoprotein positive dendritic cells were predominantly detected in the cancer ‘nest’, whereas mature dendritic cells staining for cluster of differentiation 83 glycoprotein were prominent in the peritumour area. In the metastatic lymph nodes, in contrast to the cluster of differentiation 1a glycoprotein positive dendritic cells, the degree of infiltration of cluster of differentiation 83 glycoprotein positive dendritic cells was significantly higher in the peritumour area than in the cancer nest. There was a significant difference in survival status, comparing patients with different degrees of dendritic cell infiltration for each type of phenotypic antigen.

Dendritic cells may play different roles in tumour immunity against hypopharyngeal and laryngeal carcinoma. The phenotypic antigens of dendritic cells may thus constitute important indices with which to predict the prognosis of patients with hypopharyngeal and laryngeal carcinoma.

We describe a case of an internal carotid artery loop presenting as an oropharyngeal mass.

Case report and review of current literature.

A 71-year-old woman presented with an asymptomatic oropharyngeal mass. This was an incidental finding by her general practitioner and was urgently referred as a suspicious lesion. A magnetic resonance imaging scan revealed an internal carotid artery tonsillar kink indenting into the pharyngeal wall. No further treatment was necessary.

The internal carotid kink is an important anatomical variation which ENT surgeons should be aware of, as there are significant complications if blind biopsy is undertaken prior to appropriate imaging.

To report an extremely rare and interesting case of a woman who developed a laryngeal stone.

A 44-year-old woman was referred to our ENT clinic complaining of dyspnoea and stridor. She had been treated for chest problems for approximately 30 years. On examination, she had a large, spiky, subglottic lesion compromising the airway. A laryngeal computed tomography scan and histopathological and biochemical examination showed the lesion to be a calcium phosphate stone. Review of the literature from the past 50 years, using several search engines, revealed no similar cases.

To the author's knowledge, this is a unique case of a stone that developed in the subglottis. This rare entity was the cause of long-standing chest problems unresponsive to medical treatment. The patient recovered completely from all her symptoms after removal of the laryngolith.

We report a rare case of parotid dermoid cyst.

A case report of parotid dermoid cyst is presented, as well as a brief review of the literature and a summary of the lesion's salient clinicopathological features.

A 69-year-old man presented with a slow-growing, soft tissue mass of the left parotid gland. Pre-operative evaluation included fine needle aspiration cytology and computed tomography. He subsequently underwent a superficial lobectomy; both the macroscopic and histopathological findings were consistent with a dermoid cyst. Although dermoids within the head and neck are not uncommon, such cysts have only rarely been encountered in the parotid gland.

To our knowledge, there are only four previous case reports of parotid dermoid cyst in the English literature. Although the majority of cases of parotid dermoid cyst are diagnosed retrospectively, our case demonstrates the role of fine needle aspiration cytology and highlights the key cytological features suggestive of this entity.

Following laryngectomy, a distinct population of patients fails to achieve successful tracheoesophageal voice. These patients' voices range from strained and effortful to none at all. Such patients may present with severe hypertonicity or spasm of the pharyngoesophageal segment. Botulinum toxin has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this article is to review the evidence for using botulinum toxin to achieve an improvement in post-laryngectomy voice.

A Medline literature review (1966 to January 2009) and a search of the Cochrane database were performed. Foreign language articles and those not pertaining to post-laryngectomy voice restoration were excluded.

Nine articles reporting a total of 134 patients were identified. Although there were differences in the outcome measures used, objective improvement in voice production occurred in between 70 and 100 per cent of cases.

Botulinum toxin can be used as a safe and cost-effective treatment in patients with confirmed pharyngoesophageal segment hypertonicity and/or spasm following laryngectomy, to obtain an improvement in voice quality.

Most patients with hereditary haemorrhagic telangiectasia suffer with frequent episodes of epistaxis. The aim of this case report is to highlight the effect on epistaxis, occurring in hereditary haemorrhagic telangiectasia, when nasal airflow ceases.

We present the interesting case of a patient with hereditary haemorrhagic telangiectasia who experienced cessation of her recurrent, refractory epistaxis through the development of coexisting polyp disease. The patient's enlarged, grade three nasal polyps were behaving as physiological obturators, limiting airflow through her nose. This reduced the intranasal trauma and subsequent frequency of her nosebleeds.

Epistaxis is a debilitating part of hereditary haemorrhagic telangiectasia, and poses a frequent management challenge. Our patient was more tolerant of her grade three nasal polyps than of her recurrent epistaxis. This case highlights the importance of reducing nasal airflow when treating patients with hereditary haemorrhagic telangiectasia.

This study aimed to determine the expression of the Cap43 gene in supraglottic laryngeal squamous cell carcinoma, and to evaluate any correlation between Cap43 gene expression and tumour-associated macrophage infiltration.

Four human head and neck squamous cell carcinoma cell lines were cultured (Hep2, KB, Ca9-22 and HSC-3) and expression of the Cap43 gene was analysed by Western blotting. In addition, paraffin-embedded samples of supraglottic laryngeal squamous cell carcinoma and normal supraglottic laryngeal mucosa from 84 patients were analysed immunohistochemically using antibodies to Cap43 and cluster of differentiation 68 glycoprotein. Patients' clinical status was compared with their immunohistochemical results.

All four head and neck squamous cell carcinoma cell lines exhibited Cap43 expression. The Hep2, Ca9-22 and HSC-3 cells showed a markedly higher level of Cap43 protein than the KB cells. A statistically significant difference was found in Cap43 expression, comparing different differentiation levels and comparing different metastasis stages, for supraglottic squamous cell carcinoma. The number of tumour-associated macrophages correlated with expression of Cap43, not only in the tumour area (r = 0.3708, p = 0.0005) but also in the peritumour area (r = 0.2847, p = 0.0087).

In supraglottic laryngeal squamous cell carcinoma, overexpression of the Cap43 gene is associated with tumour differentiation and acts an important suppressive factor in the process of tumour metastasis. The Cap43 gene may be a cancer-specific marker. High expression of the Cap43 gene appeared to correlate with infiltration of tumour-associated macrophages.

We report the unique case of a 16-year-old man presenting with sudden and profound left-sided hearing loss following application of a Halo vest.

Case report and review of the world literature concerning spinal realignment procedures, spinal manipulation and Halo vest application.

A 16-year-old man presented to the ENT clinic with sudden and profound left-sided hearing loss after undergoing posterior release of a fixed flexion extension deformity of the cervical spine and Halo vest application. The hearing loss slowly improved until the patient disrupted the Halo vest while boarding a bus. Regular audiometry documented the progress of the patient's hearing loss.

Procedures that significantly alter the established bony anatomy of the neck can be associated with profound audiological deficit through disturbance of the vertebrobasilar arterial system. Such a phenomenon may be associated with application or disruption of a Halo vest.

Skin cancer is the most common cancer, and often occurs in the head and neck region. This study aimed to investigate whether a combination of inhibitors of cyclo-oxygenase-2 and 5-lipoxygenase, applied via a microemulsion delivery system, would be effective in topically inhibiting skin carcinogenesis.

Randomised animal study.

Twenty-four nude mice were intradermally inoculated with carcinoma cells and then divided into three groups (eight animals each): group one received no treatment; group two received celecoxib alone; and group three received a combination of zileuton and celecoxib. Tumour incidence and growth were measured for 14 days.

Both treatments significantly delayed the onset and development of tumours. However, the combined treatment had the best response (p < 0.01).

The results clearly showed that topical treatment with either celecoxib alone or celecoxib plus zileuton significantly inhibited skin carcinogenesis, and that a combination of both agents had the best results.

To determine the prevalence of GJB2 mutations among subjects with congenital, non-syndromic, sensorineural hearing loss, within a north Indian population.

This was a case–control study in which the frequencies of the three most prevalent GJB2 mutations (35delG, W24X and 167delT) were studied. Polymerase chain reaction restriction fragment length polymorphism assays were performed to detect these mutations. The entire coding region of the GJB2 gene was sequenced in all patients, and also in any of their family members who showed GJB2 mutations.

The 35delG mutation was found to be the most prevalent mutation (21 per cent), followed by the W24X mutation (7 per cent). This is the first report of the 35delG mutation in an Indian population. One patient was a compound heterozygote for 35delG/W24X. The 167delT mutation was not observed in any patient.

These findings challenge the classical view that the W24X variant of the GJB2 gene represents a single ‘founder’ mutation.

Verrucous carcinoma is a variant of well differentiated squamous cell carcinoma characterised by an exophytic, warty growth which is slowly but locally invasive and which can cause extensive local destruction if left untreated.

We report the first known case of veruccous carcinoma of the paranasal sinuses with rapid orbital invasion. A 58-year-old man presented with right-sided nasal obstruction, a huge right intranasal lesion, intractable dacryocystitis and cutaneous involvement of the nasolacrimal sac region. The tumour was partially removed using an endoscopic transnasal approach. Post-operatively, and while waiting for the histological result, the patient developed signs of rapid invasion of the orbit, with uniocular visual acuity deficit. He underwent combined radiochemotherapy, with a moderate response.

Knowledge of the potentially aggressive nature of verrucous carcinoma may be helpful in early management of intraorbital invasion and salvaging of the eye.