Silastic implants are very widely used in surgical practice and are considered to be relatively inert. They do however present with complications, including infection, local foreign body inflammatory response, calcification, migration and failure of repair of the defect, which sometimes may necessitate explantation. Head and neck implants do present a special case, as complications can cause obstruction and disruption of function in small cavities. A pertinent history, clinical review and computed tomography scan are usually invaluable in obtaining a diagnosis. We present a rare case of migrated Silastic orbital sheet, presenting as a nasal polyp and causing maxillary antral pain and infection. A detailed search of the medical literature revealed no other such case.

Laryngeal squamous cell carcinoma (SCC) is one of the most frequent malignancies in the head and neck region. The risk of multiple malignancies is reported as 2–11 per cent and most of the second primaries are SCCs. Lymphogenic tumours as second primaries are extremely rare. In this paper, we report a case of laryngeal SCC with synchronous non-Hodgkin's lymphoma and review the literature on the clinical and histopathological aspects of these malignancies.

Smooth muscle tumours of the head and neck are rare. An unusual case of laryngeal leiomyosarcoma in a 69-year-old man is presented. Histological diagnosis of this tumour is difficult, and immunohistochemical studies are vital. Treatment is discussed, and should include local control with debulking, radiotherapy and long term follow up.

Aneurysms of the extracranial portion of the internal carotid artery are rare. Generally, they occur just at the level of, or above, the bifurcation. Here we report a case of a left internal carotid artery aneurysm presenting as an oropharyngeal mass causing dysphagia.

A pilonidal sinus is most commonly seen in the sacrococcygeal region. Here we describe a rare case of pilonidal sinus of the neck following trauma due to shaving. Excision of the sinus with primary repair resulted in complete healing of the lesion with no recurrence. The possible pathogenesis of this acquired condition is also discussed.

Following a previous paper in which we documented the otological side effects of drug therapy, we here review other drug side effects that ENT surgeons may encounter when dealing with patients. Although otological drug side effects such as hearing loss and tinnitus are well recognized there are many rhinological, laryngeal, oropharyngeal and other head and neck drug side effects. Our data were sourced from the British National Formulary and Electronic Medical Compendium websites.

The aim of this study was to quantify the effect of tonsillectomy on the incidence of sore throats and its co-morbidity in adult patients. One hundred and nineteen adult patients were sent a standard questionnaire regarding their symptoms in the 12 months preceding and following their tonsillectomy. Outcome measures included the incidence of sore throats, total number of days with sore throat, amount of time taken off work or school, and number of visits to the general practitioner (GP). In addition, patients were asked to indicate the duration of their symptoms and whether or not they found the tonsillectomy effective in curing their sore throats.

Sixty-six patients (55.5 per cent) returned completed questionnaires. The age of the patients ranged from 16 to 39 years. The mean duration of symptoms was 8.3 years. On average, patients had 8.1 different sore throat episodes, 42 sore throat days, 21.4 days of sore throat related absence from work or school, and 5.9 visits to the GP in the 12 months before their operation. For the 12 months after surgery, these reduced to 0.9 episodes, four days, 2.2 days and 0.6 visits, respectively. This reduction was very significant (p < 0.001, Wilcoxon signed rank test).

After their surgery, more than half the patients achieved complete resolution of all the measured parameters mentioned above. Most of the remaining patients achieved at least 50 per cent resolution. Only three patients (4.8 per cent) achieved less than 50 per cent resolution. Ninety-five per cent of the patients found the operation effective in curing their sore throats and were glad they had had surgery.

In conclusion, retrospective questionnaire data must be interpreted with some caution, but this study suggests that tonsillectomy is effective in reducing the incidence, duration and co-morbidity of recurrent sore throats in adults; this must be balanced against the post-operative problems in a minority of patients.

Acoustic neuromas (vestibular schwannomas) comprise more than 90 per cent of all cerebello-pontine angle (CPA) lesions. We present a rare case of a giant vertebro-basilar aneurysm presenting as a CPA lesion. The general condition of the patient precluded the completion of the magnetic resonance (MR) sequences. The clinical and limited radiological results (T2 images alone, the features of which were not specific) initially did not lead to a specific diagnosis. To obtain further radiological information a computed tomography (CT) scan with contrast was performed and this revealed the lesion to be an aneurysm. The diagnostic difficulties and the treatment dilemmas of such a lesion are discussed. The importance of fine, axial, post-contrast CT arteriography with three-dimensional reconstruction, MR angiography and digital subtraction angiography are highlighted. The limitations of MR imaging in patients with CPA lesions are discussed.

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.

The insertion of a myringotomy tube is a common ENT procedure. Traditionally, this procedure is performed under otomicroscopic view. In this paper I describe a technique using rigid endoscopy with the Hopkins rod and a video monitor as a visual aid for the insertion of myringotomy tube in older children and adults. The technique is safe and effective; it allows demonstration of the entire tympanic membrane during surgery and also enables better teaching of the procedure than does the otomicroscope.

We report a case of sinolith in the left ethmoid sinus of a 61-year-old man. The patient complained of nasal obstruction. Computed tomography revealed a small, calcified mass associated with a nasal polyp in the left ethmoid sinus. The antrolith and polyp were removed via endoscopic sinus surgery. Histopathological analysis of the antrolith revealed it to be bone-like in formation. The antrolith was about 1 cm in diameter. Infrared spectroscopy revealed that the antrolith contained protein (45 per cent), calcium phosphate (43 per cent) and calcium carbonate (12 per cent).

Airway obstruction secondary to bleeding from warfarin therapy is difficult to manage and uncommon but has been previously described. Previous reports have emphasized the need for reversal of therapy using vitamin K and fresh frozen plasma (FFP). Where a definitive airway has been required, cricothyroidotomy or tracheostomy seem to have been favoured. Several authors have reported failed attempts at endotracheal intubation due to the obstructive effects of a sublingual haematoma. We report here a case which illustrates how endotracheal intubation can be used successfully under the right conditions. It also highlights the superiority of prothrombin complex concentrate over FFP in achieving rapid reversal of abnormal international normalized ratio in the emergency situation.

We present a patient suffering from salivary duct carcinoma in the mobile portion of the tongue, arising from a minor salivary gland; this condition is extremely rare. The patient was a 64-year-old woman who presented with a nonpainful, hard mass in her tongue. An aspiration smear showed cells with very scant cytoplasm and pale oval nuclei containing small, single nucleoli. Scattered clusters of small cells had darkly stained nuclei. Neither necrosis nor cribriform areas were seen. The smears suggested a salivary gland neoplasm; however, definitive diagnosis of salivary duct carcinoma remained difficult. Partial glossectomy was performed with a wide margin. Macroscopic examination revealed an unencapsulated, submucosal tumour infiltrating underlying muscle. Microscopic examination revealed a salivary duct carcinoma with comedonecrosis and relatively few cribriform and papillary areas. This case suggests that it may not be easy to establish a definitive diagnosis of salivary duct carcinoma from an aspiration smear if the salivary duct carcinoma is composed of comedonecrosis surrounded by solid tissue in a noncribriform pattern.

Maxillary haemangioma is a rare entity. It presents with a painless, slow-growing swelling and if it involves the paranasal sinuses it may present with severe epistaxis, mimicking a malignancy. A case of haemangioma arising in the bony maxilla and causing a cosmetic problem is presented here.