An historical account of descriptions of malformation of the inner ear.

The facial nerve is often injured by trauma, infection or during the course of tumour resection. Many techniques of nerve anastomosis have been described with the current standard nerve repair using the microscope and monofilament suture. The purpose of this study was to evaluate the CO2 surgical laser as a tool for facial nerve anastomosis. Following preliminary electrical measurements 36 nerves were anastomosed using either laser or conventional monofilament suture. Laser anastomosis had neither beneficial nor detrimental effects on nerve regeneration. This method of anastomosis may be advantageous when surgical access is limited. In addition this study found that the use of CO2 laser as a dissecting or vapourizing tool in proximity to intact facial nerves results in degenerative changes.

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.

In a small prospective series of 10 children who presented with incipient subglottic stenosis following neonatal intubation a protocol of formal reintubation for two weeks, with sedation, enabled six of the children to avoid tracheostomy or other forms of surgery and in the remaining four it is unlikely that the trial of reintubation made the degree of laryngeal and subglottic damage worse.

Four cases with a neopharyngeal diverticulum following total laryngectomy are presented. Each patient required surgery for complications directly related to the pouch. The relevance of these diverticulae is discussed with reference to their aetiology, complications and management.

Twenty cases suffering from rhinoscleroma were studied. Bronchoscopy was performed for detection of secondary involvement of the subglottic region, trachea and bronchus. The study revealed that the larynx was involved in 40 per cent, the trachea in 20 per cent and the bronchus in 10 per cent of cases. The intranasal lesion, endotracheal and endobroncheal lesions all occur in the form of an atrophic stage, granulomatous (proliferative) stage and finally a fibrotic or scarring stage. The role of bronchoscopy in early diagnosis, initial symptomatic treatment and in follow-up is discussed in the light of the available literature.

In many cases of carcinoma of the floor of mouth, oncologic resection includes marginal mandibulectomy. Reconstruction poses a significant challenge. Requirements include coverage with thin but supple tissue to allow for dental implant or denture, and recreation of a mobile tongue and sensate floor of mouth gutter. Reconstructive efforts have ranged from skin grafts to free flaps, with variable success in fulfilling the above-mentioned requirements.

This paper describes the preferred technique of the author, in which external mandibular periosteum is saved and elevated with a submucosal flap of lower lip, raised to the level of the vermilion border. This flap is then advanced to ventral tongue. In this manner the entire anterior floor of mouth can be reconstructed.

Cases are presented demonstrating different aspects to the technique.

We present the case of a 40-year-old male Caucasian patient who developed surgical emphysema of the neck five weeks after surgery for exostoses of the external auditory canal. Imaging of the temporal bone demonstrated that the surgery had resulted in entry into the temporomandibular joint. A mechanism is proposed for this novel complication.

Malignant external otitis is classically associated with insulin-dependent diabetes mellitus probably due to generalized systemic immunodeficiency (Mowet and Baum, 1971). A unique case of malignant external otitis associated with Waldenstrom's macroglobulinaemia is presented.

Abnormal sensitivity to environmental sounds is a short-term feature often observed following insertion of grommets. Here we describe a child with this symptom who was found to have Williams syndrome, a condition in which hyperacusis is observed in 95 per cent of patients.

The first isolated case of agenesis of the mastoid antrum, previously only described in association with the congenital syndromes trisomy 13 and mandibulofacial dysostosis, is reported. The loss of this important surgical landmark may result in disorientation and iatrogenic trauma. The surgeon must be aware of its existence, and where it is suspected the middle fossa dura should be exposed and followed posteriorly until the lateral sinus is encountered.

We present a previously undescribed site of a subperichondrial haematoma – the alar cartilage. Two children presenting acutely, following trauma, with the clinical appearance of a ‘blueberry’ within the nasal vestibule are described. We recommend early surgical drainage of this lesion, as delay in definitive treatment may give rise to a cosmetic deformity.

A case of hepatocellular carincoma with a solitary metastasis in the sphenoid sinus is described. The extreme rarity of the tumour and the problems of early diagnosis are underlined. The importance of endoscopic examination as a diagnostic procedure is emphasized.

A case of tuberculous lymphadenitis with a nasopharyngeal tuberculoma is presented where a novel use of the flexible nasendoscope to provide a diagnostic aspiration biopsy avoided an examination and biopsy under general anaesthesia. The use of this approach is discussed.

Lipomas are common benign connective tissue tumours composed of adult adipose tissue. They are relatively rare in the upper aerodigestive tract, although they occur with considerable frequency in other areas, particularly in the subcutaneous tissues of the neck. Although there are several reports of this tumour occurring in the oropharynx, there is no recorded case of a lipoma of the tonsillar fossa. An 83-year-old man with a left tonsillar fossa lipoma is presented. Clinical presentation, management and a literature review are discussed.

A case of a direct burn to the pharynx and larynx is described. This occurred after a patient swallowed a microwaved treacle tart. The potential danger of excessive heating of food in microwave ovens is discussed.

Cervical spine osteomyelitis is rare. Haematogenous spread is the usual method by which organisms reach the spine. A review of the English literature reveals very few reported cases of local spread of infection to the spine. Here we present the case of a 68-year-old woman with cervical spine osteomyelitis and cord compression complicating pharyngeal myotomy.

Three cases of mycobacterial cervical lymphadenitis in children are presented. The diagnosis and treatment are described in brief. None of the patients were from the risk groups traditionally associated with tuberculosis. With an increasing number of tuberculosis cases reported in the UK, the need for awareness of this re-emerging condition to ENT surgeons and paediatricians is stressed.

We report an unusual case of bulimia nervosa with bilateral swelling of parotid and submandibular glands as the only symptom of the underlying behavioural disorder. Histologically, sialadenosis was diagnosed in a parotid biopsy. The parotomegaly in bulimia may be a diagnostic primer as these patients often deny their eating disorder. B-scan ultrasonography is an important diagnostic tool to assess the nature of the parotid enlargement. Hyperamylasaemia occurs commonly in bulimic patients and may help to confirm the diagnosis. All patients with suspected bulimia should have a thorough medical history and physical examination to rule out other aetiologies of asymptomatic parotid swelling. As the enlargement is usually transient surgical intervention is only rarely required.

Lateral cervical fistulae which communicate with the oropharynx are considered to result from incomplete obliteration of the second branchial cleft and pouch. Classically these fistulae have a well-defined pathway through the neck. We present a case, and discuss the aetiology, of a fistula extending from the lateral neck via a previously undescribed course through the neck structures and opening into the posterior aspect of the tongue at the level of the vallate papillae.