Orbital pseudotumour is a non-specific inflammation of the orbit which forms a tumour-like mass composed of increased connective tissue and ground substance with vascular proliferation and an infiltrate of chronic inflammatory cells. No demonstrable aetiological agents are found locally, and there is no evidence of specific disease entities such as Hodgkins, SLE or temporal arteritis.

The condition may present in many different ways to the otolaryngologist, and is therefore a rare but important differential diagnosis to be born in mind. We report a rare case of orbital pseudotumour presenting initially with involvement of the maxillary antrum and in association with Riedel's thyroiditis.

Parotid metastases from a cutaneous malignant melanoma are uncommon. Although the long-term prognosis is poor, loco-regional palliation is important. In a group of eight patients with parotid metastases, local control was obtained by superficial parotidectomy. Occult cervical lymph node metastases were identified in five cases in whom radical neck dissection provided regional control. Superficial parotidectomy with elective neck dissection is advocated for patients with parotid metastases from cutaneous melanoma to ensure optimal loco-regional palliation.

We report a lateral saccular cyst of the larynx with both an internal and external component. The patient had a four year history of a cervical swelling and hoarseness. He presented acutely with stridor. The cyst was resected successfully without tracheostomy.

We present an extremely rare case of fourth branchial fistula in a 23-year-old male. The characteristic clinical feature was a recurrent left lower neck abscess which did not respond to appropriate medical and surgical therapy. Radiography and a computed tomographic scan with contrast material revealed a fistula running from the apex of the left pyriform sinus (internal opening) to the left lower neck abscess. The fistula tract was excised surgically. Histological examination of the excised fistula revealed a squamous epithelial lining and subepithelial lymphoid tissue. This pyriform sinus fistula is thought to be of fourth pharyngeal pouch origin, because of its surgical aspects and the histologicalfindings of the excised fistula.

We report a case of septicaemia and death due to occult sinusitis in an otherwise healthy adult. Septicaemia was diagnosed on clinical grounds and blood culture grew Streptococcus pneumoniae. Maxillary sinusitis was discovered incidentally on a CT scan four days after the onset of symptoms. A sinus wash-out revealed pus which on culture was positive for Streptococcus pneumoniae. The patient deteriorated gradually and died despite appropriate therapy. We conclude that sinusitis should be suspected in any case of septicaemia where the primary focus is not known and the patient does not respond quickly to treatment.

A 42-year-old female Jordanian patient presented with a history of sudden painful dysphagia following swallowing of a fish bone. Though soft tissue X-rays showed a foreign body in the neck, repeated oesophagoscopies failed to reveal it. Computed axial tomography was done and showed a fish bone embedded in the left thyroid lobe. Left thyroid lobectomy was carried out and the fish bone was seen within the lobe surrounded by an area of acute inflammation.

Non-chromaffin paragangliomas are unusual tumours arising in specialized tissue, probably of neural crest origin. A primary non-chromaffin paraganglioma of the paranasal sinuses is a very rare tumour with only a handful of such cases documented in the literature. The presence of such a tumour raises interesting questions as to the origin of such specialized tissue within the nose and paranasal sinuses.

Metastatic tumours in major salivary glands are uncommon with a higher incidence of primary sites from the head and neck. The lungs and breast are the common primary sites, while metastases from the kidney are very rarely found. The authors describe a case of renal clear-cell carcinoma with metastastis to the parotid gland. The incidence of a metastasis in the parotid gland from a primary renal carcinoma, even if rare, should not be overlooked in making a correct differential diagnosis with acinic cell carcinoma and monomorphic clear cell adenoma.

An unusual incident of aspiration of a silver tracheostomy tube obturator is described. Common sense advice to patients performing home tracheostomy care may help avoid similar occurrences in the future.

Death from respiratory causes in acromegaly is three times more common than in the general population and is most often the result of upper airways obstruction, although less commonly pulmonary dysfunction and disturbance of the central nervous system may occur. These factors may be found alone or in combination.

Despite several reports of laryngeal involvement, upper airway obstruction in acromegaly is usually regarded as being due to macroglossia and pharyngeal soft tissue hypertrophy. We present four cases of acromegaly in which tracheostomy was required for laryngeal obstruction, with a review of the literature concerning the nature of respiratory problems in acromegaly.

Cystic hygroma is considered a disease of childhood. It may appear for the first time in adult life but recurrence by that stage is rare and may present difficulties in diagnosis due to previous treatment. The authors present a case where early pharmacological intervention may have prevented a potentially life threatening situation. The world literature is also reviewed.

Inter-arytenoid glottic bar is a rare complication of prolonged endotracheal intubation. We present two such cases and their treatment.

The aetiology of this complication is multifactorial and involves local factors—local tauma, movement of the endotracheal tube within the larynx, infection, and anatomical influences–together with systemic factors such as in our two cases.

The relative importance of these factors is discussed.

A comment is also made on the use of a pre-operative topogram and the importance of an ENT assessment in patients with airway problems following prolonged intubation.

Invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon. Twelve cases of cancer of the larynx fungating through the cervical skin are presented. They mostly followed initial treatment by deep X-ray therapy or partial laryngectomy. A high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap. The management and follow-up of these patients is described.

Although upper airway obstruction and superimposed infection are well-known complications of infectious mononucleosis, lingual tonsillitis in this context has not been mentioned in the literature. We describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis. The role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed.

Laryngeal amyloidosis is a rare disease. Surgery has been the mainstay of treatment either endoscopically or by an external neck approach. In more recent years, surgery with the carbon dioxide laser has been advocated for this condition. Four cases of laryngeal amyloidosis are presented. The application and the advantages of the carbon dioxide laser for the treatment of laryngeal amyloidosis are discussed.

A case of oesophageal intramural pseudodiverticulosis is presented and the clinical, pathological and specific radiological features are documented.

Metastases to the larynx from distant primaries are very rare. Usually the secondary lesjon comes from an hypemephroma or malignant melanoma. A case of metastatic laryngeal tumour from a colonic adenocarcinoma, occurring in a 59-year-old woman, is presented and the routes for laryngeal spread are discussed. The poor survival-rate of these patients justified only conservative surgery.