A per-oral approach to pharyngeal branchial cysts is possible, and ideal when they are placed medially to the pharyngeal constrictors and no fistular duct is connected to the mass.

At present MRI is found to be the best means of achieving the correct diagnosis of morphology and site.

A case is described where neck pain of unknown origin associated with dysphagia was found to be caused by a foreign body in the thyroid gland.

Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting inearly pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.

We present a patient with established histiocytosis who developed dysphagia, retching, regurgitation, hoarseness and stridor. These symptoms were managed with carbon dioxide laser vaporization, electively on three occasions, and once as an urgent procedure, while awaiting radiotherapy, to control her airway.

Histiocytosis is a rare cause of a number of otolaryngological syndromes, but there has been no previous record of this disease causing laryngopharyngeal symptoms. This paper discusses the classification of histiocytosis, and describes our management of this rare and intriguing case.

Cowden's disease is a rare predominantly inherited disease, characterized bymucocutaneous lesions, gastrointestinal polyposis and benign or malignant thyroid and breast tumours. The report deals with a typical case of this disease with emphasis on its importance forotolaryngologists.

Magnetic resonance imaging (MRI) features in a case of malignant glomus jugulare tumour are reported. Chemodectomas are benign in 95 per cent of cases and malignant in five per cent. Only one case report of CT findings in this unusual CP angle tumour with pulmonary metastases has been cited in the literature.

It is concluded that MRI can provide useful information about the nature of chemodectomas although it cannot dislinguish between benign and malignant tumours, except when regional lymph nodes are involved or when distant metastases exist.

Synovial sarcoma is a soft tissue malignancy which most commonly affects the lower limbs of young adults and rarely occurs in the head and neck region. The term synovial sarcoma may be a misnomer as most of these tumours occur in tissues not known to contain synovial tissue. There has only been one previously reported case affecting the middle ear, which was metastatic, and we report the first case of primary synovial sarcoma of the middle ear.

A rare and possibly unique benign polypoid tumour of the palatine tonsil is described. It contained the two basic tissue types of the tonsil–lymphoid and epithelial–in the characteristic close anatomical relationship of tonsillar tissue. The features of this rare lesion lend support to the hypothesis that benign tumours of the tonsil may be hamartomas of tonsil or branchiogenic remnants rather than true neoplasms.