Tuberculosis is very common in India and Southeast Asia, where the prevalence rate is about four per 1000 population and the incidence rate of the disease is two per cent. Fifteen per cent of the tuberculous population of the world reside in India. Both secondary and primary tuberculous lesions of the tongue and oral cavity are rare. We report a 60-year-old male with the seventh case of primary lingual tuberculosis.

We present an unusual case of generalized erosion of the skull base. We have not found a similar case reported in the world literature. The presenting symptom was spontaneous cerebrospinal fluid (CSF) rhinorrhoea which arose from a bony defect associated with herniation of the right temporal lobe into the sphenoid sinus. We discuss the management of such a case including imaging of the skull base and the endoscopic repair of the bony defect.

Verrucous carcinoma is a distinct variant of well differentiated squamous cell carcinoma. Its occurrence in the maxillary antrum is rare. Only three cases have previously been documented. We present a case report of verrucous carcinoma in the maxillary antrum and a review of the literature.

We report an unusual case of an extravasation mucocele complicating superficial parotidectomy. The tumour excised was a Warthin's tumour. Three months following theprimary surgery a cystic lesion appeared in the parotid bed. It was initially thought to represent a recurrence. The area was re-explored and a mucocele excised. The pathogenesisof mucoceles and the difficulties encountered when dealing with parotid tumour recurrenceare discussed.

Bronchogenic cysts are rare congenital benign lesions that are usually detected in the paediatric patient with symptoms of infection or compression on vital structures. They are rarely diagnosed in the adult population. We present a case of bronchogenic cyst presenting as a lump in the neck in an adult patient. Radiological imaging helped to diagnose this lesion accurately before any form of intervention. Complete surgical excision is the treatment of choice.

Laryngeal granulomas are uncommon lesions of an inflammatory origin. They are conventionally managed by simple excision with the occasional use of adjuvant treatment depending on the aetiological factors. Unfortunately, recurrences can occur, requiring repeated excision. Some lesions are refractory to this approach and alternative management approaches include excision and immediate adjuvant radiotherapy. The use of radiotherapy in the management of benign disease can be limited by the risk of induction of late malignancy and informed consent of a patient must include an assessment of this risk. We describe a case of refractory laryngeal granuloma successfully treated by excision and immediate radiotherapy in a patient occupationally dependent upon his voice.

Radiological findings including ultrasonography, computed tomography (CT) and Tc-99m sestamibi scintigraphy of a patient with multilocular giant parathyroid adenoma which caused hypercalcaemic crisis are presented. The location of the tumour by grey scale sonography, CT and Tc-99m sestamibi scintigraphy was not certain because the tumour was uncommon in shape, location, size and internal structure. Whereas, increased flow in the solid portion of the mass was demonstrated on power Doppler sonography, which proved to reflect abundant vessels in the adenoma in pathological findings.

There is controversy whether idiopathic mid-line destructive disease remains a valid entity, some authors considering that such cases are unrecognized malignant lymphoma or Wegener's disease. A case is presented in which numerous nasal biopsies over several years failed to show evidence of either lymphoma or Wegener's disease. Molecular genetic analysis of archival tissue did not demonstrate a monoclonal lymphoid population. It is proposed that idiopathic mid-line destructive disease remains a valid description in a small number of cases.

We present three cases of blastic mantle cell lymphoma with an unusual initial manifestation in Waldeyer's ring with methods for differentiating it from other blastic neoplasms of the head and neck. All cases presented with a feeling of fullness inthe area of the mass. Morphologically, the tumours were blastic with a high mitotic rate (three to nine per high power field). All were B-cell phenotype with coexpression of CD43. In all cases cyclin Dl and bcl-2 were positive and CD23 negative. Blastic mantle cell lymphoma occurring in Waldeyer's tonsillar ring may be mistaken for other high grade haematopoietic neoplasms. Immunohistochemistry and awareness of this type of lymphoma arehelpful in differentiating it from other neoplasms.

Lipomatosis has not previously been reported in minor salivary glands. Its occurrence in the parotid gland is well recognized. We present the first reported case of lipomatosis of the minor salivary glands in the nasal cavity. We also review the tumours of the minor salivary glands, lipomas and lipomatosis of the parotid, and the few reported cases of lipomas of the sinonasal tract.

Sinonasal teratocarcinosarcoma is very unusual malignant neoplasm histologically consisting of an epithelial element and one or more mesenchymal components. This is a report of teratocarcinosarcoma, in a 74-year-old male, involving the right nasal cavity and ethmoids with intracranial extension. The tumour was totally resected via the craniofacial approach and the patient was given post-operative chemotherapy. Extensive tumour necrosis, rapid growth and local destruction are the prominent features of this tumour. The clinical presentation, pathological features and clinical course of this rare malignancy are discussed with a review of the literature.

Radical neck dissection is one of the commonest procedures performed in any unit dealing with head and neck surgery. Intracranial complications following this procedure are uncommon. Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection have not been reported in the literature. We present a case in which this complication occurred following an uneventful radical neck dissection.

A parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).

We present a case of a 15-year-old girl with bilateral parotid and sub-mandibular salivary gland enlargement as the sole presentation of primary Sjögren's syndrome. The clinical, radiological, immunological and pathological features have been discussed. The relevant literature has been reviewed. To our knowledge this is the only reported case of Sjögren's syndrome presenting as multicystic disease with bilateral major salivary gland involvement.

Laryngeal metastases from remote primary tumours are uncommon. They derive mostly from melanomas or renal cell carcinomas. The generally rare laryngeal adenocarcinomas can only be classified as metastatic tumours in the presence of a distant primary of the same histology. Only five cases of a laryngeal secondary originating from adenocarcinoma of the large bowel have been reported in the world literature. A further case is presented which to our knowledge is the first to arise from the rectum, a site which suggests haematogenous tumour spread. This paper emphasizes the need for the search of synchronous metastatic disease and discusses the therapeutic options on the grounds of current management of singular colorectal secondaries.

A seven-year-old boy complained of intermittent epistaxis for several months. Computerized tomography (CT) scans showed increased soft tissue density over the left ethmoid sinus. Endoscopic sinus surgery was used to remove the mass completely. The pathological report was craniopharyngioma. No other focus of lesion was found, and he continues to do well.

We present a rare case of pseudoaneurysm of right subclavian artery who presented with supraclavicular mass. Injury of the subclavian artery causing pseudoaneurysm is a serious surgical emergency and a surgical intervention is indicated.

Parotitis complicated by parotid abscess remains a potentially life-threatening problem. Conventional surgical treatment involves incising the parotid parenchyma in the direction of the facial nerve until the abscess is located and evacuated. Intra-operative ultrasound greatly assists in localizing the abscess and in ensuring' its complete drainage. Expeditious and exact localization of the abscess reduces operative time. Equally importantly, ultrasound-assisted drainage reduces surgical dissection and the potential for facial nerve damage.

Intramuscular haemangiomas are rare benign haemangiomas occurring within the skeletal muscle. These are uncommon tumours in the head and neck region and occur most frequently on the trunk and extremities. Fewer than 80 cases of intra-muscular haemangioma in the head and neck region have been reported in the literature.

A case of intramuscular haemangioma of the sternocleidomastoid muscle is presented. The review of occurrence and natural history of such tumours is described and clinical and radiological presentation, histological classifications and treatment modalities are discussed.