A case of laryngeal squamous cell carcinoma recurrence presenting as multiple cutaneous metastases is presented. Such metastases are rare and are associated with a poor prognosis. Treatment is usually aimed at providing pain relief in these patients with a limited life expectancy.

A case of sensorineural hearing loss (SNHL) in MELAS syndrome, a variety of mitochondrial cytopathy, is presented. Mitochondrial cytopathies have gone almost unreported in the otolaryngology literature, despite evidence from a recent review that about 60 per cent of such patients suffer from SNHL (Gold and Rapin, 1994). The same review revealed that only one of 117 case reports in the period 1984–1993 contained an audiogram (Swift and Singh, 1988), and none presented sequential audiograms. However, audiometry has since been published on 23 members of a family with a mitochondrial point mutation causing only sensorineural hearing loss with no other symptoms (Vernham et al., 1994). We present a case of mitochondrial cytopathy three years after diagnosis with two sequential audiograms.

An unusual case of laryngeal carcinoma metastasizing to the small intestine is reported. The patient was admitted to our hospital due to hoarseness, sore throat and dyspnoea. Pathological examination on the laryngeal mass revealed it to be moderately differentiated squamous cell carcinoma, staged as T4N0M0. A total laryngectomy and right modified neck dissection were performed. Over two years after the operation a small intestinal tumour was found, with a resultant resection of the ileum and sigmoid colon. An infiltration of the cell nests of squamous cell carcinoma were present at the submucosal regions of the ileum. These findings indicated that the laryngeal cancer had already metastasized to the small intestine at the time of the initial treatment.

A new-born boy with severe stridor was found to have a laryngeal hamartoma. The airway was secured by means of a tracheostomy, and the hamartoma was subtotally resected endoscopically using a carbon dioxide laser. A good functional result was achieved, even though decannulation was delayed until the age of 33 months. This is the ninth known case of hamartoma of the larynx and the sixth presenting with stridor in the neonatal period.

Pseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.

We present a rare case of renal cell carcinoma metastatic to the tonsil. Tonsillectomy was inadvertently performed during an attempt to drain what was clinically a peritonsillar abscess.

The morbidity of long-term ventilation tubes (Goode T-tubes) is often discussed with reference to otorrhoea, tympanosclerosis and long-term perforation. We report three cases of the T-tube slipping into the middle-ear cleft. In two of the three patients this was asymptomatic and the T-tubes were left in situ. In the third patient this complication was documented on three occasions when the T-tube was removed and reinserted for recurrent effusions. We are unaware of this complication being previously reported in the literature.

The relative rarity of pharyngeal lipomas and paucity of clinical manifestations in the early stages of tumour growth conspire to task the diagnostic acumen of the clinician. A high index of suspicion and meticulous examination are essential in order to arrive at the diagnosis, which may be achieved pre-operatively by computerized axial tomography, revealing a mass lesion with a characteristic low attenuation value. A case of pharyngeal chondrolipoma in a 25-year-old male is reported. It is suggested that this conceptually intriguing and rarely encountered lesion can be explained on the basis of neoplastic transformation of the second to fourth pharyngeal cleft mesenchymal rests displaying both adipose and cartilaginous differentiation. Alternatively, the cartilage could represent vestigial remnants of non-neoplastic pharyngeal cleft tissue entrapped within a primarily lipomatous neoplasm. Slow growth may occur over a period of several years, prior to overt clinical manifestation.

We present a case of obstructive sleep apnoea in a child that is caused by papillomatosis of the post-nasal space.

We report a case of parapharyngeal abscess complicating an elective tonsillectomy in a healthy thirty-three- year-old woman. The clinical features and management of this very rare complication are discussed. In addition, we review the possible aetiology and pathogenesis of this potentially life-threatening condition.

Acute torticollis may result from an inflammatory process irritating the cervical muscles. In children there is often an association between acute torticollis and retropharyngeal cellulitis/abscess.

Over six weeks, two children with acute torticollis presented to our Department. Both children were found to have retropharyngeal cellulitis/abscess. The problem of differentiating between the non-suppurative and the suppurative phases of the disease process is discussed.

Ortner's Syndrome (described 100 years ago in 1897) is a clinical entity with hoarseness due to a left recurrent laryngeal nerve (LRLN) palsy caused by cardiac disease. A 35-year-old woman presented with a LRLN palsy due to a huge thoracic aneurysm. The anatomy of the LRLN and the cardiothoracic complaints which may cause the palsy are discussed.

Chlorine gas is known to be a potent irritant to the eyes, nose, throat and lungs with severe exposure resulting in pulmonary oedema and even death. There have been no case reports, however, of chlorine inducing anosmia. We present such a case, along with a review of the literature on the toxicology of chlorine and its effect on the nose.

Although subglottic cysts have previously been reported as a cause of airway obstruction in the neonate, they have previously been considered to be a relatively rare cause. Cystic narrowing of the subglottis has been associated with endotracheal intuhation. With improving survival of pre-term infants the incidence of the condition could be expected to rise. Prior to 1996, only 58 cases had been reported in the literature. We believe that the true incidence of the condition has been considerably under-reported. Over a six-month period our unit diagnosed five cases of compressible cysts in the subglottis in low birth weight, pre-term infants. All patients underwent diagnostic microlaryngobronchoscopy and vaporization of the cysts by CO2 laser. Three children required more than one procedure. In all cases a satisfactory airway was achieved. The pathogenesis, diagnosis and treatment of the condition is discussed.

Retropharyngeal abscesses in adults are very rare and usually secondary to chronic tuberculous cervical spine osteomyelitis. We report a case of Staphylococcus aureus septicaemia with multifocal abscesses and osteomyelitis of the cervical spine causing a retropharyngeal abscess. This presented as neck pain and dysphagia following a fall. In addition, we have reviewed related cases.

Post-radiation necrosis of the larynx is a major complication after irradiation and has become rare. Recently, combined chemotherapy and radiation therapy has been introduced for head and neck tumours. The authors report a case of laryngeal necrosis after combination therapy for a patient with cervical lymph node metastases of nasopharyngeal carcinoma and review the literature on late laryngeal necrosis. Although radiation-induced laryngeal necrosis has become a rare complication, the combination of chemotherapy and radiation therapy may increase its incidence. We should always consider it as a possible late complication and treat it appropriately.

Non-Hodgkin's lymphoma (NHL) is a frequent head and neck malignancy. Squamous cell carcinoma of the tonsil is the second most common head and neck carcinoma. We report a case of a tonsillar carcinoma metastasis in an angioimmunoblastic-transformedlymph node. To our knowledge this is the first description and histopathological documentation of such a case in the literature.

Pulmonary oedema is an uncommon but important complication of laryngeal spasm which in turn occurs more commonly in ENT practice than in most other surgical specialities. A case is reported and the literature reviewed, with particular reference to the proposed pathophysiological mechanism of this phenomenon.

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

Extension of recurrent respiratory papillomatosis (RRP) to the lower airway in children is life-threatening and an extremely difficult condition to treat. We present the case of a seven-year-old girl with progressive RRP since the age of two. Repeated CO2 laser treatment and interferon-alpha treatment could not prevent tracheotomy and spread to the trachea. We used argon plasma coagulation (APC) with flexible endoscopy for the first time for the treatment of RRP. APC gives a controlled limited penetration into the tissue and good control of bleeding. There is no carbonization or vaporization which makes it a suitable method for the treatment of lower airway RRP. After a few treatments with APC, we gained very good control of the disease with no side-effects or complications. The described application of APC seems to be a promising way to treat lower airway RRP.