Traumatic facial nerve neuroma is rare. There are only 10 reported cases in the literature, caused either by physical trauma or chronic inflammation. Traumatic facial neuromata differ from true facial nerve neoplasms in radiological, macroscopic and microscopic appearance, but clinical presentation is less reliable in differentiating the two. Management depends on the pre-operative grade of facial palsy, as this is a benign condition and surgical management carries a risk of further affecting facial nerve function. We present a further case of traumatic facial nerve neuroma following surgery for cholesteatoma. We also review the literature and discuss the management of this condition.

Objective: To demonstrate the feasibility and complexities of cochlear implantation in the setting of bilateral temporal bone osteoradionecrosis.

Study design: Case report.

Setting: Tertiary care referral centre.

Case description: A 66-year-old woman with bilateral temporal bone osteoradionecrosis and profound hearing loss, following treatment for tonsillar cancer, underwent cochlear implantation. Prior canal wall down mastoidectomy and subsequent temporal bone resection with free flap reconstruction had been performed on the implanted ear. The contralateral ear received a canal wall down mastoidectomy. A completely dehiscent mastoid segment of the facial nerve and extensive fibrosis were evident in the implanted ear. Only minimal fibrous reaction was found within the cochlea, allowing for full electrode insertion. At three months, speech recognition testing documented a consonant-nucleus-consonant (CNC) word score of 54 per cent.

Conclusions: This report demonstrates the feasibility of cochlear implantation after temporal bone surgery and free flap reconstruction in the setting of diffuse osteoradionecrosis. The patient's excellent open-set speech understanding using the cochlear implant implies that radiation did not severely damage the central auditory pathways. Thus, some patients with radiation-induced hearing loss may be appropriate cochlear implant candidates. Special attention should be paid to surgical planning, as complications related to wound healing, electrode insertion and facial nerve injury may be more likely.

We report a case of severe unilateral epistaxis requiring surgical arrest of bleeding, via endoscopic sphenopalatine artery ligation and anterior ethmoidal artery ligation. This followed recreational nasal insertion of St John's wort (Hypericum perforatum). Interactions between this substance and prescribed drugs have been described following oral ingestion. However, this unusual case highlights a further, worrying potential rhinological side effect of this substance.

We describe in this case report a new technique for treatment of hypopharyngeal haemangioma, using the surgical diathermy snare. The snare was easily introduced through the direct laryngoscope, without any difficulties. The procedure was simple, rapid and involved minimal bleeding. We also discuss the histological types of haemangioma, clinical picture, radiological findings and other modalities of treatment.

Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.

The implementation of the European Working Time Directive, from the Council of the European Union (93/104/EC), in August 2004 has provoked a change in the working hours of junior doctors in the United Kingdom. With the evolution of the subsequent cross-cover arrangements combined with the modernising of medical careers, training is becoming increasingly important. Here we present a simple method of teaching junior doctors the skills and competencies required to aspirate a peritonsillar abscess or ‘quinsy’. The model is easy to construct, low cost and reusable.

Endoscopic endonasal surgery on a 36-year-old man was complicated by perforation of the right internal carotid artery. The immediate, substantial haemorrhage was controlled by packing the sphenoid sinus. Intra-arterial angiography of the right internal carotid artery showed small irregularities proximal to the ophthalmic artery. A follow-up examination two weeks later documented a large pseudoaneurysm in the initially irregular arterial segment, which was successfully treated by endovascular coiling.

This case report illustrates the need for angiographic follow-up examinations following traumatic intracranial vessel injury in order to identify late pseudoaneurysm development.

Meningitis is a life-threatening complication of otitis media. The appropriate management and the role of surgical intervention are still controversial, and there are no evidence-based guidelines in this regard.

We report three cases of otogenic meningitis, initially treated with parenteral antibiotics and myringotomy, followed by surgery. Two patients had an emergency mastoidectomy and one patient underwent surgery one month post-recovery due to the suspicion of bone erosion on a computed tomography scan. In two cases, a canal wall up procedure was performed, and one patient underwent revision of a radical mastoidectomy. In all cases, no pus or granulations were seen in the mastoid. Two patients fully recovered and one patient died.

We review the literature and critically discuss the role, timing and preferred type of surgery for otogenic meningitis.

Mycobacterium marinum is an atypical mycobacterium found in both salt and fresh water. It occasionally causes soft tissue infections after minor trauma, principally affecting the limbs.

A 17-year-old male aquarium worker presented with preseptal cellulitis of his right eye, after attempting to lance a hordeolum some days previously. The condition failed to respond to antibiotics and a necrotic area developed, which subsequently required debridement. Histology of the debrided area demonstrated granulomatous inflammation which when considered with his occupation led to the diagnosis of Mycobacterium marinum – ‘fish-tank granuloma’.

A Medline search did not demonstrate any previous cases of Mycobacterium marinum infection occurring peri-orbitally. The current literature regarding diagnosis and management is reviewed. Although infection with Mycobacterium marinum is rare in the general population, this case demonstrates the importance of considering the diagnosis when dealing with patients frequently exposed to fresh or salt water.

We report a case of follicular lymphoma in a healthy individual, which presented as saliva- and serum-proven mumps. The patient presented with a sore throat and parotid and submandibular lymphadenopathy. Fine needle aspiration, undertaken three weeks following presentation, revealed no malignant cells. An excision biopsy of a level two node was performed due to persistent lymphadenopathy, five weeks following presentation. As far as we are aware, this is the first reported case of follicular lymphoma presenting as mumps. This case highlights the importance of follow up in patients in whom lymphadenopathy is persistent despite the proven diagnosis of mumps.

Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved.

Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.

Vestibular schwannomas containing cystic parts are common, but it is extremely rare for a vestibular schwannoma to contain fluid–fluid levels. In this report, we present two cases of vestibular schwannoma with magnetic resonance imaging findings of a fluid–fluid level, and we discuss the radiological features and possible mechanism of fluid–fluid level formation.

We present the case of a 19-year-old woman who developed a nasal septal perforation and atrophic rhinitis following septal surgery. During the subsequent five years, she also experienced intermittent episodes of swelling and ischaemia of the left foot, as well as livedo reticularis. Ultimately, haematological investigations revealed the presence of lupus anticoagulant and elevated antiphospholipid immunoglobulin M levels. A diagnosis of antiphospholipid syndrome (Hughes syndrome) was made.

A search of the literature revealed that nasal septal perforation has been described in up to 0.8 per cent of patients with antiphospholipid syndrome. However, it is undescribed in the otorhinolaryngological literature. The impact of this syndrome on otorhinolaryngology practice is examined.

Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxysmal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure.

The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsatile tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.

Objectives: Balancing new referrals with limited clinic capacity is a challenge. At Lincoln County Hospital, referrals for tonsillectomy have been managed by an experienced ENT nurse practitioner, in order to deal with this problem more effectively. We reviewed tonsillectomy referrals made in a one year period to determine if surgical outcomes were satisfactory. Results were compared with figures available from the national prospective tonsillectomy audit.

Methods: This was a retrospective study, assessing patients referred to the ENT department at Lincoln County Hospital. We reviewed the number of patients who had proceeded to surgery and the rate of complications.

Results: One hundred and fifty-nine patients had been referred for tonsillectomy over the one year period. One hundred and forty-seven patients had been seen in clinic and 12 had not attended their clinic appointment. Following consultation with the nurse practitioner, 125 patients had proceeded to surgery. Five episodes of bleeding were recorded as complications postoperatively; giving a bleeding complication rate of 4.7 per cent, compared with a rate of 5.7 per cent from the national prospective tonsillectomy audit.

Conclusion: A trained nurse practitioner can safely and effectively facilitate the complete process of managing a routine pre-operative tonsillectomy patient, from primary care referral to arranging admission for surgery.

Treatment of salivary stones includes both surgical and non-surgical techniques. Surgical approaches range from excision of the sialolith, for those near the duct orifice, to removal of the affected salivary gland and its associated duct, for stones near the hilum of the gland. We present a case of two sialoliths triggering an acute infection in a residual Wharton's duct, 12 years after the removal of the associated submandibular gland. Excision of the sialoliths and treatment of the infected duct via sialodochoplasty was successfully performed in this patient. If the Wharton's duct is not removed with the associated submandibular gland, the potential for infection and continuous growth of dormant calcifications exists. We also address the aetiology, pathogenesis, and management of patients with sialolithiasis in the absence of a major salivary gland.

We present a case report of a patient who developed a sinonasal myopericytoma treated by surgical excision through a lateral rhinotomy. Some aggressive features on pre-operative computed tomography scanning and the complexity of recent changes in the histological nomenclature for these tumours led to consideration of adjuvant therapy. The close histological relationship between myopericytoma, myofibromatosis, solitary myofibroma and infantile haemangiopericytoma is discussed. This group of lesions constitute a single morphological spectrum with differentiation towards perivascular myoid cells (pericytes). Currently myopericytoma is the most appropriate and accepted term embracing all these entities. A review of the literature has been reassuring in identifying these tumours as benign but with a reasonably high rate of local recurrence (17 per cent). The treatment of choice is surgical excision with further excisions for local recurrence.

Ossifying fibroma is an uncommon benign osteogenic neoplasm arising from cells of the periodontal ligament, typically with a slowly progressive enlargement of the affected bone. The neoplasm sometimes presents with hyperparathyroidism, most of which cases are due to familial parathyroid tumours. We report a rare case of ossifying fibroma of the mandible which showed very rapid growth and presented with primary hyperparathyroidism due to non-familial parathyroid adenoma. Despite improvement of parathyroid dysfunction after removal of the parathyroid adenoma, the tumour continued to grow very aggressively. The case required partial mandibular resection for complete resection of the tumour, and fixation of the remaining mandible with a titanium plate.