Silastic implants are very widely used in surgical practice and are considered to be relatively inert. They do however present with complications, including infection, local foreign body inflammatory response, calcification, migration and failure of repair of the defect, which sometimes may necessitate explantation. Head and neck implants do present a special case, as complications can cause obstruction and disruption of function in small cavities. A pertinent history, clinical review and computed tomography scan are usually invaluable in obtaining a diagnosis. We present a rare case of migrated Silastic orbital sheet, presenting as a nasal polyp and causing maxillary antral pain and infection. A detailed search of the medical literature revealed no other such case.

Auditory neuropathy (AN) is a hearing disorder characterized by the absence or severe distortion of the auditory brainstem responses, in the presence of preserved otoacoustic emissions. This peculiar combination suggests the presence of a defect impinging upon the functional complex formed by inner hair cells, the primary afferents (spiral ganglion neurones) and the first order synapses between hair cells and the cochlear nerve. Typically, AN patients show a severe speech perception impairment, which appears reduced out of proportion to pure tone threshold, but the clinical presentation of AN is quite complex.

Hearing loss is a common symptom associated with mitochondrial diseases; however, AN has only rarely been reported in these disorders.

Here we report a rare association, the first case observed in Italy, in a patient with autosomal recessive mitochondrial myopathy and mitochondrial DNA multiple deletions, and a hearing deficit with the audiological and electrophysiological features of AN.

Cystadenocarcinoma (papillary cystadenocarcinoma) of the salivary gland is a rare malignant neoplasm. Major locations of this neoplasm are the parotid gland, the sublingual gland, and minor salivary glands, while occurrence in the submandibular gland is extremely rare. As far as we know, only one report, written in the French language, has been published concerning cystadenocarcinoma of the submandibular gland, but no report is available in the English language. In this report, we describe a case of cystadenocarcinoma arising from the submandibular gland of a 54-year-old male patient. The neoplasm is a low-grade carcinoma, and pre-operative examination may not show typical characteristics of malignant neoplasms. Therefore, as was true in this case, the differential diagnosis from benign lesions is sometimes difficult. This is the first report on cystadenocarcinoma of the submandibular gland in the English language and the first to show a computed tomography (CT) scan and magnetic resonance imaging (MRI) of this neoplasm in the submandibular gland.

Laryngeal squamous cell carcinoma (SCC) is one of the most frequent malignancies in the head and neck region. The risk of multiple malignancies is reported as 2–11 per cent and most of the second primaries are SCCs. Lymphogenic tumours as second primaries are extremely rare. In this paper, we report a case of laryngeal SCC with synchronous non-Hodgkin's lymphoma and review the literature on the clinical and histopathological aspects of these malignancies.

We present a case of an oesophageal foreign body (approximately 2×2 cm) which was not seen on the initial lateral soft tissue neck X-ray but was detected following manipulation of the X-ray using the Picture Archiving and Communication System of X-ray viewing. This system gives the user much greater flexibility, including a choice of magnification and contrast.

Neuroblastoma is the most common extra-cranial solid malignancy in children and the most common tumour occurring during infancy. This tumour arises from undifferentiated precursor cells of the sympathetic nervous system. The abdomen (65 per cent) is the most common site for these tumours, followed by the throat (15 per cent), pelvis (5 per cent) and cervical region (5 per cent).

We report a case of primary retropharyngeal neuroblastoma in a three-week-old baby boy presenting with upper airway obstruction

Smooth muscle tumours of the head and neck are rare. An unusual case of laryngeal leiomyosarcoma in a 69-year-old man is presented. Histological diagnosis of this tumour is difficult, and immunohistochemical studies are vital. Treatment is discussed, and should include local control with debulking, radiotherapy and long term follow up.

Camurati-Engelmann's disease (CED) is a rare hereditary disorder affecting mainly the diaphysis of long bones but multiple cranial nerve deficits may also develop secondary to bony sclerosis of their foramina, including visual loss, facial palsy, deafness, vestibular disturbances and sensory deficits along the distribution of the trigeminal nerve. Deafness has been reported in about 18 per cent of these cases due to narrowing of the internal auditory canals caused by bony encroachment on nerves and vessels. We report an extremely rare case of a patient with CED who presented with deafness due to gross abnormalities affecting both middle ear and cochlea. The issues relating to the management of these patients with temporal bone involvement are discussed.

The transsphenoid approach to the petrous apex, a surgical procedure described for the first time by Montgomery in 1977, is a rarely performed approach for the drainage and ventilation of cholesterol granuloma. We consider this approach to be the technique of choice when the cholesterol granuloma is located in the medial section of the petrous apex abutting and/or prolapsing into the posterior wall of the sphenoid sinus. The transsphenoid approach, unlike other lateral approaches to the petrous apex, is highly conservative and spares cochlear and vestibular function; moreover, it allows simple and adequate post-operative endoscopic follow up as an out-patient, with easier treatment in the case of recurrence.