A case of pneumopericardium in a child following blunt injury to his trachea is described. Such a case has not been previously described in the literature. A probable anatomical explanation for this rare event is offered.

Spontaneous massive haemorrhage form a parathyroid adenoma is rare. It can cause extensive cervical ecchymosis as well as compression of structures within the neck. We present a case, discuss the diagnostic features and review the literature

Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases. A case of a patient with a lateral neck abscess caused by S. bovis is reported. During the treatment the patient was found to have colonic malignant lesions. The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.

A 32-year-old man presented to the otolaryngology department with acute dysphagia after vomiting. Radiological investigation suggested a piece of meat lodged in the lower oesophagus and rigid oesophagoscopy was performed. However, a plastic shotgun cartridge wad was found and removed. This had gained access to the stomach when the patient had been shot at point-blank range 18 months previously, and appeared to have been forced into the oesophagus by the vomiting, where it caused obstruction.

The surgical management of intractable epistaxis by external carotid artery ligation may become complicated if there is a high bifurcation of the common carotid artery. Occlusion of the bleeding vessels by catheter embolization is described in a patient in whom exploratio n of the neck had failed to locate the external carotid artery.

Three hundred and seven normal CT scans of the head were prospectively analysed to assess jugular foramen dominance. After assessment, hand preference was elicited. Of these, 276 were right-handed and 31 were left-handed. Of the right-handed patients: 180 had a larger jugular foramen on the right; 63 had a larger jugular foramen on the left; and in 33 no difference could be discerned. Of the left-handed patients: 11 had a larger jugular foramen on the right; 16 hada larger jugular foramen on the left; and in four no difference couldbe discerned. The results suggested a significant association betweenjugular foramen dominance and hand preference.

A case of occult sphenoid sinusitis was diagnosed by an MRI scan in a patient who presented clinically with meningism and unilateral parotid swelling. Although the patient improved with a prolonged course of antibiotics complete resolution occurred only after surgical drainage of the affected sinus.

We present a 42-year-old male with botryomycosis initially presenting with left-sided proptosis due to an infraorbital mass. A biopsy through an anterior orbitotomy yielded indeterminate histopathology. The patient later developed a similar oral lesion which was biopsied and found to be botryomycosis. The oral lesion recurred after initial surgical treatment, but responded to antibiotic therapy. Discussion of this case along with a review of the literature is presented to offer guidelines for recognition and managment of this rare disorder.

The origin and course of the carotid arterial sysem in the superior mediastinum and neck are remarkably constant. Although variations are rare, they can have important implications in certain clinical problems. In this report, a patient underwent free jejunal graft repair of a cervical oesophageal stricture caused by radiotherapy for a post-cricoid carcinoma. The common carotid artery on the side of the surgical approach was found to cross the midline to the other side of the neck, and created difficulties both with the procedure and future management. This has not been previously reported.

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at th e apex of th e posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic ‘sulphur granules’ in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobi c culture of pus and biopsy specimens should be performed in addition to Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

The dural tail on contrast-enhanced magnetic resonance (MR) images, frequently observed in meningiomas, has been used to distinguish between cerebellopontine angle meningiomas and vestibular schwannomas. We report on a 66-year-old female with vestibular schwannoma showing the dural tail on contrast-enhanced MR images. Histological examination revealed that the dural tail corresponded to the thickened dura mater comprising of collagen fibres and scattered hyalinization with no tumoral invasion.

A case of a deep neck abscess caused by Salmonella enteritidis in a 29-year-old previously undiagnosed diabetic patient is reported. Review of relevant literature has shown 11 cases of Salmonella neck abscess. Predisposing conditions include immunosuppression due to any cause. Salmonella sp. should be included in the differential diagnosis of head and neck abscesses in predisposed individuals and treated accordingly.

Kimura's disease (KD) is an uncommon condition once thought to affect only Orientals. The patients present with swelling of the major salivary glands associated with cervical lymphadenopathy. The clinical, histopathological and radiological findings of a young Caucasian female with KD will be presented and discussed.

Primary branchial cleft carcinoma is a diagnostic challenge. The majority of cases have been shown, following the application of rigid criteria, to have developed from an occult metastasis elsewhere.

We describe what we believe to be only the second reported case in a patient who fulfils all of the established criteria.

Most salivary gland tumours present with an obvious mass and are usually diagnosed clinically. We present a case of occult adenoid cystic carcinoma of the parotid which, due to its peculiar septal pattern of growth and complicated clinical setting. defied diagnosis for several years.

Inflammatory myofibroblastic tumours are aetiologically enigmatic, nosologically confusing and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumours have also been documented in a number of extrapulmonary sites including the head and neck. So far only two cases of inflammatory myofibroblastic tumour of the tonsil have been reported in the English literature. We document another case, occurring in a 41-year-old man with history of cadaveric renal transplant nine years ago. A comprehensive review of the literature is also presented.

We report a case of a 13-year-old boy who inserted a 5 cm nail into his nose. X-ray showed it in the post-nasal space and it was removed through the mouth.

Infantile fibromatosis, one of the fibrous tumours of infancy and childhood, is a fibroproliferative lesion characterized by aggressive local invasion without any tendency to metastasize, the absence of cytological evidence of malignancy and a high rate of local recurrence when incompletely excised. We report a case of infantile (desmoid-type) fibomatosis in a seven-year-old girl arising from the deep lobe of the parotid gland that was treated by complete surgical excision with preservation of the facial nerve. The clinical features, pathology and treatment are briefly discussed.

Parapharyngeal abscess is not an uncommon condition and may be due to spread of infection from acute tonsillitis or dental or secondary to perforating injury of the pharynx. We present a case report of a patient with an external auditory meatus foreign body who developed a parapharyngeal abscess.

Merkel cell carcinoma is an increasingly recognized tumou r of the skin. The commonest presentation is the head and neck region. Only three cases of this rare tumour have been reporte d on the pinna. A further such case is presented here.