We present a case of cervical necrotizing fasciitis following quinsy in a previously fit and healthy man. This is a potentially fatal condition with few specific clinical signs that requires early diagnosis and surgical debridement. Other features of the disease are discussed.

A case of laryngeal leishmaniasis, with symptoms of hoarseness and odinophagia which had developed over the past year, is presented. Clinical features and histological findings are discussed. Visceral leishmaniasis is increasingly associated with HIV infection and some authors have suggested the possibility of including it as a diagnostic criterium for AIDS in HIV-positive patients.

When any case of leishmaniasis presents atypical clinical features, localization or treatment response in endemic areas, HIV infection should be ruled out.

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.

Extrapleural sites of solitary fibrous tumours have been identified. In a review of the literature 11 cases of solitary fibrous tumours of the upper respiratory tract have been reported. We report the second parapharyngeal solitary fibrous tumour which was discovered as an incidental finding emphasizing the importance of a full ear, nose and throat examination of all patients attending outpatient clinics

A 66-year-old Japanese man was diagnosed as having a MALT-type lymphoma by histopathological examination. The lesion involved the vocal folds bilaterally, occupying the larynx and extending beyond it, as shown by computed tomography (CT). A course of radiation therapy with moderate doses was given. Six months later, a squamous cell carcinoma was found in the larynx and total laryngectomy was then performed. The patient remained well, without recurrence, 46 months after the operation, thus, MALT-type lymphoma may coexist with a squamous cell carcinoma of the larynx.

Papillary carcinoma is the most common malignant tumour of the thyroid gland, accounting for at least two-thirds of newly diagnosed carcinomas. This tumour may be occasionally multicentric in origin. It frequently spreads to regional lymph nodes in the neck and mediastinum, but uncommonly metastasizes outside these regions. Local invasion of this tumour to the upper airway or digestive tract structures is infrequent. However, when that occurs, it is a source of significant morbidityand mortality.

In the last two years four patients suffering from invasive papillary carcinoma to the aerodigestive tract were treated in our department. A short case history of one of them is presented and current trends in management of the disease are reviewed.

Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall.

Two consecutive cases of parapharyngeal space cysts totally excised by transoral and transparotid routes are presented.

Three cases of mycobacterial cervical lymphadenitis in children are presented. The diagnosis and treatment are described in brief. None of the patients were from the risk groups traditionally associated with tuberculosis. With an increasing number of tuberculosis cases reported in the UK, the need for awareness of this re-emerging condition to ENT surgeons and paediatricians is stressed.

The clinical presentation and management of a case of self-inflicted laryngopharyngectomy in a 48-year-old male psychiatric patient with a paranoid disorder is described

The case of a 46-year-old man who presented with acute respiratory distress due to a tracheal mass is reported. The patient underwent endoscopic resection of the mass and the histopathology revealed scleroma. No other sites of involvement by scleroma were found. This case is reported because laryngotracheal involvement by scleroma as the only manifestation of this disease is extremely rare.

A laryngopyocoele is a rarely encountered neck mass which may cause respiratory obstruction. Spontaneous regression of an established symptomatic laryngopyocoele is an even more unusual situation, since most of the reported cases require immediate intervention for impending airway obstruction. A case of a laryngopyocoele showing spontaneous regression after antibiotic therapy is presented and the clinical aspects are reviewed.

Epidermoids are the third most common cerebellopontine angle tumour, and their diagnosis in the last two decades has been largely obtained using computed tomography (CT). More recently magnetic resonance imaging (MRI) has become a valuable diagnostic tool, and the signal characteristics and enhancement pattern of an epidermoid following intravenous gadolinium with MRI is presented and the literature reviewed.

Voice restoration following laryngectomy can be achieved by the now well accepted technique of inserting a ’Blom–Singer‘ prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion include haemorrhage, oesophageal perforation, peristomal cellulitis and aspiration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being forced from the fistula up between the trachea and the pharynx, this plane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phonate. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.

We report myasthenia gravis presenting as dysphagia of acute onset in a 56-year-old female who had no other stigmata of the disease and who was generally well despite rheumatoid arthritis and hypothyroidism. She recovered respiratory function following a general anaesthetic for oesophagoscopy only when antimyasthenic treatment was instituted. She remains well to date. In patients who are known to have autoimmune diseases and who present with dysphagia, features of myasthenia gravis should be specifically sought.

Removal of a parotid duct calculus using a Dormia basket is described and the literature reviewed. To our knowledge, this procedure has not previously been reported.

The patient was a 50-year-old alcoholic man with a left palatine tonsillar ulcer. Histopathological and bacteriological studies established the diagnosis of tonsillar tuberculosis with asymptomatic advanced pulmonary tuberculosis and multiple cerebral supra- and infratentorial tuberculomas previously unnoticed.

Hydatid disease is an important medical problem in countries of the temperate zones. Only occasional cases are reported in the head and neck region. An unusual location for hydatid disease in the infratemporal fossa is presented. Characteristics of this rare disease together with treatment modalities are discussed.

A rare complication of denture use is presented. The clinical and radiological findings are documented and the optimum method of treatment discussed.

A solitary fibrous tumour is a pleural tumour which may rarely be detected at non-pleural sites. In this report, the case of a solitary fibrous tumour arising from the sublingual salivary gland is described.

Seven infants with unilateral parotid haemangiomas seen at one centre are presented. Their case notes and special investigations are reviewed. Magnetic resonance imaging (MRI) is revealed as the investigation of choice because of picture quality, definition of soft tissues and lack of exposure to ionizing radiation. MRI allows a definite diagnosis to be made without any invasive procedure being required. A future study following up these infants may be of interest because of controversy regarding the spontaneous resolution of these lesions.