A patient suffering from persistent hoarseness was eventually shown to have laryngeal leishmaniasis. The incubation period for the disease must have been at least 16 years, following infection in Southern Europe. Mucosal leishmaniasis is rare in the Eastern hemisphere, and laryngeal leishmaniasis has not previously been reported in the UK. Previous Mediterranean cases have run a similar chronic course and have caused diagnostic difficulty, in particular being mistaken for malignancy. Treatment with aminosidine was ineffective, but the patient responded to liposomal amphotericin.

Lingual thyroid is a rare lesion caused by maldescent of the thyroid gland. It is an important cause of a mass on the posterior third of the tongue, and may coexist with other developmental abnormalities such as thyroglossal cyst. The diagnosis is made by radioisotope scan. Treatment is indicated in the presence of symptoms and consists initially of thyroxine. Severe or unresponsive cases require complete excision through a lateral pharyngotomy. Hypothyroidism is common postoperatively, but may be avoided in some cases by transplantation of excised tissue. We present a case report and review of the literature

The case of a male child with a benign neurogenic laryngeal tumour caused by von Recklinghausen's disease is presented. At the age of eight years, tracheostomy was necessary. The tumour, deforming the right half of the larynx and extending into the right half of the neck, was removed three years later. Following this procedure, decannulation was possible, and the patient has been free of laryngological complaints for six years.

Attention is drawn to the fact that autosomal dominantly inherited neurofibromatosis is a generalized benign tumour with a special form. If it involves any vital structure or forms a functional obstacle, meticulous surgical removal is necessary, and this provides good prospects over a long period.

We present a 68-year-old woman with a vascular leiomyoma of the larynx, a benign tumour that rarely involves that organ. Chief complaints were a feeling of a narrowing of the pharynx and difficulty in breathing in the supine position. A spherical tumour measuring 1.5 cm and covered with normal mucosa was found avthe margin of her epiglottis. The patient was administered a general anaesthetic and the tumour was successfully removed via direct laryngoscopy. Histological examination revealed that the tumour lay beneath a layer of stratified squamous epithelium and was encased in a welldefined fibrous capsule. The tumour parenchyma was composed of proliferated fibres that consisted of elongated cells, surrounded by an abundance of blood vessels. Its complete removal is the treatment of choice with care taken to avoid profuse bleeding. Recurrence is rare.

A case of a direct burn to the pharynx and larynx is described. This occurred after a patient swallowed a microwaved treacle tart. The potential danger of excessive heating of food in microwave ovens is discussed.

Uncontrolled epistaxis may require a long hospital stay, multiple blood transfusions and multiple arterial ligations. Thiscase report highlights vertebro-carotid anastomosis as a rare cause of uncontrolled epistaxis. The importance ofangiography in the identification of rare arterial anastomoses is stressed.

Partial avulsion of the middle turbinate is an unusual complication of nasotracheal intubation while minor nasal mucosal trauma is not uncommon. Nasal turbinate avulsion often presents with persistent epistaxis but in the case reported, unilateral nasal obstruction with minimal epistaxis was the presenting feature. Unilateral nasal obstruction following nasotracheal intubation should raise suspicion of significant disruption of the intranasal architecture.

A case of bilateral laryngeal nerve paralysis caused by a small goitre is reported. After thyroidectomy the return of vocal fold movements was observed. A review of the literature is presented. The possibility of acute airway distress caused by a slightly enlarged goitre is emphasized.

The case of a 57-year-old man who presented with acute bilateral deafness and vestibular dysfunction following occipital bone fracture is described. Plain radiographs and a CT scan of the head demonstrated a single fracture of the occipital bone. Complete loss of cochlear and vestibular function bilaterally was demonstrated and followed by partial recovery of auditory function over the following months. Review of the literature has not revealed a previously reported case.

Lipomas in the head and neck region usually occur in the immediate subcutaneous tissue, and only rarely in the upper aerodigestive tract. We report here a case of a 58-year-old female with a lipoma in the peri-tonsillar space. The tumour originated from the left peri-tonsillar space over the palate tonsil and partly protruded into the oral cavity. MRI (magnetic resonance imaging) showed not only the acccurate location of the tumour but also suggested its pathology. To our knowledge, a lipoma in the peri-tonsillar space is quite rare and MRI is useful in its diagnosis.

A case of schwannoma of the larynx is reported. It originated from the left ventricular fold submucosally and extended to the left side of the neck outside the larynx near the carotid sheath. It presented with stridor. CT scan showed a mass in the larynx which had fractured the left thyroid lamina and extended into the neck. An external surgical approach was used and the mass was removed in toto without laryngofissure. Left vocal fold paralysis was noticed during laryngoscopy at the time of the operation. The possibility that the tumour originated from the recurrent laryngeal nerve is discussed. Histopathological photomicrographs and a CT scan are presented.

Primary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease.

We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.

The localization of Leishmania spp. in the larynx is rare but it has recently been described in patients infected by humanimmunodeficiency virus (HIV). The normal treatment given is antimonials. We describe a case of isolated leishmaniasis inthe larynx which was cured by surgery. Our patient was a 47-year-old man who had suffered visceral leishmaniasis in hischildhood with no immunosuppression.

The carcinogenic effect of ionizing radiation is a well known phenomenon. However, the induction of malignancies following irradiation for head and neck cancers is quite rare (Steeves and Vataini, 1982). Most reported cases are osteogenic sarcomas with soft tissue sarcomas encountered less often.

We report a rare case of fibrosarcoma of the larynx, following radiation therapy for glottic carcinoma.

Angioedema secondary to angiotensin-converting enzyme (ACE) inhibitors is rare, but it is a side effect which is likely to be seen more frequently because of the increased use of these drugs to treat cardiac failure and hypertension. Presentation is variable and the diagnosis may go unrecognized for many months or years. The cases reported illustrate problems both in the diagnosis and management of this life-threatening condition.

While the numerous complications of intravenous hyperalimentation (IVH) are well recognized, we encountered a unique one. A 60-year-old man developed a sore throat, neck pain and fever seven days after catheterization of the subclavian vein to provide post-operative nutrition. Marked swelling was visible at the right posterior wall of his oropharynx and hypopharynx. X-ray of the neck revealed that the tip of the catheter was positioned in the internal jugular vein, not the subclavian vein as intended. The acute pharyngitis, diagnosed as due to phlebitis of the internal jugular vein due to the malpositioned catheter, subsided within two days of catheter removal.

Extraintestinal involvement of Crohn's disease is becoming more readily identified. Laryngeal involvement by Crohn's disease, however, has been reported in only five cases in the medical literature. We present the sixth case as well as an analysis of the prior reports.

Anaplastic nasopharyngeal carcinoma (NPC) metastatic to the thyroid gland is rare. We report the first such case in a 54- year-old Malaysian Chinese woman. The correct diagnosis should be made so that thyroidectomy may be avoided and an appropriate chemoradiotherapeutic regimen instituted.

Cervical spine osteomyelitis is rare. Haematogenous spread is the usual method by which organisms reach the spine. A review of the English literature reveals very few reported cases of local spread of infection to the spine. Here we present the case of a 68-year-old woman with cervical spine osteomyelitis and cord compression complicating pharyngeal myotomy.

The presentation and management of four cases of spontaneous haemorrhage from the tonsil in association with acute tonsillitis are reported and discussed. Interestingly, younger patients presented with haematemesis. This is a newly recognised, rare, but potentially dangerous complication of acute tonsillitis. Its possible aetiology, pathophysiology and treatment options are discussed.