Viral reactivation is thought to be an important cause of post-operative facial palsy of delayed onset. We present an unusual case of Ramsay-Hunt syndrome that occurred as a consequence of middle-ear surgery by triggering varicella-zoster virus reactivation. As a pathognomonic auricular eruption was not seen, the patient was initially misdiagnosed as iatrogenic facial palsy. Clinical features, diagnosis and management are discussed.

Gastric transposition has been used extensively in this department since 1965 for reconstruction following pharyngolaryngoesophagectomy (PLO). A previous report by Harrison and Thompson in 1986 detailed our experience with 101 cases dating back to 1965. Here we review our experience between 1986–1996.

Medical records of 41 cases were examined. The primary site and stage of tumour and associated lymph nodes, patient demographics, complications, in-patient mortality and survival as demonstrated by the Kaplan-Meier method were recorded.

Gastric transposition is now used for more extensive tumours: 70 per cent T4 (83 per cent pathologically T4) compared to 21 per cent in the previous report. A high proportion of ‘radiation failures’ remains (54 per cent). The in-hospital mortality has fallen from 11 per cent to seven per cent. The five-year-survival calculated using the Kaplan-Meier method is 11 per cent.

This procedure is increasingly being used as a palliative procedure aiming to restore swallowing in the relatively young patient who has very extensive hypopharyngeal carcinoma. Long-term survival rates specific to this operation have fallen. This is attributed to patient selection for the procedure with the vast majority having disease extending into bone, cartilage or soft tissues (T4). The defect created by the resection of less extensive tumours are now increasingly reconstructed with jejunal free flaps and musculocutaneous flaps.

Adenotonsillectomy and tonsillectomy are amongst the most commonly performed surgical procedures. In our prospective study we looked at early post-operative morbidity (haemorrhage, vomiting and pyrexia) in 521 consecutive children following tonsillectomy, adenotonsillectomy and adenoidectomy. While the incidence of reactionary haemorrhage is low, pyrexia and vomiting are common. The implications of this high early post-operative morbidity for day surgery are discussed.

A series of surgical simulation exercises has been developed using an animal model to allow trainees to practise basic instrument handling and develop psychomotor skills in bronchoscopy, without risk to patients. A pig model was found to be most suitable. After suitable preparation the model can be used for diagnostic and therapeutic exercises in bronchoscopy, including lavage, biopsy and the removal of various foreign bodies. The model is a safe, inexpensive and convenient means of bronchoscopic training for otolaryngology trainees. For the trained specialist who has to remove bronchial foreign bodies infrequently, the model is a useful way of maintaining skills.

Between November, 1996 and May, 1997 a series of 100 consecutive unselected patients undergoing all types of thyroid surgery – including even those inducing large dead space e.g. substernal goitre and carcinoma thyroid with recurrent nerve dissection – were randomly allotted to either receive drainage (n = 43) or not (n = 57). Patients with cervical dissection for lymph node metastasis were not included. Severe intra-operative haemorrhage was not a reason for exclusion. No complications such as haematoma or seroma were found in the undrained group whereas only minor complications such as haematoma (n = 4) were noted in the drained group. Whatever the group, none of the patients required reexploration. The difference in overall hospital stay (1.72 days in the group of undrained patients versus 2.09 days in the drained group) was not statistically significant.

The temporocele, a rare case of extra-mastoid pneumatization is discussed. It presented as a swelling over the mastoid in a 16-year-old female and the diagnosis was made by computed tomography (CT) scan. It was treated by obliteration by covering the sieve-like mastoid with bone dust and a large piece of temporalis fascia as well as ventilating the middle ear.

The causative agent of rhinosporidiosis is a microscopic round body in polypoidal masses that is believed to be the sporangium of a fungus Rhinosporidium seeberi. But fungal aetiology can not be proved with certainty. Attempts to culture the fungus on various media have also been unsuccessful. In a recent study pond water samples, from water in which patients had been bathing, were analysed and a unicellular prokaryotic cyanobacterium Microcystis aeruginosa was isolated. The same cyanobacterium was demonstrated in clinical samples from patients with rhinosporidiosis. Consequent to these findings, attempts were made to culture the causative organism of rhinosporidiosis under conditions that support growth of cyanobacteria.

This study describes a simple method for laboratory culture of this organism. Observations based on laser-scanning confocal microscopy, light and electron microscopy confirm that a cyanobacterium, Microcystis sp. is the causative agent of the disease. Rhinosporidiosis is the first human disease to be shown to be caused by a cyanobacterium. The findings have opened the way for development of therapy.

The use of the buccal fat (BFP) and palatal rotating flaps for the closure of oro-antral communication and reconstruction of palatal defects was compared clinically. The BFP proved to be consistently successful in closing oro-antral fistulae and palatal defects resulting from tumour resection, preserving the normal anatomical architecture of the oral mucosa. No denuded area requiring secondary granulation was required as in the case of palatal flaps. In addition, no facial disfigurement was observed on the operated side.

BFP is considered a reliable, convenient method for closure of palatal defects and closure of oro-antral communication. It can also be considered as a reliable back-up procedure in the event of failure of other techniques.

Oral rinses/gargles and oral sprays are frequently used in the management of oropharyngeal inflammation. This pictorial study, using methylene blue dye as a marker of the distribution of these topical preparations in the oropharynx, suggests that oral sprays are more effective in coating the oropharynx than oral rinses, whilst oral rinses are better at staining the oral cavity and base of tongue. The authors therefore suggest that oral rinses should be used to treat disease in the oral cavity and oral sprays should be used to treat ailments in the oropharynx.

We report the first case in the world literature of deliberate ablation of vestibular function in unilateral Meniere's disease with aminoglycoside eardrops (Garasone).

These findings give conclusive proof that Garasone eardrops, and by implication, all topical aminoglycoside ear drops can be vestibulotoxic in the presence of a tympanic membrane defect. The lower concentration of gentamicin in Garasone, in comparison to the standard intratympanic preparations for chemical ablation of vestibular function, may also offer a reduction in the potential risk of cochleotoxocity.

We present a rare case of neurilemmoma of the larynx, which was excised through a lateral thyrotomy approach with resulting restoration of laryngeal function. The advantage of the lateral thyrotomy approach for submucous tumours of the larynx is discussed.

The authors present a technique using electrocautery diathermy to make surgical tattoos. This method has been used in over 300 patients who underwent head and neck surgery at Aberdeen Royal Infirmary and Albany Medical College, New York, over a period of five years. A wide variety of operative procedures such as total laryngectomies and neck dissections were performed. The electrocautery surgical tattoos have a major advantage of persisting until the end of the operative procedure by which time other types of tattoos have faded. The technique is widely available, inexpensive, and has to date been complication free.

In this report we present a case of squamous cell carcinoma developing in a mastoid cavity after prolonged exposure to the chemical disinfectant Eusol. The efficacy and safety of Eusol and other chloric acid (hypochlorous acid) derivatives in clinical use is debated.

The need for, and choice of, radiological staging investigations for distant metastases in the management of head and neck squamous cell carcinoma is a contentious issue. To address this problem a retrospective audit of routine computerized tomography (CT) and ultrasound scanning of the chest and abdomen respectively was undertaken. The records of 103 patients who, over a six and a half year period, underwent major surgery for head and neck squamous cell carcinoma were reviewed. A total of 57 patients (59 per cent) had CT scanning of the chest of whom two were identified as having synchronous tumours. In both cases, the lesions were identified on chest X-ray prior to scanning. Seventy patients (68 per cent) had routine ultrasound scanning of the abdomen. In none of these was metastatic disease identified. As a result of the audit findings routine CT and ultrasound scanning of the chest and abdomen has been discontinued.

Malignant (invasive) otitis externa is an infection involving the external ear canal, often in elderly diabetic patients, which carries a high morbidity and mortality. It may involve widespread areas of soft tissue around the skull base, and in more advanced cases, may give rise to osteomyelitis and cranial neuropathy. We describe two patients who were treated for malignant otitis externa complicated by destructive osteomyelitis of the temporomandibular joint (TMJ). For both patients, diagnosis was made using magnetic resonance imaging (MRI), and repeat scans were employed during follow-up. Improved scan appearances mirrored improvements in clinical condition in both cases.

Extraskeletal myxoid chondrosarcoma presenting in the head and neck is extremely rare. Histological diagnosis is difficult and requires close co-operation between clinician, radiologist and pathologist. The tumour has a good prognosis in comparison to myxoid chondrosarcoma of the bone but surgical resection may be difficult due to its gelatinous nature. We present a case of extraskeletal myxoid chondrosarcoma originating in the external auditory meatus of a 42-year-old man. This is the first report of this tumour in this site.

Hypertrophy of the inferior turbinates is a common cause of nasal obstruction. Many cases respond to medical treatment with topical steroids or antihistamines. In some patients, however, this therapy is not sufficient and through the years many surgical procedures have been used to reduce the size of the inferior turbinates, but without any satisfactory long-term results. Furthermore, these procedures have often been painful to the patient and post-operative complications such as bleeding and crusting have not been uncommon. However, instead of conventional surgery of the turbinates, laser-surgery can be used to reduce their size. In order to investigate the long-term effect of such gross reduction of the turbinates we investigated the post-operative condition of 78 patients who had undergone CO2-laser-turbinectomy due to symptoms of nasal obstruction. Twenty-four to 36 months post-operatively three quarters of all the patients reported a marked decrease in nasal obstruction as well as a reduced frequency of nasal and sinus infections. No complications were reported and the procedure was without any discomfort to the patient. Thus, laser-turbinectomy seems to be an effective, simple and painless method for treatment of nasal obstruction due to hypertrophy of the inferior turbinates.

A case of infantile fibromatosis involving the cheek of a three-year-old Sudanese girl is described. The tumour was resected through a sublabial approach.