The synchronous or metachronous occurrence of two tumours of the salivary glands in one patient is rare. These are mainly benign and of the same histological type. Here we report a 56-year-old man who developed a mucoepidermoid tumour of the left parotid gland four years after diagnosis of adenoid cystic carcinoma of the right submandibular gland. This combination of neoplasms has not to our knowledge been reported before.

Nine cases of tuberculous otitis media were treated by us over the past 10 years. Six patients presenting with large tympanic membrane perforations were treated for suppurative otitis media at various ENT clinics. The remaining three patients presented without perforation. Intractable otorrhoea, aggravation of hearing loss, dizziness, and in one case facial palsy, resulted in eventual referral to us. Histological examination revealed a tuberculous granulation, confirming the diagnosis in most cases. CT in four cases with profound sensorineural hearing loss showed bone destruction of the otic capsule around the oval window and the promontory. Changes noted included a notch in one case, disappearance of the bony contour around the hook in two cases, and a distinct fistula in the final case. A cochlear fistula seemed to be characteristic of advanced tuberculous otitis media.

Inhalation of a foreign body is a serious event. The number of foreign bodies that become impacted in the larynx is small and requires urgent recognition. We describe the case of a six-month-old baby with an impacted open safety pin in the larynx. The sharp end of the safety pin was upwards and had penetrated the anterior end of the left vocal fold. We discuss the management and describe our method of removal of the foreign body. Tracheostomy was not required in this case and the child had an uneventful recovery

A brief review of the literature is included

We report an unusual case of bulimia nervosa with bilateral swelling of parotid and submandibular glands as the only symptom of the underlying behavioural disorder. Histologically, sialadenosis was diagnosed in a parotid biopsy. The parotomegaly in bulimia may be a diagnostic primer as these patients often deny their eating disorder. B-scan ultrasonography is an important diagnostic tool to assess the nature of the parotid enlargement. Hyperamylasaemia occurs commonly in bulimic patients and may help to confirm the diagnosis. All patients with suspected bulimia should have a thorough medical history and physical examination to rule out other aetiologies of asymptomatic parotid swelling. As the enlargement is usually transient surgical intervention is only rarely required.

A case of adult onset laryngeal papillomas with tracheal and bronchial involvement present at onset is presented. The presence of human papilloma virus (HPV) DNA type 6/11 is demonstrated by in situ hybridization.

We report an unusual case of unilateral vocal fold palsy due to intracranial haemorrhage in a neonate with undiagnosed haemophilia A. Bleeding disorders in neonates are briefly discussed and the importance of a systemic investigation of stridor in children is emphasized.

A case of left pyriform sinus fistula in a 20-year-old male is presented. The surgical management of this uncommon condition is discussed. Its embryological and clinical aspects are reviewed.

A case of an unusual foreign body, the bristle end of a broken toothbrush which was removed for the ethmoid sinus complex is presented.

A case of squamous cell carcinoma of the maxillary antrum is presented in which autopsy examination revealed widespread disseminated disease including metastatic deposits in the unusual sites of the myocardium and skin. Apart from the skin deposit the metastases were clinically unsuspected. This case demonstrates the role of the autopsy in the study of malignancy and the possible effects of local disease control on the natural history of the disease process.

An unusual case of cervicofacial actinomycosis presenting as acute upper airway obstruction and demanding urgent tracheostomy is reported. Diagnosis was established by microscopic examination of the pus and culture of Actinomyces israelii. Repeated surgical drainage of the purulent foci and prolonged treatment with penicillin obtained resolution of the disease. Clinicians dealing with acute head and neck swellings should always consider actinomycosis as a possible diagnosis.

Carcinosarcoma of the salivary glands are rare tumours, often associated with a history of pleomorphic adenoma. A case of carcinosarcoma of the parotid arising following irradiation to the resection site of a pleomorphic adenoma is presented. The clinical and histological features are discussed and the literature reviewed.

A case of plasmacytoma arising from the hyoid bone is described, this is a distinctly unusual site, as the marrow-containing flat bones are more commonly affected. On a review of the literature this appears to be the first report of plasmacytoma occurring in the hyoid bone. The patient underwent a CT scan and plain radiographs. Histopathology was diagnostic.

We present a rare case of unilateral anterior jugular venous phlebectasia in an 82-year-old female patient presenting as a soft cystic lump in the anterior aspect of the neck increasing in size during straining and valsalva manoeuvre. Although cases of internal and external jugular phlebectasia have been reported, as far as we are aware no case of anterior jugular phlebectasia has been reported in the literature previously.

Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.

Necrobacillosis is a potentially life-threatening septicaemic illness occurring in the previously fit and healthy. The authors illustrate a case presenting as an atypical pharyngotonsillitis with renal complications, initially misdiagnosed as poststreptococcal glomerulonephritis. Necrobacillosis should be considered in cases of unusual pharyngotonsillitis.

Pigmented villonodular synovitis is a benign reactive process of the synovial tissue, that usually involves the knee or other major joints. Reports of this entity in the temporomandibular joint are rare. The authors describe a case involving this joint, initially clinically diagnosed as a parotid tumour.

It is common practice in many parts of Africa for traditional healers to remove the uvula to prevent infections and other disorders associated with the throat.

We report two cases of children presenting with recurrent tonsillitis. On examination both children showed complete absence of the uvula and prominent tonsils. It was later revealed that they both had undergone uvulectomy, performed by traditional healers in Eritrea. We report this because this practice, although commonly performed, is little known to otolaryngologists practising outside Africa. In addition, although velopharyngeal competence seems to be maintained after uvulectomy, it may theoretically be at risk if adenoidectomy is performed in these patients.

Kikuchi-Fujimoto disease (KFD) has been widely reported from Japan and sporadically from many parts of the world including Saudi Arabia, since its original description in 1972 but the disease remains poorly known by clinicians. In this paper we report two Saudi patients seen in Tabuk. Saudi Arabia. One was a 36-year-old Saudi man and the other a 16-yearold Saudi girl. Both presented with cervical lymphadenopathy and pyrexia. Histological examination of biospy material from both showed classical features of KFD. Other laboratory findings were unremarkable except for leucopenia. Following excision biopsy both patients recovered without sequelae. KFD is a self-limiting process of uncertain aetiology that predominantly affects young women aged 20–-30 years. We review the pathology, clinical featuers and possible aetiology of this interesting disease, which may well be underdiagnosed. Increased awareness of KFD will minimize the risk of confusing this entity with malignant lymphoma or other serious conditions.

Internal jugular vein ectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Literature reports of bilateral presentation are rare. Bilateral Doppler ultrasonography is the diagnostic investigation of choice. The possible pathology, aetiology and management are discussed. Conservative management of bilateral cases is recommended in uncomplicated cases

Lateral cervical fistulae which communicate with the oropharynx are considered to result from incomplete obliteration of the second branchial cleft and pouch. Classically these fistulae have a well-defined pathway through the neck. We present a case, and discuss the aetiology, of a fistula extending from the lateral neck via a previously undescribed course through the neck structures and opening into the posterior aspect of the tongue at the level of the vallate papillae.