Stenotic malformations of the internal auditory meatus (IAM) are rare. They are known to symptomatically mimic vestibular schwannomas leading to potential diagnostic error. We present a case (along with literature review) where a stenotic IAM was clinically and radiologically misdiagnosed as a vestibular schwannoma.

Synchronous laryngeal malignancies are extremely uncommon. To the best of our knowledge, only four cases of primary synchronous squamous cell carcinoma (SCC) of the larynx are available in the literature. We report the case of a 52-year-old patient with simultaneous spindle-cell carcinoma and SCC in situ of the larynx. The pathogenesis, treatment and prognosis of this rare occurrence have been discussed.

Aims: to determine correlations between relative quantities of telomerase catalytic subunit m-ribonucleic acid (hTERT mRNA) and conventional clinicopathological parameters (such as site, size and grade of tumour, the presence of regional lymph node metastases, and, in particular, survival) in patients with laryngeal and hypopharyngeal squamous cell carcinomas (SCCs).

Material and methods: The relative quantity of hTERT mRNA was analysed by a commercially available LightCycler Telo TAGGG hTERT Quantification Kit in 56 cases of SCC (40 laryngeal and 16 hypopharyngeal). The association with cancer-specific survival was evaluated by univariate and multivariate analysis.

Results: Location of the tumour in the hypopharynx was the only significant negative predictive factor for survival, as determined by univariate analysis (p = 0.028). Although a tendency towards a better overall survival was observed for female patients younger than 50 years, for lower tumour grades and sizes, and for the absence of regional lymph node metastases, the prognostic significance of these factors could not be confirmed. No differences existed in hTERT mRNA expression between laryngeal and hypopharyngeal SCCs. Furthermore, no correlation was found between the relative quantities of hTERT mRNA and the tumour size, regional lymph node metastases or survival of patients with laryngeal or hypopharyngeal SCCs.

Conclusions: The results of the present study suggest that genetic abnormalities other than telomerase reactivation are responsible for progression of laryngeal and hypopharyngeal SCCs.

Internal jugular vein thrombosis from non-otological causes is not well documented in the otolaryngology literature. The authors report a case of left internal jugular vein thrombosis due to severe ovarian hyperstimulation syndrome. Causes, investigations and treatment of internal jugular vein thrombosis from non-otological causes are discussed.

A 55-year-old man with cervical radiculopathy (C5–C8) was referred to us following intra-arterial infusion of cisplatin (CDDP) because of a recurrent neck mass of laryngeal cancer. Three hours after the CDDP infusion, he had noticed general weakness of the left upper extremity and hypoaesthesia of the lateral side of the upper and lower arm. The next day he was diagnosed with left cervical radiculopathy of C5 to C8, which improved gradually and had resolved completely six months after the infusion. Even with proper positioning of the infusion catheter to minimize potential complications, for anatomical reasons there are always some risks of neural injury with intra-arterial infusion from branches of the subclavian artery. This procedure should be carefully indicated in the case of a large neck tumour that is perfused from the major branches of the subclavian artery.

Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.

Vocal fold scarring results in the formation of fibrous tissue which disturbs the vibratory pattern of the fold during phonation. However, vocal fold scarring in humans is poorly understood because of the lack of clear case reports focusing on voice quality. The authors present a case of vocal fold scarring with changes in voice quality. At the time of injury the pedicle mucosa was cemented with fibrin glue. Phonation was inhibited for two weeks and tranilast (300 mg/day) was given for 3 months. Sixty-nine days later, perceptual evaluation showed a normal result and the phonation time became better, but the mucosal vibration was still lacking. Ninety-seven days later, mucosal vibration was finally restored. We suggest that characterization of vocal fold scarring in humans may be different from that in animals, and recommend that surgical management should be avoided for at least three months after injury.

Laryngeal necrosis is a serious complication that usually occurs within the first year following completion of radiotherapy, although it is reported that cases can develop after a long period of latency. Factors such as dosage and irradiation technique employed, tumour invasion into the laryngeal cartilage, infection, continued smoking, trauma and general vascular condition of the patient have been considered to increase the rate and degree of development of radionecrosis. We report an unusual case of laryngeal radionecrosis in a patient with hypertension, hyperlipidaemia, diabetes and a history of cigarette smoking, which developed 25 years after radiotherapy for laryngeal carcinoma. His systemic illnesses and continued smoking were speculated to have contributed to the progress of the radionecrosis, suggesting that cessation of smoking and control of arteriosclerotic diseases should be considered to decrease its incidence.

We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.

Primary tracheal masses are rare. Secondary masses of the trachea are commonly foreign body granuloma, intubation granuloma or viral granuloma. The differential diagnoses given in such cases include both benign and malignant lesions. The otolaryngologist is often asked to perform a biopsy of the lesion to arrive at a diagnosis. However, even malignant processes can cause a granulomatous reaction. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion. A rare case of tracheal granuloma leading to pneumomediastinum in a 53-year-old female is presented. The clinical features, investigations and treatment are detailed. The tracheal granuloma was managed by excision through bronchoscopy and the pneumomediastinum was managed conservatively.

Haemangioma of the thyroid gland is extremely rare. We report a case of a cavernous haemangioma of the neck that was located both inside and outside the thyroid gland of a 21-year-old man. Ultrasonography of the neck revealed numerous calcified nodules. Computed tomography (CT) showed a large calcified soft tissue mass in the right lobe of the thyroid. Based on the imaging findings a papillary thyroid carcinoma was suspected, but examination of the surgical specimen revealed a huge cavernous haemangioma containing numerous phleboliths.

We present the first case of a thoracic ranula which originated from the left submandibular area extending into the subcutaneous tissue planes of the anterior chest wall. The patient had a history of surgery for a previous benign left salivary gland cyst, and presented with an enlarging mass in the anterior chest wall. This was a recurrence of a ranula, with an extension into the anterior thoracic wall. The thoracic ranula was excised, together with ipsilateral sublingual and submandibular glands, via a transcervical approach. No recurrence was detected over a 3-year post-operative follow up.

We present a case report of an aggressive natural killer T cell lymphoma in a police officer who presented with combined features of orbital cellulitis and mid-facial destruction. However, his initial diagnosis was confused with other disease conditions that had overlapping features. This emphasizes the significance of clinical alertness and adequate tissue sampling; this can have a great impact on early diagnosis and treatment.

Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which retropharyngeal liposarcoma occurred in a patient who had had multiple previous subcutaneous lipomas excised. This paper explores this very unusual presentation and discusses the difficulties in the diagnosis and management of this rare tumour.

Crohn’s disease is a chronic idiopathic inflammatory disease of the bowel, and in most cases it involves the small bowel and colon. Extraintestinal manifestations occur frequently and multiple organ systems may be affected. In contrast, nasal manifestations are extremely rare and only a few cases have been reported to date. Saddle nose deformity in a patient with Crohn’s disease has not been reported in the English literature. We report a case of such a deformity and the current literature on nasal manifestations in Crohn’s is reviewed. The normal diagnostic and therapeutic features are also discussed.

Tuberculosis affecting the thyroid gland is a rare condition. We present the case of a 30-year-old man with thyroid tuberculosis whose presenting complaints were dyspnoea and hoarseness. There was a cystic mass in the posterosuperior right thyroid lobe extending into the paraglottic space. There was also recurrent laryngeal nerve involvement. We performed surgery and administered post-operative antituberculous treatment

We present the first reported case of a squamous cell carcinoma recurrence on a reconstructed flap in the pharynx treated successfully with topical chemotherapy. The patient, treated for a pharyngeal cancer with resection and reconstruction with a free radial forearm flap, and post-operative radiotherapy, developed a tumour on the flap more than two years after surgery. The recurrence was also squamous carcinoma, but there was only superficial infiltration. This was treated with 5-fluorouracil paste placed in the pharynx, with resolution of thetumour. The patient was alive and well more than 28 months after this treatment, with no sign of disease recurrence. Topical chemotherapy for treatment of oral cancer is well described for early disease, but we show that it may be a useful treatment in recurrent disease in selected patients.

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an autosomal dominant angiopathy characterized by recurrent cerebrovascular events, migraine and dementia. We describe a case of sensorineural hearing loss as the presenting feature of this condition. We have found no previous reports in the world literature of CADASIL presenting with a sudden sensorineural hearing loss. The significance of questioning a patient with regard to family history is exemplified in this case.