A per-oral approach to pharyngeal branchial cysts is possible, and ideal when they are placed medially to the pharyngeal constrictors and no fistular duct is connected to the mass.

At present MRI is found to be the best means of achieving the correct diagnosis of morphology and site.

A rare case of synovial osteochodromatosis of the temporo-mandibular joint is presented. Important diagnostic information can be obtained by CT, MRI, 99m Tc bone scan and aspiration biopsy. Observation using a light microscope showed mild cellular atypia, but the hallmarks characteristic of chondrosarcoma were not found. Observation using an electron microscope showed the mature chondrocytes contained a well-developed rough endoplasmic reticulum. Histological evaluation indicated that the present case was benign synovial osteochondromatosis in an early stage.

Two cases of cervicofacial actinomycosis, resulting in submandibular swelling, are presented. How actinomycosis may present under the guise of malignancy is well demonstrated.

Factors predisposing to the condition, difficulties with diagnosis, isolation methods of the causative organism and treatment of the disease, are discussed.

Within the black population of South Africa tuberculosis and leprosy are endemic. There is also a significant incidence of laryngeal carcinoma. A patient who presented in acute respiratory stridor to a rural hospital with limited resources is reported. The differential diagnosis and management is discussed in the light of the available literature.

A case of peritonsillar abscess in an infant is described, which is a rare lesion in infants and young children. To our knowledge this is the youngest child described in the English literature. The clinical presentation and treatment of peritonsillar abscess in infants and young children are discussed. Serious complications can occur early in the course of the disease because of physiological and anatomical factors and thus early aggressive treatment is required.

For patients with laryngeal tumours, the use of computerized tomography (CT) or magnetic resonance imaging (MR) may facilitate accurate staging by the demonstration of cartilage invasion or tumour extension to areas such as the pre-epiglottic space. The role of imaging in the follow-up of patients after radiotherapy, however, has not been examined. A prospective study of 18 patients undergoing laryngectomy was performed. The results of pre-operative CT and MR imaging were correlated with the pathological findings from whole organ axial sections of the laryngeal specimens. In five patients (28 per cent) both CT and MR images were significantly impaired by movement artefact. In the eight patients without previous radiotherapy, seven had adequate quality imaging and both CT and MR accurately demonstrated the site, size and extent of laryngeal tumour. In eight of the ten patients following radiation therapy the presence of tumour was correctly identified, however there was a poor correlation between the imaging and pathological findings. Two patients had radionecrosis alone. Neither CT nor MR imaging could differentiate between radionecrosis and recurrent tumour.

Chondrosarcoma of the head and neck is relatively rare. We report the sixth case known to us in which the chondrosarcoma had originated in the hyoid bone. The patient, a 66-year-old man, underwent surgery. The resected tumour was a 5 cm encapsulated lesion composed of lobulated, firm, gray-white tissue. Histologically it showed mature chondrocytes without capsular invasion. There was high cellularity and a few binucleated chondrocytes. Although the tumour grade was prognostic significance, our literature review of the five other cases suggests that the location of the primary lesion and the adequacy of its resection to be more important. Our patient continues to do well 15 months post-operatively. However, long-term follow-up is essential as recurrences have been reported even after eight or 10 years.

The sagittal plane, computerized tomography (CT) scan has been proposed as the most important radiological view in the diagnosis of orbital floor blow-out fractures. This view however is impractical and unnecessary. Direct, coronal plane CT scan with careful attention paid to the shape of the inferior rectus muscle and antral roof will successfully diagnose this traumatic condition, as in our reported case in which no other radiological abnormalities were present.

We present a rare case where the introducer of a metal tracheostomy tube became lodged in the tracheobronchial tree. This may be the only reported case. The literature is reviewed to study the possible cause of tracheostomy tube component fracture and to suggest methods for preventing this complication.

Solitary fibrous tumours are uncommon spindle cell neoplasms generally associated with serosal surfaces, especially the pleura (‘localized fibrous mesothelioma’). Recently, these tumours have been documented in extraserosal sites. We report two solitary fibrous tumours, including one occurring in the paediatric age group, arising in two previously unreported locations, parapharyngeal space and epiglottis. These cases expand the range of sites where this tumour may originate and confirm the tendency of extrapleural cases to involve the upper respiratory tract and adjacent structures.

Neurilemmomas of the hypoglossal nerve are uncommon neoplasms. A unique case of submaxillary hypoglossal neurilemmoma is presented with radiological and surgical results. Methods of diagnosis and differential diagnosis are discussed.

We describe a patient who developed upper respiratory tract symptoms following long-term treatment of Wilson's disease with penicillamine. These symptoms were attributed to areas of pharyngeal thickening and were treated with a laser. Histological examination of the lesions showed proliferations of abnormal elastic fibres similar to those previously described at other sites, especially the skin, in patients receiving penicillamine. This drug impairs the maturation and reduces the stability of elastic fibres and although elastic tissue throughout the body is affected, we are aware of no previous reports of penicillamine- induced changes presenting with upper respiratory tract symptoms.

A case is described where neck pain of unknown origin associated with dysphagia was found to be caused by a foreign body in the thyroid gland.

Hibernoma is a benign tumour, arising from vestigial remnants of brown adipose cells, which have persisted from embryonic life. Although it is a well recognized entity, it is an extremely rare tumour. Recent reports estimate 81 cases in the world literature, only seven being in the neck. To our knowledge, it has never been reported in the parotid region. We report such a case and discuss the historical background of a hibernoma, along with its pathological and clinical behaviour.

Metastatic tumours involving the head and neck region are rare. Over the past 18 years, seven such cases were treated at our clinic. Of those, four were in one of the paranasal sinuses, three had arisen from a primary hepatocellular carcinoma and one from an osteogenic fibrosarcoma of the leg. In the remaining three cases, metastases to the larynx, the tonsil, and the parotid gland arose from a primary renal cell carcinoma, a thyroid carcinoma, and a breast carcinoma, respectively. In metastatic tumours, the primary site can often be identified by the histopathological features. Accordingly, when malignant head and neck tumours are suspected of being metastatic in character, it is important to search carefully for the primary site.

Three cases of retropharyngeal haematoma are described. In one case there was underlying aneurysm of the carotid artery which could have led to significant morbidity if undetected.

Neurofibromatosis (NF) or von Recklinghausen's disease is frequently accompanied by malignant tumours, which can occur at any site in the body. These malignancies are mainly of soft tissue origin. Of all head and neck malignancies, the number of soft tissue sarcomas is limited and in combination with NF this type of tumour is a rare event. In this report we describe the clinical course of a young female patient with NP, who presented with a massive malignant schwannoma in the parapharyngeal space, and review the pertinent literature.

Endolaryngeal spread of laryngeal malignant tumours is usually determined by conventional endoscopy; however, it can not measure the outward extension of the tumour. As an alternative method for assessing the extension of a tumour and detecting metastatic lymph nodes, we have introduced high-resolution ultrasonography (US) in 34 patients with laryngeal epidermoid carcinoma. The ultrasonographic results were compared with the clinical, operative and histological findings. The ultrasonography revealed malignant extensions in the thyroid cartilage in nine cases, in the carotid artery in four cases, and in the thyroid gland in five cases. These were confirmed by surgical and histopathological examinations. Six patients out of the 34 were subclinical cases, who had metastatic lymph nodes, which were diagnosed by US only. In this study US had a sensitivity of 94.44 per cent and a specificity of 93.75 per cent. The sensitivity and specificity of palpation of the cervical lymph nodes were 66.66 per cent and 87.55 per cent respectively.

It may be concluded that high-resolution real-time US is a sensitive, simple and inexpensive method for evaluating laryngeal cancers and subclinical cervical lymph node metastasis.

Open cavity mastoidectomy remains the principle surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge.

In this study the temporal bone histopathology of four patients who had undergone open cavity mastoidectomy is presented. Cavities were predominantly lined with stratified keratinizing squamous epithelium. Residual air cells were obliterated by fibrous tissue, with no evidence of persistent respiratory epithelium. Where inflammatory changes were found, these consisted of areas of granulation tissue in association with epithelial ulceration. Residual cholesteatoma pearls (epidermoids) were not associated with significant inflammatory changes.