A candidal abscess is a known complication of disseminated candidiasis, particuarly in immunocompromised patients. We report a second primary growth in the neopharynx brought to light by a candidal abscess in a non-immunocompromised patient.

Narrow internal auditory canal (IAC) syndrome is a malformation of the temporal bone, that is defined as an IAC diameter of only 1–2 mm on high-resolution computed tomographic scans (HRCT). This syndrome is known to be caused by the absence (aplasia or hypoplasia) of the vestibulocochlear nerve. We present a case of unilateral narrow IAC syndrome which was diagnosed by HRCT. The aplasia of the vestibulocochlear nerve was confirmed using parasigittal reconstruction magnetic resonance image (MRI). The IAC was composed of two separate canals, one of which contained a facial nerve and the other was empty with aplasia of the vestibulocochlear nerve.

An 18-month-old boy presented to the accident and emergency department following trauma to the oropharynx by a doll’s umbrella. Although no significant injury could be identified at first, it later transpired that he had developed retropharyngeal surgical emphysema with abscess. This case report aims to review the nature of retropharyngeal abscesses and to highlight and re-emphasize the fact that apparently non-serious pharyngeal injuries in children should be treated with suspicion.

Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5–30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.

The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.

Endoscopic stapling is a relatively new surgical technique for the treatment of pharyngeal pouch. We present a serious complication of the technique, resulting in a large perforation of the posterior pharyngeal wall, and discuss possible causes.

The uncommon occurrence of acute retropharyngeal abscess in adults can be the result of a retained foreign body. A large piece of wood impacted in the neck in a road traffic accident and presenting as retropharyngeal and bilateral parapharyngeal abscesses is reported for its rarity and clinical interest.

A bilobed pharyngeal pouch is a very rare finding. One such case is reported here, and is the first to be treated successfully by endoscopic division and stapling.

We present a case of oral ulceration in a patient with essential thrombocythaemia, that proved to be secondary to treatment with hydroxyurea. This complication has not yet been reported in the ENT literature. Hydroxyurea should be considered as a possible cause of persistent oral ulceration in patients with haematological conditions. It should be noted that the onset of this complication is not related to the dose and duration of therapy.

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier’s disease, is an ossifying condition frequently encountered in otolaryngology as it affects 12–28 per cent of the adult population. This form of hyperostosis can manifest clinically with dysphagia, food impaction, hoarseness, stridor, myelopathies and other neurological problems. Judicious management of severe dysphagia proves challenging. The failure of conservative care often leaves surgery as the only option. In this report an anterolateral transcervical surgical approach to the confluent osteophytes is discussed and the value of videofluoroscopic swallow highlighted

The latest 3D-image guidance systems to assist surgeons have greatly improved over earlier models. We describe the use of an optical infra-red system to assist in the removal of a juvenile nasopharyngeal angiofibroma. The specific advantages of this system in pre-operative assessment, intra-operative evaluation and excision of the angiofibroma are discussed.

An unusual case of Echinococcus oligarthrus infestation of the submandibular salivary gland is reported. Echinococcus oligarthrus is a rare variant of the Echinococcus species affecting humans. To the best of our knowledge only one case of submandibular hydatid cyst caused by Echinococcus oligarthrus has been reported. A 28-year-old female patient was admitted with a progressively increasing swelling in the left submandibular region of four years’ duration. There was no pulmonary or hepatic involvement. The present case of submandibular hydatid cyst caused by Echinococcus oligarthrus is of interest because of the unusual site of the disease.

A rare plexiform neurofibroma of the submandibular gland in a patient with neurofibromatosis is presented. The clinical manifestations of the disease are reviewed. The need for early diagnosis of neurofibroma is emphasized because of malignant tranformation.

Despite the dramatic decrease in cuff-related complications with the introduction of high-volume low-pressure devices for intubation and tracheostomy, notable problems can still occur. A case is reported of a patient who developed persistent dilatation of the trachea after prolonged mechanical ventilation. This is an underrecognized, life threatening clinical entity occurring after cuffed intubation for prolonged time. At present there is no definitive treatment regarding the management of a dilated trachea on a ventilator-dependent patient and therefore emphasis is directed at prevention. The patient presented was managed with periodical alterations of the cuff level which although not achieving any reversal of the dilatation, have prevented further progression of tracheal damage. During the follow-up period, regular assessment with flexible endoscopy has provided more reliable information on the condition of the trachea than computed tomography (CT) scanning.

We report a case of metastatic endometrial carcinoma of the neck. A patient with a past medical history of squamous cell carcinoma of the larynx, breast carcinoma and endometrial carcinoma presented with a neck mass. Fine needle aspiration cytology (FNAC) showed this to be a poorly differentiated carcinoma with squamoid features and thus a potentially curative neck dissection was performed. Histology of the mass showed a clear cell endometrial carcinoma. Metastatic gynacecological malignancies to the head and neck are rare and this is the first reported case of metastatic endometrial carcinoma in the neck.

The gastric pull-up or pharyngogastroplasty is the most widely used technique in reconstructing the digestive tract in cases of distal oesophageal tumours. This operation consists of drawing the stomach or part of it up through the chest and mediastinic region to the neck where a mucosal anastomosis with the residual pharyngeal act is made.

The most feared complication is proximal necrosis of the gastric stump with salivary fistulae usually followed by a mediastinitis. In the presence of such a complication the surgeon must tackle the challenge of reconstructing the missing part of the intrathoracic digestive tract. We describe the case of a patient in whom the missing intrathoracic oesophagus, following complete necrosis of a previously performed pharyngogastroplasty, was reconstructed using a revascularized lateral thigh free flap.

We report the first case of dysphagia due to engorgement of a congenital vascular ring as a result of the haemodynamic changes of pregnancy. The clinician should be aware of this in the differential diagnosis.Spontaneous recovery may occur six months post partum as the haemodynamic changes resolve, but if further pregnancies are planned surgery is effective.

Computerized tomography (CT) offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy, both pre-requisites to the safe practice of endoscopic sinus surgery. Neither plain X-rays nor magnetic resonance imaging (MRI) offer optimal information in this respect. A variety of protocols minimizing radiation dose to the lens whilst providing high quality images are presented together with a menu of anatomical features that require careful evaluation pre-operatively.

This paper describes the surgical procedures for a fibrolipoma that first appeared as a giant tumour in the hypopharynx and extended to the cardiac antrum of the oesophagus. At the initial surgery, a pedunculated tumour originating from the left arytenoid of the larynx was found to occupy the cervical as well as thoracic oesophagus and was thus removed through a lateral pharyngectomy. A histological examination revealed fibrolipoma. However there was a recurrence of the tumour in the arytenoid and the patient suffered from dyspnoea. In addition, a submucosal tumour was also found in the left false vocal fold. At the second surgery, the masses in the arytenoid and false vocal fold were subtotally removed without damaging the mucosa. The mucosa of the arytenoid was sutured to the thyropharyngeal muscle on the same side and the arytenoid swelling disappeared almost completely. The post-operative course has been uneventful for more than two years.

A case of pharyngeal (Zenker’s) pouch in a patient suffering from polymyositis is presented. Although dysphagia is a recognized manifestation of polymyositis, in this unique case it was caused by a pharyngeal pouch. The aetiology of Zenker’s diverticulum is discussed in the light of this unexpected association.