We present a previously unreported technique which we have found useful for closure of the donor site created by a paramedian forehead flap, during nasal reconstruction.

An 80-year-old woman was referred to the ENT department for management of a large tumour involving the left nasal dorsum. The lesion measured 2.5 × 2.5 cm, and an incisional biopsy confirmed moderately differentiated squamous cell carcinoma. Complete excision with an interpolated paramedian forehead flap reconstruction was performed. The pedicle was divided three weeks post-operatively, and the 2 × 2 cm forehead defect was closed at this time. A frontalis muscle flap and full thickness skin graft were used to close the donor site.

A frontalis muscle flap is a novel method of closing large forehead defects created by a paramedian forehead flap. A frontalis muscle flap provides a healthy base for a full thickness skin graft, which allows good skin colour matching and an enhanced cosmetic result.

We report a rare case of new bone formation (osteogenesis) within an inverted papilloma, occurring in the ethmoid and frontal sinuses.

The histopathological and radiological findings, differential diagnosis, and treatment of tumour-induced osteogenesis are discussed.

A 68-year-old man complained of headache and left-sided, purulent rhinorrhoea of five years' duration. On nasal endoscopy, lesions similar to inflammatory nasal polyps were seen. Pre-operative radiological images demonstrated opacification of the left nasal cavity and anterior ethmoid and frontal sinuses, plus a bone-density lesion. The mass with bony lesion was completely removed endoscopically. The mass was histopathologically diagnosed as an inverted papilloma surrounding bony tissue. Furthermore, the histopathological findings (including immature bony tissue rimmed by osteoblasts) indicated an extremely rare case of inverted papilloma induced osteogenesis. Six months after surgery, no recurrence was detected.

This case highlights the importance of clinical awareness of tumour-induced osteogenesis.

We report a case of Sweet's disease associated with rapid, profound loss of hearing, against a background of progressive, bilateral, sensorineural hearing loss.

The clinical features were indistinguishable from those of immune-mediated inner ear disease. Establishment of a definitive diagnosis was a challenge due to the absence of a reliable diagnostic test. The patient was unresponsive to extensive immunosuppressive therapy and subsequently underwent cochlear implantation, with good hearing outcomes.

Profound, bilateral, sensorineural hearing loss in the context of Sweet's disease may be related to the underlying immunological aetiology. Cochlear implantation can successfully restore hearing when immunotherapy fails.

We report a case of anterior spinal artery syndrome, an extremely rare complication, following head and neck surgery.

A case report and literature review concerning anterior spinal artery syndrome is presented.

A 64-year-old man developed an anterior spinal artery infarction following total laryngectomy and bilateral neck dissections for post-radiotherapy glottic carcinoma. Anterior spinal artery infarction is a rare syndrome. It typically presents with weakness, loss of pain and temperature sensation below the level of the injury, with relative sparing of position and vibratory sensation. Recovery is variable.

To the best of our knowledge, this is the first case report in the English language literature of anterior spinal artery syndrome following a head and neck procedure. This case report highlights a rare complication, and also the susceptibility of head and neck surgery patients to different complications. In head and neck cancer patients suffering anterior spinal artery syndrome following primary surgical treatment, we recommend that the management of this complication should be as aggressive as that of the primary cancer.

To examine the usefulness of a three-dimensional model for surgical navigation of cholesteatoma.

A three-dimensional model was prototyped using selective laser sintering. Based on detailed computed tomography data, powder layers were laser-fused and accumulated to create a three-dimensional structure. The computed tomography threshold was adjusted to simultaneously replicate bony structures and soft tissues.

The cholesteatoma, major vessels and bony structures were well replicated. This laser-sintered model was used to aid surgery for recurrent cholesteatoma. The cholesteatoma, which extended from the hypotympanum through the styloid process sheath and the internal carotid artery sheath, was removed safely via a minimal skin incision.

The laser-sintered model was useful for surgical planning and navigation in a cholesteatoma case involving complex bony structures and soft tissue.

We describe a case of endolymphatic sac tumour confined to the middle ear, which radiologically mimicked a glomus tympanicum, in a 58-year-old woman with tinnitus.

A 58-year-old woman presented with a one-year history of right-sided tinnitus. The clinical, radiological and surgical features were felt to be in keeping with a glomus tympanicum. However, the histopathological picture was that of a low grade papillary carcinoma of the endolymphatic sac, i.e. an endolymphatic sac tumour.

Endolymphatic sac tumours are classically locally aggressive and centred around the petrous temporal bone. Further growth results in complete replacement of the mastoid and petrous pyramid by tumour. To the best of our knowledge, there have been no previous reports of an endolymphatic sac tumour located solely within the hypo- and epitympanum of the middle ear.

We report a very rare case of a hydatid cyst in the infratemporal fossa, causing visual loss over a 10-day period, which disappeared with rapid surgical and medical treatment.

A 14-year-old girl presented with right exophthalmos and visual loss. Over a 10-day period, her visual acuity had decreased to detection of hand motion only, due to pressure on the optic nerve caused by a parapharyngeal cyst pressing through a inferior orbital fissure on the right side. A craniotomy had previously been performed for a right frontoparietal hydatid cyst. The patient had been treated intermittently with albendazole. The patient was primarily diagnosed with hydatid cyst, on the basis of her previous medical history and radiological findings, and underwent surgery. Three cysts were carefully removed from the right maxillary sinus, via a standard Caldwell–Luc approach, and the surgical area was irrigated with hypertonic saline.

Infratemporal hydatidosis is very rarely reported in the world literature, although hydatid cysts are endemic in many countries, including Iran. We discuss the common presenting features, investigation and treatment options for infratemporal hydatosis. Constant evaluation of adjacent organs is necessary, with treatment as required, due to the propensity of hydatidosis to recur in essential organs. Immediate surgery is recommended, both to prevent the development of disease and to improve the prognosis.

To highlight the first reported case of necrobiotic xanthogranuloma of the parotid gland. We also review the clinical presentations and treatments for this rare condition.

Case report and review of necrobiotic xanthogranuloma.

A 48-year-old man presented with a right parotid mass. Fine needle aspiration cytology was suggestive of Warthin's tumour, for which the patient underwent a subtotal parotidectomy. The final histopathological diagnosis was necrobiotic xanthogranuloma.

Necrobiotic xanthogranuloma may clinically mimic commoner tumours such as Warthin's tumour. Once diagnosed, the clinician should be wary of extracutaneous manifestations and paraproteinaemias. Because of the variability of presentation, there is no consensus on the best treatment for necrobiotic xanthogranuloma, which may include surgery, chemotherapy, interferon, plasmapheresis and radiation therapy.