A case report of a cavernous haemangioma arising in the nasal bones is described, together with a discussion of the relevant literature. The condition, although rare, can be reliably diagnosed pre-operatively.

Cowden's disease is characterized by multiple hamartomas and neoplasias of ectodermal, mesodermal and endodermal origin. A case of a 22-year-old man suffering from nocturnal dyspnoea is reported. The patient had a large number of hyperkeratotic, lichenoid papules, scattered over the right side of the trunk, back and palm. In his oral cavity, papules were present on the gingiva and hard palate. The patient was operated on for tonsillar hypertrophy and for excluding the possibility of malignant lymphoma. An examination of immunophenotypes of the palatal tonsil lymphocytes revealed B-cell proliferation and poly-clonal immunoglobulin.

Many patients with cancer of the head and neck are unable to receive or continue treatment with cisplatin, which is nephrotoxic, because of poor renal function. We present here, however, the case of a patient who underwent conventional cisplatin therapy but who then had to be withdrawn from treatment because of renal toxicity despite having undergone partial remission. Treatment was then changed to cisplatin in the form of a cisplatin-albumin complex which is not nephrotoxic. The patient went on to a histologically confirmed complete response and we suggest that although the cisplatin-albumin complex may not be as effective as the conventional form of the drug it offers a possible form of treatment of patients with compromised renal function who could not otherwise be treated.

A 10-year-old schoolboy presented with a penetrating wound to the neck after a children's slide accident. A CT scan and endoscopy showed a traumatic oesophageal-cutaneous fistula. Neurologically the child deteriorated over a period of 34 hours and finally succumbed to a respiratory arrest.

Post-mortem findings showed a hypoplastic right vertebral artery. In the left suboccipital triangle a venous clot had blocked the dominant artery thus leading to cerebellar and brainstem infarction.

This extraluminal compression leading to obstruction of an otherwise non traumatized vertebral artery is unique in the literature.

A previously unreported association between bilateral abductor paralysis and hypokalaemia is reported in a patient presenting with stridor. Both the stridor and the bilateral abductor paralysis gradually resolved as the serum potassium was corrected. A causal link is suggested though the mechanism is unclear.

An unusual case of a chordoma of the parapharyngeal space is presented with no direct involvement of the axial skeleton. Diagnosis was confirmed with the aid of immunocytochemical tests.

A pigmented lesion of the soft palate was excised to exclude melanoma. The histology suggested an amalgam tattoo which was confirmed on energy dispersive X-ray analysis by the detection of silver and copper. This represents a very rare mimic of melanoma of the soft palate.

Tuberculosis is a disease of protean manifestations, and despite a falling incidence is still prevalent in our society.

We present a case of a child whose history and preoperative chest radiograph suggested the presence of a foreign body, but subsequent examination of the material removed at endoscopy revealed a diagnosis of tuberculosis. We suggest that all friable material removed from the lower respiratory tract be submitted for microscopy, culture and histopathology with this diagnosis in mind.

Observations based on two contrasting cases of myringitis bullosa haemorrhagica indicate that tympanosclerosis involving the tympanic membrane may have a significant effect on the clinical course of the disease. The evidence suggests that the bullae associated with the condition arise from the epidermal layer of the eardrum.

The authors describe a rare case of plexiform neurofibroma of the cervical portion of the vagus nerve, and discuss its aetiopathogenesis, clinical, histological and therapeutic features, emphasizing the difference from other benign tumours of the vagus nerve.

The clinical characteristics of the mass, ultrasound tomography, CT scanning and digital subtraction angiography were useful in defining its extension and relationships with the surrounding structures.

Surgery is the treatment of choice. After mentioning the most commonly employed surgical approaches, they emphasize the advantages of the lateral-cervical approach which allows a wide exposure of the possible sites of origin of the tumour and its complete removal.

Finally they stress the need of an accurate histological and immunohistochemical examination in order to differentiate neurofibromas from neurilemmomas.

Parenchymatous parotid tuberculosis diffusely affecting the entire gland is very rare. We present a case, associated with a primary pulmonary focus, that was confirmed after positive identification of alcohol and acid-fast bacilli in gastric washings. Both sites of infection resolved with quadruple anti-tuberculous chemotherapy.

Malignant germ cell tumours of the head and neck are extremely rare. Their behaviour, despite aggressive surgical and adjuvant therapy, is relentless with most cases resulting in a fatal outcome. In this paper we present a case of a cervical embryonal carcinoma and review the presentation, clinical course and treatment of malignant germ cell tumours.

Tuberculosis of the parotid gland may be clinically indistinguishable from a neoplasm. This poses a problem with regard to management, because the treatment of tuberculosis is medical, whilst that of the majority of tumours is surgical. If radical surgery with resection of a branch or branches of the facial nerve is embarked upon in a patient with tuberculosis, without prior histological diagnosis, unnecessary permanent disability will result.

Two cases of tuberculosis of the parotid gland are reported, demonstrating the clinical similarity of tuberculosis to a parotid neoplasm and the absolute need for histological diagnosis before embarking on surgery that will require resection of the branches of the facial nerve.

The conclusion is that although tuberculosis of the parotid gland is rare, it still exists and must be thought of as one of the differential diagnoses of a parotid tumour. This must be kept in mind, especially when the decision to sacrifice branches of the facial nerve is indicated, in order to get a tumour-free margin on an excisional biopsy. If the suspicion of tuberculosis is high, a therapeutic trial of antituberculous chemotherapy, for one week, can be diagnostic.

We report the first known cases of Fusariosis of maxillary sinus with granuloma and oro-antral fistula in two immunocompetent hosts. Fusarium solani was demonstrated in the direct microscopic examination and isolated in heavy growth from the biopsy materials. Both these patients were successfully treated with oral ketoconazole (200 mg daily) for three weeks followed by a Caldwell-Luc operation. Ketoconazole was continued for two months post-operatively.

Ectopic and supernumerary teeth occur in a wide variety of sites. Those that have been reportedinclude the mandibular condyle, coronoid process, orbit, palate, nasal cavity and the maxillaryantrum. Eruption of teeth into these sites is rare, and easily overlooked. We present two casesin which eruption of teeth into the nose and paranasal sinuses was associated with significant morbidity and show how this was relieved by appropriate surgery.

The first case of an inhaled Montgomery Safe T-tube plug is reported. Both the surgeon and the patient should be aware of this possible complication and regular inspection of the plug is recommended. More than one plug should be provided with each T-tube.

Although advances in antibiotic therapy have made adult neck space infections an uncommon event, it is essential to bear them in mind when treating oro-dental and oro-pharyngeal sepsis, as they can often progress with life threatening sequelae.

Three cases of neck space infection as a consequence of dental infection, pharyngitis and peritonsillar abscess are presented. The management of a potentially compromised airway is of paramount importance in the immediate treatment of neck space sepsis.

Angiosarcoma of the nasal cavity is extremely rare. We present a case of angiosarcoma of the nasal cavity in an eight-yearold boy. He was treated with medial maxiUectomy via lateral rhinotomy. The histological diagnosis was confirmed by immunohistological stain with Factor Vlll-like antigen. Magnetic resonance imaging (MRI) was useful in determining the extent of the tumour.

We report two cases of terminal duct carcinoma of the minor salivary glands. The histological features, biological behaviour, treatment and the long-term management are described.