Sarcoidosis affects many different organ systems. However, laryngeal involvement is rare and most cases with laryngeal involvement affect the supraglottis, occasionally secondarily extending to the vocal fold. The features of sarcoidosis in the supraglottic region have been described in several reports, but vocal fold involvement has not been presented in detail. We report an unusual case of laryngeal sarcoidosis initially involving the vocal folds in a 66-year-old man, associated with hypercalcaemia. Our report describes characteristics of the involved vocal folds. Hypercalcaemia is one of the characteristics of sarcoidosis. We concluded that laryngeal sarcoidosis should be added to the differential diagnosis of vocal fold lesions, particularly in patients with hypercalcaemia.

We report a case of thyroid papillary carcinoma lying within a lateral cervical cyst for which no occult primary tumour of the thyroid was identified. We explore the possible diagnoses and include a discussion of how ectopic thyroid tissue may come to lie within a branchial cyst.

The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 × 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.

Otitic hydrocephalus is characterized by increased intra – cranial pressure without focal signs of neurological dysfunction. It usually occurs secondary to lateral sinus thrombosis more commonly on the right side, but it can also occur without lateral sinus thrombosis. With the advent of new antibiotics there has been a spectacular decrease in the complications of otitis media. Otogenic intra – cranial hypertension, always an uncommon condition, is seen only very rarely nowadays. Tubercular otitis media still occurs in India, and due to delays in its diagnosis it usually presents with complications. We present three patients with otitic hydrocephalus of tubercular origin.

Idiopathic calcinosis of the tongue is very rare. We report a case of idiopathic calcinosis of the tongue in a 19-year-old female.

A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in a 29-year-old man is reported. The characteristic features of Rosai-Dorfman disease, such as massive painless cervical lymphadenopathy, fever, raised erythrocyte sedimentation rate and raised white cell count, were all found to be absent. However, typical histological features, such as diffuse lymphoplasmacytic infiltrate, Russel bodies, foamy histiocytes and histiocytes with emperipoiesis, confirmed the diagnosis. Rosai-Dorfman disease is an uncommon disorder and its presentation with progressive subglottic narrowing is extremely rare. Our experience in the management of this condition is reported and the review of literature is discussed.

The clinical and radiological differential diagnosis of cystic lesions of the submandibular region can be difficult. We report an unusual case of a submandibular salivary duct cyst mimicking an external laryngocele on presentation by appearing to expand on Valsalva manoeuvre, and where computed tomography (CT) scanning was unhelpful in reaching a diagnosis. We present the case, discuss the theories of pathogenesis, and review the literature on the differential diagnosis of cystic lesions in the submandibular region.

Extracranial meningiomas comprise two per cent of all meningiomas. Primary extracranial meningiomas are even less common. The authors report the first case of a primary extracranial meningiomas of the soft palate, which presented as an intraoral mass. This was treated by surgical excision and there was no evidence of tumour recurrence at four years of follow-up.

Congenital vallecular cysts are rare. In this report, four infants having vallecular cysts encountered over a six-year period from 1992 to 1997 were reviewed. All of them presented with upper aerodigestive tract symptoms. Marsupialization was performed in three of them and CO2 laser excision was performed in the fourth patient. There was no recurrence of the cyst in any patient. One of them also had co-existing laryngomalacia. The degree of airway collapse caused by laryngomalacia improved after cyst removal. The laryngomalacia resolved spontaneously. Cyst fluid culture was performed in one of the patients and yielded Staphylococcus aureus but there was no other definite indicator of infection. Staphylococcus aureus could also be isolated in the respiratory tract from two of the other patients.

Benign substernal goitres usually extend into the upper anterior mediastinum and are easily extractable through a cervical approach. Very infrequently these tumours extend into the thoracic cavity causing compression of mediastinal structures. The authors report a case of pulmonary hypertension and severe cardiac failure secondary to a long-standing substernal goitre, and support the surgical management of this disease.

In this case a secondarily infected pseudoaneurysm of the common carotid artery presented with clinical features suggestive of a parapharyngeal abscess. The causative organism was identified as community-acquired methicillin-resistant Staphylococcus aureus. To the authors’ knowledge this condition not previously been reported.

Paragangliomas can develop in a number of head and neck sites, the most common being the carotid body paragangliomas and glomus jugulare tumours. This is a case of a paraganglioma confined entirely within the lumen of the jugular vein.

An unusual extremely benign course of an 8 cm long, rusting, metallic oropharyngeal foreign body that had entered post-aurally (penetration injury) four years previously to lie completely within the pharyngeal lumen has not yet been reported in the world literature. The need for additional investigations and special precautions to be taken during surgical extraction are highlighted.

A case of an isolated pleomorphic adenoma of the retropharyngeal space is reported, this has not been documented previously in the literature. Attention is drawn to the wide spectrum of benign and malignant neoplasms that can potentially occur within this complex anatomical region. The importance of a systematic and logical approach to the management of such lesions is emphasized.

Recent epidemiological research has raised the possibility of a connection between viral infection by the human papilloma virus (HPV) and the existence of squamous cell carcinoma of the oral cavity and oroharynx (SCCa). Some 60 subtypes have been identified to date, and specific subtypes are associated with lesions or infections at specific tissue sites. Twenty-three patients with SCCa of the oral cavity were studied for the presence of HPV in their tumours. HPV DNA (all type 16) was isolated from four specimens (17.3 per cent) using the Polymerase Chain Reaction (PCR) method. The four patients were all over age 50, and had advanced tumours (two T3 and two T4) that originated in the oropharynx. Our data supports other reports in the literature, demonstrating the presence of HPV DNA type 16 within cells from oropharyngeal SCCa. We conclude that the PCR method is a useful and reliable method for the detection of HPV DNA within tumour cells.

An unusual case of acute purulent thyroiditis in a 45-year-old man forming a large abscess in the left lobe of the thyroid gland is described. It perforated the capsule at the posterior wall of the thyroid, causing extensive retropharyngeal and retrotracheal abscesses. The patient was treated with broad-spectrum antibiotics and surgical excision of the infected tissues. He has remained well one year after the operation.

Cranial nerve damage following head and neck radiotherapy is an unusual event. Cranial neuropathy following concurrent chemotherapy and radiotherapy is unreported. The authors report a case of a 54-year-old man treated with curative chemotherapy and radiotherapy for a stage III nasopharyngeal carcinoma who developed an unilateral hypoglossal nerve palsy five years after therapy. Follow-up examination and magnetic resonance imaging (MRI) show no evidence of recurrent disease. Hypoglossal nerve injury occurring after head and neck radiotherapy is an indirect effect due to progressive soft tissue fibrosis and loss of vascularity. This process develops over years leading to nerve entrapment and permanent damage. Cranial nerve palsies, including damage to the hypoglossal nerve, can develop years after therapy with no evidence of tumour recurrence. Chemotherapy and radiotherapy have improved progression-free and overall survival in advanced nasopharyngeal cancer. As more patients achieve long-term tumour control following chemotherapy and radiotherapy, we must be cognizant of potential late injury to cranial nerves.

We report a case of thrombosis of the right internal jugular vein associated with right parotitis. The literature is briefly reviewed.

A rare case of an intratemporal pleomorphic adenoma is presented and the management of such a tumour is discussed. Some anatomical aspects of the facial nerve, pertinent to the pathophysiology of facial paralysis are outlined. This case demonstrates that tumour extension into the temporal bone can be resected successfully at initial surgery with excellent facial nerve functional outcome. We advocate exploration of the fallopian canal to be carried out at primary surgery and be performed by a surgeon familiar with the surgical anatomy of the intratemporal segment of the facial nerve. This approach will reduce the risk of facial nerve injury and palsy both at surgery and subsequently.