Adenosquamous carcinoma is a very rare tumour which is characterised pathologically by the simultaneous presence of distinct areas of adenocarcinoma and squamous cell carcinoma. Generally, adenosquamous carcinoma has an aggressive clinical course and is associated with a poor prognosis. Most cases have been treated by surgery alone or combined with radiotherapy. Chemotherapy is rarely used in treating adenosquamous carcinoma, and it has been difficult to establish treatment guidelines due to the paucity of cases.

We report a case of adenosquamous carcinoma which arose in the maxillary sinus of a 77-year-old man. Despite surgical treatment and chemoradiotherapy to the primary site, he developed bilateral neck metastases after the surgery. The patient was treated with S-1, a novel oral fluoropyrimidine anticancer agent, with a complete (albeit finite) response.

This report presents the aggressive character of adenosquamous carcinoma and the possible role of S-1 in the treatment of this uncommon neoplasm.

A pneumocoele is a pathologically expanding, air-containing paranasal sinus. Pneumocoeles are uncommon entities, with very few cases reported in the literature. The most plausible aetiological theory is that of a one-way valve effect allowing air into the sinus under increased pressure without pressure equilibration.

Review of a frontal sinus pneumocoele caused by a type III frontal cell and intersinus septal cell.

We present a patient with chronic sinusitis who developed a pneumocoele of her left frontal sinus with erosion into her orbit. This patient was a habitual, chronic nose-blower with a large type III frontal cell adjacent to an intersinus septal cell.

We propose the new theory that, in our patient, such cells formed a one-way valve, causing air-trapping and pathological expansion of the frontal sinus. To our knowledge, there are no previously published cases that establish an association between large frontal cells and expansion of a pneumocoele.

We present the first reported case of primary carcinoid tumour of the nasal septum.

Case report of our experience of a carcinoid tumour of the nasal septum. We discuss our clinical, radiological and pathological findings.

An 83-year-old woman presented with a history of left-sided nasal blockage. Clinical examination showed a unilateral, left-sided nasal polyp. Further imaging and histological analysis confirmed this to be a carcinoid tumour. Carcinoid tumours outside the gastrointestinal tract are rare. There have been reports of carcinoid tumours in the head and neck region, but no published cases occurring in the nasal septum. Our management involved wide surgical resection with regular follow up to monitor for recurrence and for the development of carcinoid syndrome. Four years from initial presentation, the patient remained free of the primary tumour and had displayed no signs or symptoms suggestive of carcinoid syndrome.

To the authors' best knowledge, and after searching the world literature, the presented case represents the first report of primary carcinoid tumour of the nasal septum. Despite its rarity, this tumour should be considered as part of the differential diagnosis, as timely recognition and intervention are critical for successful treatment.

Bony canalplasty is a common otological procedure performed to widen a narrow ear canal. The aim of this report is to describe two unusual patients who presented with a canal wall cholesteatoma many years after bony canalplasty.

Two patients, aged 28 and 52 years, are presented. Both underwent canalplasty, 14 and 17 years before re-presenting with cholesteatoma evident through posterior canal wall defects. Both patients underwent exploration of the mastoid cavities and cartilage reconstruction of the canal walls. There was no recurrence at 24 and three month follow-up examinations (variously), hearing was preserved in both cases, and the patients suffered no early complications.

The most frequent long-term complication of canalplasty is re-stenosis of the external auditory canal. The importance of sealing any inadvertently opened mastoid air cells, in order to avoid the late complication reported, is emphasised.

We report a case of lymphangioma circumscriptum of the tongue, a very rare site of occurrence, which was successfully managed with intralesional bleomycin therapy.

We present a case report and review of available literature regarding lymphangioma circumscriptum of the tongue and the role of bleomycin therapy.

The patient was a 19-year-old man with a long-standing lesion involving the tongue, who presented with spontaneous, episodic bleeding over the previous few months. A diagnosis of lymphangioma circumscriptum was established on biopsy. Intralesional bleomycin injection resulted in successful resolution, and the patient remained asymptomatic over more than one year's follow up.

Lymphangioma circumscriptum is usually seen in the extremities and genitals. This case had a very rare site of occurrence, the tongue, and was successfully managed with conservative treatment, using intralesional bleomycin alone.

To demonstrate a simple, practical, cheap method of preventing potentially fatal aspiration of a dislodged voice prosthesis; this method was developed by a laryngectomised patient.

A patient diagnosed with squamous cell carcinoma of the larynx underwent total laryngectomy. Upon completion of radiotherapy, a tracheoesophageal fistula was created and a voice prosthesis inserted to enable voice restoration. Unfortunately, the patient presented subsequently with repeated episodes of dislodgement and an episode of potentially fatal aspiration of the voice prosthesis, despite various measures taken by the surgeons to overcome the problem. The patient subsequently developed a method enabling him to retrieve the voice prosthesis himself should it become dislodged. He attached a ring to the prosthesis, which was larger in diameter than the tracheal stoma, thus preventing ingestion or recurrence of aspiration.

To our knowledge, this is the first report in the world literature of this form of innovation, created by a laryngectomised patient, to overcome the problem of aspiration or ingestion of a dislodged voice prosthesis.

To report the case of an adult patient who developed auditory complaints following xylene exposure, and to review the literature on the effects of solvent exposure on hearing.

The patient presented with a gradual deterioration in his ability to hear in difficult acoustic environments and also to hear complex sounds such as music, over a 40-year period. His symptoms began following exposure to the solvent xylene, and in the absence of any other risk factor. Our audiological investigations revealed normal otoacoustic emissions with absent auditory brainstem responses and absent acoustic reflexes in both ears, consistent with a diagnosis of bilateral auditory neuropathy. Central test results were also abnormal, indicating possible involvement of the central auditory pathway.

To our knowledge, this is the first report of retrocochlear hearing loss following xylene exposure. The test results may provide some insight into the effect of xylene as an isolated agent on the human auditory pathway.

We report a case of infection against a background of pre-existing cranial fasciitis.

Case report and review of world literature on cranial fasciitis.

Cranial fasciitis of childhood is a benign condition and a rare variant of nodular fasciitis. We present the case of a 10-week-old infant with symptoms and signs consistent with a subperiosteal abscess complicating acute mastoiditis. Subsequent findings showed this to be an infection against a background of pre-existing cranial fasciitis.

To our knowledge, this is the first such reported case in the literature. Knowledge of the distinctive histopathological features, coupled with an awareness of the condition, are crucial to establishing a definitive diagnosis of cranial fasciitis and, in turn, to instituting appropriate management. The aetiopathogenesis of the condition remains unclear.

We report a case of malignant peripheral nerve sheath tumour seen in our department.

We present case reports and a review of the world literature concerning malignant peripheral nerve sheath tumour.

A 38-year-old Caucasian woman was diagnosed with malignant peripheral nerve sheath tumour of the infraorbital nerve. She underwent a wide enbloc resection followed by a course of radiotherapy. A five-year post-operative magnetic resonance imaging scan revealed no evidence of recurrence.

Malignant peripheral nerve sheath tumours are rare in the head and neck. An awareness of their occurrence is important for early diagnosis. Management involves: accurate histological diagnosis; radiological imaging to define tumour extent and plan resection; wide surgical excision with histologically negative margins; reconstruction of the tissue defect; and post-operative radiotherapy.

We report an extremely rare case of maxillary haemangioma.

Case report and review of the literature concerning haemangioma arising from the nasal cavity and paranasal sinuses.

Maxillary haemangioma is rare and sometimes requires wider resection than nasal haemangioma if a large tumour is found. We present a case of maxillary haemangioma in a 37-year-old Japanese woman, which was completely resected by pre-operative embolisation and endoscopic sinus surgery.

Our findings suggest that if a large maxillary haemangioma is diagnosed pre-operatively, the treatment of choice is pre-operative embolisation followed by endoscopic sinus surgery, in order to avoid the surgical complications associated with wide resection.

We present a case of a patient who had undergone embolisation and resection of a left glomus jugulare tumour, who presented three weeks post-operatively with magnetic resonance venography confirmed symptomatic cerebral venous sinus thrombosis.

We present a case report and a review of the world literature concerning glomus jugulare tumours and cerebral venous sinus thrombosis.

A 42-year-old man presented with blurred vision and reduced Snellen visual acuity just three weeks after glomus jugulare tumour surgery. Fundoscopy revealed bilateral haemorrhagic optic disc oedema. Urgent magnetic resonance venography confirmed a left lateral venous sinus thrombosis. It was felt that this was responsible for inadequate cerebrospinal fluid drainage, resulting in raised intracranial pressure and papilloedema.

To the authors' knowledge, this is the first account of a magnetic resonance venography confirmed venous sinus thrombosis and secondary papilloedema following glomus jugulare tumour surgery. Patients undergoing surgery involving resection or manipulation of the internal jugular vein may be at higher risk of developing thrombosis superior to the level of resection, and magnetic resonance venography ought to be considered an important diagnostic adjunct.

To demonstrate that sublingual immunotherapy is a safe treatment option in patients who have previously suffered anaphylaxis when undergoing subcutaneous grass pollen immunotherapy.

We report two patients who developed a systemic anaphylactic reaction following subcutaneous grass pollen immunotherapy, resulting in discontinuation of treatment. Following treatment of the acute anaphylactic episode, both patients were subsequently safely commenced on sublingual grass pollen immunotherapy.

Injection immunotherapy has a relatively low risk of severe adverse events, although anaphylaxis is a potentially fatal complication and usually results in termination of the immunotherapy programme. Sublingual immunotherapy has a safer side effect profile than subcutaneous immunotherapy, with no reported cases of anaphylaxis.

To evaluate parental experience, satisfaction and outcomes following their child's tonsillectomy surgery.

Structured postal questionnaire sent to the parents or guardians of 77 sequential children undergoing elective day-case tonsillectomy.

Seventy-seven children with a mean age of 6.25 years (range three to 17 years) undergoing day-case tonsillectomy predominantly for recurrent acute tonsillitis, upper airway obstruction or a combination of these symptoms; 63.6 per cent of the parents or guardians of these children responded to the questionnaire.

There was overall satisfaction with the operation, and positive health outcomes.

Despite the current public health agenda to limit access to routine high volume operations such as childhood tonsillectomy on economic grounds, the users of this service rated the outcomes and benefits of the procedure highly.

This study aimed to introduce the technique of tetra-probe, 24-hour pH monitoring for laryngopharyngeal reflux disease.

Tetra-probe, 24-hour pH monitoring was performed for 30 suspected cases of laryngopharyngeal reflux. The proximal probe was placed in the hypopharynx, just above the upper oesophageal sphincter, the second probe was placed in the middle oesophagus, the third probe was placed a few centimetres above the lower oesophageal sphincter, and the distal probe was placed in the stomach.

As the pH at the four sensor sites could be monitored simultaneously, gastric acid levels and gastroesophageal and laryngopharyngeal reflux could be examined. This pH monitoring technique enabled the pH relationship between the four sensor locations to be well documented, enabling gastric acid levels and patterns of reflux to be assessed. This procedure was also able to be used as a functional examination to evaluate anti-reflux medication efficacy.

Tetra-probe, 24-hour pH monitoring is a reliable functional examination for laryngopharyngeal reflux.

Schwannomas are slowly growing tumours derived from Schwann cells. We present a clinical case of schwannoma in the mandibular angle.

Case report and a review of the world literature concerning intraosseous schwannoma of the maxillofacial region.

Schwannomas or neurilemmomas are slow-growing, benign neoplasms derived from Schwann cells. Intraoral lesions are unusual and intraosseous schwannomas are even rarer, representing less than 1 per cent of benign primary tumours of the bones. We present a clinical case of schwannoma in the mandibular angle mimicking a keratocystic odontogenic tumour, with a complicated posterior evolution.

Clinically, neurilemmomas are slow-growing tumours which may be present for years before becoming symptomatic. Radiographically, the image may be suggestive of a benign process such as an odontogenic keratocyst. Histological analysis of the specimens obtained is extremely important in order to establish the final diagnosis.

We report the use of bilateral surgical decompression of the internal auditory canals to treat hyperostosis cranialis interna in an eight-year-old girl presenting with bilateral facial palsy due to hyperostosis cranialis interna.

Using a middle fossa craniotomy approach, both internal auditory canals were unroofed and cranial nerves VII and VIII were decompressed, with a one-year interval between sides. The mimic function recovered. One year post-operatively, the right and left facial sides had been restored to House–Brackmann grades I and II, respectively.

This is the first report of the use of surgical decompression of the internal auditory canal in a case of hyperostosis cranialis interna. Surgical decompression of the internal auditory canal is recommended therapeutically, but may also be performed prophylactically in younger patients with hyperostosis cranialis interna.