A 32-year-old male presented with a mass in the parotid gland. Superficial parotidectomy was performed. Histopathologically the tumour was found to be schwannoma (neurilemmoma) and because this is unusual, the case is presented together with the histopathological findings.

While tonsillectomy is the commonest operation performed by otolaryngologists, paralysis of the hypoglossal nerve following tonsillectomy is not well recognized in the otolaryngology text or literature.

We report a case of hypoglossal nerve paralysis following tonsillectomy and discuss the theories on the pathoaetiology as described in the predominantly anaesthetics literature. The likely causes of nerve injury are described and precautions are suggested to help avoid this problem.

Tumours of the hypopharynx continue to have one of the most dismal prognoses of all tumours of the upper aerodigestive tract. These tumours are frequently advanced at the time of diagnosis. They have a particularly high propensity for lymphatic spread. Treatment, thus appears difficult from the outset. Although therapeutic protocols have improved, their often radical nature is synonymous with poor tolerance. With neoadjuvant chemotherapy and reconstructive surgery, cure has become a possibility for an increasing number of patients. However, sustained long-term remission following chemotherapy alone for advanced hypopharyngeal tumours has seldom been recorded.

Ramsay Hunt’s hypothesis that herpes zoster oticus results from reactivation of the varicella zoster virus (VZV) in the geniculate ganglion is supported by the detection of viral genome in archival temporal bones of normals and Ramsay Hunt patients by the polymerase chain reaction. Ramsay Hunt syndrome is characterized by the presence of cochleovestibular symptoms in association with facial paralysis. VZV has also been demonstrated in the spiral and/or vestibular ganglion. Two cases are reported in which cochleovestibular symptoms outweighed the facial nerve symptoms, presumably representing VZV reactivation in the spiral and/or vestibular ganglion. From these observations and the known dormancy of VZV in non-neuronal satellite cells, it is argued that the cochleovestibular symptoms in Ramsay Hunt syndrome may result from VZV transmission across the nerves inside the internal auditory canal and that prompt treatment with an antiviral-corticosteroid combination might be justified in the management of any acute non-hydropic cochleovestibular syndrome.

A case of osteochondroma of the posterior nasal septum is presented. A 57-year-old female patient presented with a history of bilateral nasal obstruction for 20 years. To the best of our knowledge, this is the second reported case of an osteochondroma of the nasal septum. It was treated by endoscopic transnasal transseptal surgery.

In a patient presenting with haematemesis, known to have oesophageal varices, the bleeding would be expected to be from those varices. This case demonstrates an unusual presentation of a base of skull fracture; blood from a fracture of the temporal bone had run from the middle ear through the eustachian tube to the pharynx. It demonstrates the need to remainvigilant even when the diagnosis appears to be obvious.

A Groningen speaking valve was lodged in the oesophagus in a post-laryngectomy patient and was neglected for nine years. The patient presented with dysphagia. It was diagnosed and removed on rigid endoscopy. The procedure was complicated by a primary tear of the oesophagus, that was managed conservatively. The case has many interesting features, that are discussed below.

The present paper describes the first reported case, to our knowledge, of a myoepithelioma arising in an accessory parotid gland. Because pre-operative fine-needle aspiration cytological findings and operative findings suggested that this tumour was malignant, the decision was made to remove the tumour surgically along with the buccal branches of the facial nerve. The resected nerve was reconstructed by nerve transplantation, using the great auricular nerve. Subsequently the tumour was found to be benign. One year after surgery, the patient had excellent facial nerve function and so far there has been no evidence of recurrence.

In phonosurgery, in cases where it is not possible to use a rigid laryngoscope, a flexible fibrescope with laryngeal-mask ventilation may be used. In flexible fibreoptic surgery, the forceps are normally inserted through a small channel in the fibrescope. Since only a small forceps tip can pass through this channel, a limited range of forceps has been available for use in fibrescope procedures. We have developed a new type of forceps for flexible fibre-optic surgery that allows this size limitation to be overcome. The new forceps is made up of two parts: (i) the forceps tip and its control wire assembly, and (ii) a detachable handle. A wide range of forceps can be used, including those with tips larger than the biopsy channel. We report a case that was treated with this new technique.

Both thyroglossal cysts and aberrant thyroid tissue may present as a mid-line neck swelling. We report a case of autoimmune thyroiditis presenting as a thyroglossal swelling in a middle-aged woman. This very rare finding is discussed with reference to the optimal management of thyroglossal tract swellings.

Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30–40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.

Schwannoma arising from the posterior pharyngeal wall is extremely rare. We report a 24-year-old female patient who had suffered from dysphagia and discomfort for two months. The tumour was excised completely via the intraoral approach. No recurrence was found after the follow-up period of one year. To our knowledge, only four cases of schwannomas from the posterior pharyngeal wall have been reported, and this patient is the fifth.

Spontaneous dissections of extracranial carotid arteries occur most frequently in the internal carotid artery. In contrast, common carotid artery dissection (CCA) is a rare cause of cerebral ischaemia with only a few cases having been reported. We present the case of a 59-year-old male patient who was referred to our clinic with left cervical pain. The patient was otherwise asymptomatic. Magnetic resonance imaging (MRI) showed enhancement and double lumen in the left CCA without affecting the carotid bulb, internal carotid artery or aortic arch. We discuss the diagnostic and therapeutic management of the disease, focusing on its differentiation from other causes of cervical pain.

Most schwannomas of the hypoglossal nerve originate from the intracranial portion, but they may extend extracranially. Solitary and extracranial schwannomas are extremely rare. We report a case of submandibular hypoglossal schwannoma along with its clinical course and management.

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence.

A case of deep hard palate ulcer due to sinonasal mucormycosis in a 79-year-old man is reported. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks.

By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by dermal, mucosal, and visceral telangiectases as well as pulmonary and cerebral arteriovenous malformations. Recurrent epistaxis occurs in the majority of patients, and by the very nature of the thin walled vessels involved it is often refractory to conventional forms of treatment. We present the case of an 82-year-old lady with intractable epistaxis secondary to HHT, that was successfully controlled by the application of fibrin glue.

Mandibular osteochondromas, although rare, predominantly involve the condyloid and coronoid processes. An extremely rare case arising from the inner aspect of the gonion is reported here. Only one such case has been reported in the literature so far. Despite being very slow growing and having a benign course, histopathological examination showed reactive changes that may be confused with sarcomatous transformation. We advocate surgical excision using a combined external and internal approach followed by regular post-operative review. The relevant literature has been reviewed but various surgical approaches as advocated in the past have not been found suitable.

Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.

Intractable paroxysmal sneezing is a rare disease primarily affecting teenage girls. We present the case of a 12-year-old girl who demonstrated the classical features of intractable paroxysmal sneezing of psychogenic origin. Most of the reported cases are psychogenic in origin, but a number of other conditions may cause intractable paraoxysmal sneeze. Apart from a detailed history, clinical examination and relevant investigations, topical nasal anaesthesia should be tried for control of symptoms – that will help to differentiate psychogenic sneezing from organic sneezing. A timely diagnosis can avoid unnecessary medical trials, parental anxiety and poor school performance, as most of the patients are very young.

Clear cell carcinoma of the salivary glands is a rare tumour that represents less than one per cent of all salivary tumours. They are divided into a biphasic, epithelial-myoepithelial carcinoma and a monophasic pattern which may be myoepithelial or ductal in origin. The latter is accompanied by prominent fibrohyaline stroma and has been described recently as hyalinizing clear cell carcinoma (HCCC).

Most of the HCCC occur in the oral cavity, and are associated with minor salivary glands, unlike the biphasic pattern which is more common in the major salivary glands. In the oral cavity, the commonest site is the palate followed by the lips and the buccal mucosa. Its occurrence in the oropharynx and the larynx is extremely rare.