This study reports a case of a sinonasal inverted papilloma with spread to the temporal bone via the eustachian tube and subsequent transformation to squamous cell carcinoma.

An 81-year-old woman presented with sinonasal inverted papilloma which subsequently spread to the ear. A literature review of inverted papilloma was carried out based on a Pubmed search of studies published between 1987 and 2011, using the key words ‘sinonasal inverted papilloma’, ‘temporal bone inverted papilloma’ and ‘squamous cell carcinoma’.

Sinonasal and temporal bone inverted papillomas may sometimes be linked through direct spread via the eustachian tube. Inverted papillomas have the potential for malignant transformation; careful monitoring of both the nose and ear is therefore required for inverted papillomas found in the nasopharynx.

The surgical approaches previously reported for facial nerve decompression have focussed on achieving good exposure of the lateral or superior aspects of the geniculate ganglion. This report aims to describe a unique case of facial nerve decompression beneath the geniculate ganglion.

A 30-year-old woman with right-sided facial palsy due to a temporal bone fracture.

Bony fragments at the base of the geniculate ganglion were removed via a trans-tensor tympani approach with extended posterior tympanotomy.

The patient's facial movement recovered successfully, without complications such as sensorineural hearing loss and conductive hearing loss.

In rare cases requiring decompression of the facial nerve inferior to the perigeniculate area, the trans-tensor tympani approach should be considered as a valuable alternative option when surgical intervention is considered.

We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore.

A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day.

It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy.

To describe a case of unwitnessed lithium ion disc battery ingestion, with a review of radiology findings and current best practice management.

A three-year-old girl presented following ingestion of a foreign body, which her four-year-old brother claimed was a one pound coin. The patient was managed non-urgently and transferred for specialist ENT assessment 6 hours following the initial ingestion, with no evidence of airway compromise. A corroded battery was removed from the level of the cricopharyngeus after 8 hours, with an associated circumferential mucosal burn.

There is increasing concern regarding the acknowledged rising incidence of lithium ion disc battery ingestion. The lack of a high index of suspicion and the inability to recognise subtleties on imaging may lead to suboptimal management with a higher degree of unnecessary immediate and delayed morbidity. The recently published American Academy of Pediatrics Guidelines may guide the approach to managing battery ingestions.

Hairy polyps are rare congenital growths of the head and neck, mainly found in the nasopharynx and oropharynx. They are made up of two germ cell layers: the ectoderm and mesoderm.

This paper reports a four-month-old who presented with breathing and feeding difficulties. Clinical examination was unremarkable, but a video taken by the patient's mother on her smartphone showed a mass protruding from the infant's mouth. Laryngoscopy performed in the operating theatre showed that the mass emanated from the left posterior tonsillar pillar.

The mass was removed transorally with no complications. Pathological examination showed a skin-covered pedunculated structure characteristic of a hairy polyp. The patient's follow up was unremarkable.

To the best of our knowledge, this is the second English-language case report of a patient with a hairy polyp emanating from a posterior tonsillar pillar. This paper also highlights the growing usage of smartphones by patients to help physicians with their diagnosis and management.

To report a case where GlideScope® is used for the biopsy of the tongue base.

GlideScopes are used by anaesthetists for difficult intubations.

This paper reports a case where a GlideScope was used for biopsy of the tongue base. A review of the literature indicated that this was the first time a GlideScope had been utilised for this purpose.

It is suggested that this is a safe and ideal technique for biopsy of the tongue base, and GlideScopes could be used more frequently for this purpose in the future.

To report a rare case of delayed endovascular coil extrusion following embolisation of a lingual artery pseudoaneurysm.

A 23-year-old woman presented with dysphagia and odynophagia 11 months after having experienced massive post-tonsillectomy haemorrhage. At that time, the bleeding had been stopped by embolisation of a lingual artery pseudoaneurysm and the external carotid artery. Clinical examination at admission showed extrusion of the embolisation coils in the lateral lower pharyngeal wall. The coils were removed under general anaesthesia in the presence of an interventional radiologist. The procedure and post-operative period were without complication and no bleeding was observed. The dysphagia and pain disappeared and the subsequent seven-month follow-up period was uneventful.

Although selective embolisation is a safe and effective treatment for severe post-tonsillectomy haemorrhage, the possibility of delayed coil extrusion should be kept in mind.

To highlight the important clinical and histological features of sinonasal blue naevi.

A case of blue naevus of the nasal cavity is described (including endoscopic and histological pictures) and the existing literature is reviewed.

There have been five reported cases (including the presented case). Clinically, sinonasal blue naevi are heavily pigmented lesions that are small and asymptomatic. Histopathologically, blue naevi exhibit heavily pigmented dendritic melanocytes that are never abnormal in form.

Blue naevus should be a differential diagnosis for pigmented lesions within the sinonasal cavity, despite its rarity. It may be initially suspected by its small size and asymptomatic nature. However, histological examination is required for definitive diagnosis, looking for the key microscopic features described above.

To report a case of varix of the retromandibular vein within the parotid gland.

Case report, and discussion of the appropriate selection and use of radiological investigation techniques.

A 64-year-old lady who presented with unilateral tinnitus underwent a magnetic resonance imaging scan to exclude a vestibular schwannoma. The magnetic resonance scout images revealed an incidental finding of a hyper-echoic mass within the parotid gland. The mass was most consistent with a pleomorphic adenoma. Ultrasound-guided fine needle aspiration cytology was arranged; the ultrasound identified the mass as a varix of the retromandibular vein and fine needle aspiration cytology was not performed.

A varix of the retromandibular vein is a very rare cause of a parotid mass. Appropriate radiological investigations can prevent unnecessary invasive investigations or procedures.

The exact aetiology of congenital cholesteatoma, the less common form of this destructive disease, is still under debate.

A two-year-old boy was referred to paediatric otolaryngology with persistent, bloody, left-sided otorrhoea refractory to oral and ototopical antibiotics. Prior to its onset at age 16 months, all ear examinations on the affected side were normal. Physical examination, imaging with computed tomography and eventual tympanomastoidectomy revealed extensive cholesteatoma. The extent of the disease, age at onset of symptoms and absence of otological disease before initial presentation suggested the diagnosis of congenital cholesteatoma. Review of the family history revealed that the patient's older brother had undergone tympanomastoidectomy for a small, well-encapsulated, mesotympanic congenital cholesteatoma at two years of age.

This case joins a single, previous report describing congenital cholesteatoma in multiple family members, suggesting that in some cases, hereditary factors may play a role in the formation of the disease.

To present a rare case of lingual thyroid detected using a hybrid of single photon emission computed tomography and standard computed tomography in a young woman with hypothyroidism.

A 29-year-old woman was screened for autoimmune thyroid disorders in early pregnancy, and found to have subclinical hypothyroidism. No thyroid tissue was found in the anterior neck upon ultrasonography, raising suspicions of an ectopic thyroid. The patient was treated with levothyroxine throughout the remainder of her pregnancy, and developed postpartum thyroiditis requiring an increase in levothyroxine dosage. Whole-body scintigraphy and zoomed static head and neck scintigraphy were performed. Abnormal 99mTc-pertechnetate uptake was observed in the oral region, whereas no uptake was found in the usual thyroid location. Hybrid imaging using single photon emission computed tomography and standard computed tomography was performed to improve three-dimensional representation of the area of increased activity.

The latter imaging modality detected ectopic thyroid tissue in the tongue.

Whole body 99mTc-pertechnetate scintigraphy and a hybrid of single photon emission computed tomography and standard computed tomography are effective imaging modalities for the investigation of ectopic thyroid tissue. The latter modality is particularly recommended, as it allows more precise spatial visualisation of increased isotope uptake activity in the head and neck.

This paper describes a patient with recurrent unilateral nasal discomfort and pain due to an intranasal tooth. A short overview of the literature is provided in relation to the aetiology, symptomatology, diagnosis and treatment of intranasal teeth.

A 26-year-old man was referred with a history of recurrent left-sided nasal obstruction, facial pain and discomfort, and chronic purulent rhinorrhoea. Computed tomography revealed a nasal tooth, which was likely to have been the cause of these symptoms. After transnasal surgical extraction under endoscopic guidance, the patient was relieved of his complaints (at the one-year follow up).

An ectopic tooth in the nasal cavity is a rare phenomenon, and in most cases the cause of an intranasal tooth remains unclear. The treatment of an intranasal tooth entails surgical extraction even though such teeth may remain asymptomatic; several cases have illustrated the potential significant morbidity associated with their occurrence.

To review the incidence, treatment and prognosis of testicular carcinoma metastatic to the neck, and to propose a selective neck dissection be performed for residual disease post-chemotherapy.

A 17-year-old young man with metastatic testicular carcinoma presented with a left neck mass. A palpable neck mass is the initial sign in approximately 5 per cent of cases of metastatic testicular teratoma. Approximately 30 per cent of patients with advanced-stage testicular cancer have extra-retroperitoneal disease post-chemotherapy, which requires resection. The presented patient underwent a left selective neck dissection, thymectomy, median sternotomy, left thoracotomy and mediastinal lymph node dissection. Eighteen months later, a computed tomography scan of the thorax showed no evidence of disease recurrence in the neck or mediastinum.

While surgical management of testicular cancer retroperitoneal metastases is well described, there is limited literature on the management of cervical lymph node metastases. In the presented case of metastatic testicular carcinoma with cervical lymph node metastases, a selective neck dissection was successfully performed for a post-chemotherapy mass.

This study aimed (1) to report the long-term effects of infliximab, a murine monoclonal antibody directed against tumour necrosis factor-α, on autoimmune inner ear disease, and (2) to discuss dilemmas surrounding the long-term management of autoimmune inner ear disease.

A 49-year-old man presented with sudden-onset, left-sided, sensorineural hearing loss, tinnitus and vertigo. He was prescribed oral prednisolone, with benefit. Over several subsequent months, he experienced frequent relapses and progressive deterioration of high-frequency hearing bilaterally. Multiple agents failed to stabilise his condition. Following infliximab treatment, there was a documented and sustained improvement in his hearing and tinnitus. He stopped the treatment after 46 weeks, with rapid relapse of his condition. His hearing recovered quickly again after recommencing infliximab.

The benefits of prolonged infliximab use and potential side effects must be balanced against allowing the disease to take its course, with progressive deafness. Randomised controlled trials are required to assess infliximab's optimal duration of use, long-term efficacy and safety in the treatment of autoimmune inner ear disease.