We report an unusual case of thrombosis of a dilated external jugular vein presenting as a hard neck mass of sudden onset. The lesion's presentation, investigation, treatment and pathology are discussed.

Salivary gland involvement is rare in Wegener's granulomatosis. We report the first case of widespread major salivary gland enlargement as part of the presentation of this disease. A review of the few reported cases in the literature suggests that salivary gland involvement may be associated with a limited form of the disease and an improved prognosis. The anti-neutrophil cytoplasmic antibody (c-ANCA) assay remains the gold standard of diagnosis but care should be exercised in the interpretation of results. This patient responded well to current immunosuppressive therapy.

Bazex syndrome, or acrokeratosis paraneoplastica, is a cutaneous paraneoplastic syndrome characterized by psoriasiform lesions associated with, usually, a squamous cell carcinoma of the upper aerodigestive tract. We present a case of Bazex syndrome associated with metastatic cervical squamous cell carcinoma with an unknown primary. The features of the condition are discussed in the light of current knowledge.

Glossal abscesses are extremely rare, only 29 cases having been described in the last 28 years. Clinical and ultrasound examination should establish the diagnosis, and treatment should be by surgical incision and drainage. We report a case of glossal abscess presenting as a unilateral swelling of the tongue.

A case of Staphylococcus aureus peritonsillar abscess in an 11-week-old infant is described. The importance of peritonsillar abscess culture and its changing management is discussed.

A case of a rare and unusual variant of neurofibroma, diffuse neurofibroma (paraneurofibroma), in a young patient is presented. The clinical, radiological and histopathological features of this case are reported. The magnetic resonance imaging (MRI) features of the diffuse neurofibroma are comparable with those described in other neurofibromas.

Thyroid adenomas containing adipose tissue are rare. Only scattered case reports have been recorded. We describe an additional case of an adenolipoma of the thyroid gland, incidentally found in residual gland subsequent to excision of a papillary carcinoma.

Two cases of papillary thyroid carcinoma presenting as a cystic lateral neck mass are reported. This tumour characteristically presents in patients under 40-years-old and in the presence of an occult primary tumour may mimic a branchial cyst. In such cases simple aspiration of the cyst will produce a chocolate-brown serous fluid which excludes the diagnosis of a branchial cyst and is characteristic of papillary thyroid carcinoma. Cytological examination of the fluid has a high degree of sensitivity and specificity in the diagnosis of thyroid malignancy and should avoid delay in diagnosis and unneccessary surgical exploration prior to definitive treatment.

Palatopharyngeal injuries due to impaction of rigid objects held in the mouth are common. Most are essentially innocuous injuries requiring no specific treatment. However, there is the potential for perforation of the pharyngeal wall with the subsequent development of serious infection such as retropharyngeal abscess or mediastinitis. This possibility is more likely to be suspected in the presence of a visible laceration or puncture wound at the site of impact in the mouth or pharynx. We report three cases in which occult pharyngeal perforation occurred without any clinical signs of breech of the pharyngeal wall. In all cases a lateral soft tissue neck X-ray was diagnostic of perforation, showing the presence of retropharyngeal air. We, therefore, advocate the routine performance of soft tissue neck X-rays in all patients who present with a history of falling on a rigid object held in the mouth.

Necrotizing fasciitis of the head and neck has previously been classified as a homogeneous group. We present two cases of necrotizing fasciitis confined to the neck and demonstrate with a review of the literature that cervical necrotizing fasciitis and craniofacial necrotizing fasciitis are two distinct clinicopathological conditions.

We present a 55-year-old lady who swallowed a 3 cm pointed metal foreign body whilst eating a sardine salad. The foreign body migrated from the hypopharynx through the parapharyngeal space and traversed the common carotid artery over a period of 12 days. The foreign body was removed by exploration of the neck.

The case of a patient with carcinoma larynx who developed diaphragmatic paralysis and post-operative respiratory failure due to bilateral phrenic nerve injury is reported. The use of portable ultrasonography for an early diagnosis of diaphragmatic paralysis is discussed.

Masseter muscle enlargement is one of the differential diagnoses of swelling of the cheek. We discuss a uniquecase of a malignant tumour of the masseter which was found to be a peripheral primitive neuroectodermaltumour (PNET). A review of tumours of the masseter is presented.

A case is presented of a rare congenital anomaly of the fourth branchial arch, which presented as an abscess in the anterior triangle, related to a fistula communicating with the pyriform fossa. Histopathological examination showed the fistula to be associated with thyroid tissue supporting the hypothesis that the ventral wing of the fourth pouch contributes to the thyroid gland.

We describe multiple cutaneous squamous cell carcinomas of the head and neck in five patients with chronic lymphocytic leukaemia (CLL). When associated with CLL, cutaneous squamous cell carcinomata behave in a much more aggressive manner than otherwise expected. Four patients developed local recurrence after primary treatment. All five patients developed lymph node metastases containing squamous cell carcinoma. Three of five patients (60 per cent) had multiple primary lesions.

Whereas the increased incidence of second cancers in CLL and notably of skin cancers is documented, little has been written to describe the aggressive behaviour of these tumours. It is important, when treating these patients, to be aware of the high tendency towards local recurrence and lymph node metastasis and to consider an aggressive management plan and careful follow-up.

We present a case of severe acute pancreatitis in a 14-year-old boy that may have been caused by hyperparathyroidism. The clue to finding the parathyroid adenoma was the hypercalcaemia. Although the patient did have acute pancreatitis, no therapy had been effective until the discovery of the parathyroid adenoma. After the excision of the parathyroid adenoma, the function of the pancreas and serum calcium returned to normal. This result suggests a certain cause and effect relationship between hyperparathyroidism and acute pancreatitis.

The pathophysiology of so-called ‘reparative granuloma’ occurring after stapedectomy has not been determined and universally accepted management of this rare complication has not yet been established. A case is presented in which a mass developed in the middle ear after the use of a fat/wire prosthesis in a stapedectomy. Histological assessment revealed nonspecific granulation tissue and fat necrosis. It is suggested that ‘reparative granuloma’ is a misnomer as there is no microscopic evidence in this case nor in the literature of granulomatous formation. The condition may follow stapedectomy or stapedotomy. Furthermore, the name leads to confusion with a different condition, giant cell reparative granuloma, which involves the jaws and rarely the temporal bone. An alternative name, ‘Stapes surgery induced granulation tissue’ (SSIG) is therefore suggested for this condition.

A patient with slight dysphagia and dyspnoea on exertion was referred to us. We diagnosed a large retro- and para-pharyngeal ganglioneuroma. The mass was surgically removed in toto. The case is presented and the features are discussed.