A 33-year-old woman presented with a three-day history of an abscess in the left alar region, four weeks after drainage of a breast abscess. The later infection was confirmed to be due to Panton–Valentine leukocidin positive, methicillin-resistant Staphylococcus aureus. This report aims to raise awareness of such infections, and to advise when Panton–Valentine leukocidin toxin testing is appropriate.

Case report and discussion.

Although superficial Panton–Valentine leukocidin positive Staphylococcus aureus infections are relatively benign, more serious infections can be potentially life-threatening. Clinicians should be able to identify the features of potential Panton–Valentine leukocidin positive Staphylococcus aureus infection, in order to implement appropriate therapy.

Clinicians need to be aware of Panton–Valentine leukocidin positive Staphylococcus aureus infections, and should ask specific questions when investigating the clinical history of patients with recurrent abscesses, as this bacterial strain is not routinely assessed by microbiology departments. If such an infection is suspected, clinicians should be aware of local protocols regarding toxin testing, antibiotic choice and decolonisation agents.

To report a rare case of silicone lymphadenopathy solely affecting the left supraclavicular lymph nodes.

Our patient presented with a painless swelling in the left supraclavicular region. Notably, she had previously undergone cosmetic breast augmentation using silicone-containing implants. Radiological imaging and subsequent excisional biopsy of the swelling produced findings consistent with a silicone foreign body reaction secondary to bilateral breast implant rupture.

Silicone lymphadenopathy following breast augmentation primarily affects the axillary nodes. Supraclavicular lymph node involvement is unusual. To our knowledge, this is the first report in the English language literature of silicone lymphadenopathy manifesting solely in the supraclavicular lymph nodes. Although the need to exclude malignancy in such cases is of the utmost importance, silicone lymphadenopathy should also be considered in the differential diagnosis. Fine needle aspiration cytology is a useful initial investigation, which may be followed up by excisional biopsy and histological analysis for further confirmatory diagnostic information.

Struma ovarii is a rare, monodermal, ovarian teratoma. The common presentation is abdominal, with pelvic mass and pain, traditionally managed by gynaecologists. The malignant form is extremely rare and consists of differentiated thyroid cancer. It is rare for struma ovarii to present with features of hyperthyroidism. We present two unusual cases of struma ovarii and discuss the role of the thyroid surgeon in their management.

The first case involved a 40-year-old woman with a two-month history of swelling in the lower abdomen. Investigations revealed a mass arising from the left ovary. Surgery revealed a follicular carcinoma arising in a struma ovarii. She underwent a total thyroidectomy prior to radio-iodine therapy. The second case involved a 60-year-old woman who underwent thyroidectomy for thyrotoxicosis. Three months post-operatively, she remained thyrotoxic despite stopping thyroxine. A whole body radio-iodine scan revealed high uptake in the left ovary. Histological analysis of the resected ovary showed benign struma ovarii.

These two cases highlight the diagnostic and therapeutic role of thyroid surgeons in the management of benign and malignant forms of struma ovarii.

Carotid blow-out syndrome is one of the most devastating complications of head and neck carcinoma. It usually occurs as a post-operative complication or when the tumour compromises the vascular axis.

We report two patients who suffered carotid blow-out syndrome but who did not have the usual predisposing factors. Both patients had a pharyngolaryngeal carcinoma that was treated with chemoradiotherapy. Residual non-tumoural ulceration was seen along the lateral wall of the hypopharynx in both cases. This ulceration eventually reached the vascular axis, precipitating carotid rupture and death.

Residual non-tumoural ulceration of the lateral wall of the hypopharynx after chemoradiotherapy should be considered with the utmost caution. Once persistence of the tumour is excluded, surgery is indicated to protect the vascular axis, in order to prevent carotid blow-out syndrome.

We report an extremely rare case of the simultaneous occurrence of a thyroglossal duct cyst and a lingual thyroid in the absence of an orthotopic thyroid gland, in a seven-year-old girl from South India.

Case report and a review of the English language literature on the subject.

The patient presented with a mass on the tongue that had been present for three years, and an anterior neck swelling that had been present for two years. Examination revealed a midline, pinkish, firm mass present on the posterior one-third of the tongue. The neck showed a midline cystic swelling in the infrahyoid position. Radiological imaging confirmed the clinical findings, revealing the absence of her thyroid gland in the normal location. Sistrunk's procedure was performed leaving behind a lingual thyroid. At 13-month follow up, the patient was euthyroid with no recurrence.

To our knowledge the association of a lingual thyroid and a thyroglossal cyst has only been reported once in the literature. The presence of a lingual thyroid in the absence of a normally located thyroid gland or functioning thyroid tissue along the thyroglossal tract, confirmed by radionuclide and computed tomography imaging, may indicate the failure of the normal descent of the thyroid gland during embryonic development. This probable absence of the descent of the thyroid raises questions regarding the origin of thyroglossal duct cysts.

To discuss the pathophysiology and various treatment methods of multiple symmetrical lipomatosis.

We report a case of multiple symmetrical lipomatosis in a middle-aged man. He presented to us with an extensive, disfiguring neck mass. Clinical examination and computed tomography suggested a lipomatous mass without compression of vital neck structures. The proximity of the lipomatous mass to the carotid sheaths attracted our interest. We performed surgical excision in this case, because of the deep infiltrative behaviour of the lipoma. The benefits and drawbacks of liposuction and surgical excision of extensive neck lipomatosis are discussed.

Surgical excision and liposuction are complementary treatments in the management of multiple symmetrical lipomatosis. Patients should be aware of the limitations of both surgical options, and the risk of lipoma recurrence, before surgery. The decision on the mode of surgery relies upon the disease extent, the patient's expectations and the surgeon's experience.

We report two cases of congenital salivary fistula of an accessory parotid gland, and we discuss its occurrence in Goldenhar syndrome.

Two teenagers complained of a congenital cheek fistula with constant salivary discharge. Computed tomography fistulography and sialography were performed. The diagnosis of Goldenhar syndrome was established based on clinical and imaging findings. Previously reported cases are reviewed and the clinical and radiological features summarised.

In these two patients, a salivary fistula of an accessory parotid gland was demonstrated on computed tomography fistulography, and did not communicate with Stensen's duct. Deformity of Stensen's duct and hypoplasia of the ipsilateral mandibular ramus were present. Tragal appendices have frequently been reported in such cases.

A congenital cheek salivary fistula of an accessory parotid gland should be considered indicative of Goldenhar syndrome.

We present a case of bilateral chylothorax, a rare but life-threatening complication, which developed following a left-sided neck dissection.

Case report and literature review.

Chylous leakage fistula is a known complication following neck dissection and occurs in 1 to 2 per cent of patients. After left-sided neck dissection, chylothorax is uncommon and bilateral chylothorax is even rarer. Chylothorax is encountered following certain thoracic procedures, especially superior mediastinal dissection for thyroid cancer treatment. We discuss in detail the successful management of a complicated case.

We discuss various management options for this condition, and we summarise its successful management within our department.

We report a novel bilateral suture lateralisation technique that allowed permanent tracheostomy decannulation in a patient with severe paradoxical vocal fold movement.

A 45-year-old woman presented to the accident and emergency department with worsening shortness of breath. Flexible nasoendoscopy revealed limited vocal fold abduction and an emergency tracheostomy was sited; this was subsequently changed to a long-term Silver Negus tube. Her tracheostomy care was complicated by discomfort and dislodgement. The diagnosis of paradoxical vocal fold movement was only made when the patient presented to our department. Cognitive behaviour therapy and botulinum toxin injection were tried without success. A right vocal fold lateralisation procedure was performed, which enabled temporary tracheostomy decannulation. A left vocal fold lateralisation procedure was subsequently performed and the patient was successfully decannulated, with significant improvement in quality of life.

Paradoxical vocal fold movement is a rare condition that is most commonly managed by biofeedback sessions, relaxation manoeuvres or botulinum toxin injection. However, in cases similar to ours in which these treatments are unsuccessful, we suggest a ‘last resort’ technique to manage this rare condition.

A plunging ranula is an uncommon cause of neck swelling which typically presents in a gradually progressive fashion. This report describes a rare case of acute presentation of a plunging ranula. The condition progressed rapidly to respiratory distress, requiring urgent surgery.

A 14-year-old male student presented with a rapidly enlarging neck swelling associated with a sublingual swelling. Computed tomography suggested the diagnosis of plunging ranula. Several hours after admission, the neck swelling became very tense and the sublingual swelling enlarged dramatically. The tongue was pushed upwards and backwards by the sublingual swelling, causing respiratory embarrassment and requiring urgent surgery. Four months after surgery, there was no evidence of recurrence.

To the best of the author's knowledge, this is the first case report of a plunging ranula progressing acutely and rapidly to cause respiratory compromise. The literature is reviewed and pertinent features concerning the diagnosis and management of plunging ranula are presented.