Functional endoscopic sinus surgery (FESS) is a widely practiced technique in the UK. This procedure has variable complication rates and can have some serious consequences. We present a case of surgical emphysema of the neck, face and the pre-vertebral space following FESS. Emphysema of the face and neck has been previously reported. However, to our knowledge, emphysema of the pre-vertebral space following FESS has not been documented. Pre-vertebral emphysema following FESS is an unusual and potentially serious complication.

The aim of this study was to quantify the effect of tonsillectomy on the incidence of sore throats and its co-morbidity in adult patients. One hundred and nineteen adult patients were sent a standard questionnaire regarding their symptoms in the 12 months preceding and following their tonsillectomy. Outcome measures included the incidence of sore throats, total number of days with sore throat, amount of time taken off work or school, and number of visits to the general practitioner (GP). In addition, patients were asked to indicate the duration of their symptoms and whether or not they found the tonsillectomy effective in curing their sore throats.

Sixty-six patients (55.5 per cent) returned completed questionnaires. The age of the patients ranged from 16 to 39 years. The mean duration of symptoms was 8.3 years. On average, patients had 8.1 different sore throat episodes, 42 sore throat days, 21.4 days of sore throat related absence from work or school, and 5.9 visits to the GP in the 12 months before their operation. For the 12 months after surgery, these reduced to 0.9 episodes, four days, 2.2 days and 0.6 visits, respectively. This reduction was very significant (p < 0.001, Wilcoxon signed rank test).

After their surgery, more than half the patients achieved complete resolution of all the measured parameters mentioned above. Most of the remaining patients achieved at least 50 per cent resolution. Only three patients (4.8 per cent) achieved less than 50 per cent resolution. Ninety-five per cent of the patients found the operation effective in curing their sore throats and were glad they had had surgery.

In conclusion, retrospective questionnaire data must be interpreted with some caution, but this study suggests that tonsillectomy is effective in reducing the incidence, duration and co-morbidity of recurrent sore throats in adults; this must be balanced against the post-operative problems in a minority of patients.

Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts, epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge markedly.

This study discusses epidermoid cysts in a 34-year-old woman and a 35-year-old man, both of which were giant epidermoid cysts in the sublingual space. Both patients were admitted for difficulty swallowing and cosmetic problems. The cysts of both patients had an aetiology of trauma and were documented by pathology sections and pre-operative magnetic resonance images. Both cysts were excised completely, one intraorally and one externally. Such cysts are benign and ought to be borne in mind in the differential diagnosis of oral cavity and neck cystic masses.

Acoustic neuromas (vestibular schwannomas) comprise more than 90 per cent of all cerebello-pontine angle (CPA) lesions. We present a rare case of a giant vertebro-basilar aneurysm presenting as a CPA lesion. The general condition of the patient precluded the completion of the magnetic resonance (MR) sequences. The clinical and limited radiological results (T2 images alone, the features of which were not specific) initially did not lead to a specific diagnosis. To obtain further radiological information a computed tomography (CT) scan with contrast was performed and this revealed the lesion to be an aneurysm. The diagnostic difficulties and the treatment dilemmas of such a lesion are discussed. The importance of fine, axial, post-contrast CT arteriography with three-dimensional reconstruction, MR angiography and digital subtraction angiography are highlighted. The limitations of MR imaging in patients with CPA lesions are discussed.

This case report describes the development of a post-treatment enlargement of the sternoclavicular joint, diagnosed as a pseudo-tumour, in a patient who had previously undergone radical neck dissection and post-operative radiotherapy for metastatic mucoepidermoid carcinoma. Although pseudo-tumour has been previously reported in the surgical literature, it remains an uncommonly recognized condition. We present a review of the literature and discuss the condition's pathogenesis. We also highlight its importance to both the surgeon and the oncologist when considering the differential diagnosis of a swelling in the clavicular region, typically occurring following radical surgery for malignant disease in the neck.

Glial heterotopia is a rare disorder. However, it must be considered in the differential diagnosis of airway obstruction in the newborn. Differentiation of this lesion from nasal glioma and encephalocele is important.

In this paper we report a midline glial heterotopia, which presented with upper airway obstruction in a newborn. The origin of a glial heterotopia from the midline of the nasopharynx has not been reported before.

We present a review of the literature and discuss the clinical, radiological and pathological features of nasopharyngeal brain heterotopia in an infant.

Synovial chondromatosis is a condition which often affects the major joints. On rare occasions, it may affect the temporomandibular joint. We report such a case, which was mistakenly diagnosed and treated as a parotid mass. We include relevant radiological and histological investigations and a brief literature review.

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.

The insertion of a myringotomy tube is a common ENT procedure. Traditionally, this procedure is performed under otomicroscopic view. In this paper I describe a technique using rigid endoscopy with the Hopkins rod and a video monitor as a visual aid for the insertion of myringotomy tube in older children and adults. The technique is safe and effective; it allows demonstration of the entire tympanic membrane during surgery and also enables better teaching of the procedure than does the otomicroscope.

We report a case of sinolith in the left ethmoid sinus of a 61-year-old man. The patient complained of nasal obstruction. Computed tomography revealed a small, calcified mass associated with a nasal polyp in the left ethmoid sinus. The antrolith and polyp were removed via endoscopic sinus surgery. Histopathological analysis of the antrolith revealed it to be bone-like in formation. The antrolith was about 1 cm in diameter. Infrared spectroscopy revealed that the antrolith contained protein (45 per cent), calcium phosphate (43 per cent) and calcium carbonate (12 per cent).