We have studied 47 children (58 ears) with external and middle-ear malformations. Tomography was useful and effective in the pre-operative evaluation of anatomical patterns. We have divided our cases into four groups and described the most characteristic tomographic findings in each. We also discuss problems concerning patients immobilization and X-ray protection.

Disease of the apex of the petrous temporal bone, while rarely encountered, can present a unique challenge to the otologist. Lesions tend to be advanced at presentation, as massive bony erosion can remain asymptomatic. When symptoms occur, they reflect involvement of the neurovascular contents of the temporal bone. The earliest clinical features, such as headache, facial numbness and middle-ear effusion, do not immediately suggest the site or gravity of the underlying pathology. Anterior extension of disease may produce ophthalmoplegia and diplopia whilst posterior spread involves the lower cranial nerves, within the internal auditory canal, jugular foramen and hypoglossal canal.

Conventional histological studies of stapes footplates from patients with osteogenesis imperfecta revealed, in nine out of 15 stapes examined, an otospongiotic-like lesion. Although the morphology of the stapedial lesion was comparable to the early otosclerotic focus, a greater structural disorganization and larger resorption spaces in osteogenesis imperfecta distinguished the two conditions. The histopathology of the stapes was related to the morphology of cortical and trabecular bone from the iliac crest. Various degrees of immature, osteogenic bony tissue were found in the iliac crest, showing no resemblance to the otospongiotic-like focus in the footplate. Even though the histologic appearance of the stapes footplates differed from the findings in peripheral bone, the present study indicates that the stapedial lesion in osteogenesis imperfecta is most likely a manifestation of the generalized bone and connective tissue disorder. The study further supports the view that osteogenesis imperfecta and otosclerosis are of different aetiology.

The design and use of the levator scapulae flap is reviewed. Particular attention is paid to the blood flow. A description is given of how this flap may be employed to repair smaller defects of the mouth and pharynx. It is used in association with split skin. The use of such a technique is compared to musculo-cutaneous flaps, with particular reference to the skin blood flow.

Involvement of the temporal bone by eosinophilic granuloma is rare. Four cases are presented here and the pertinant literature is reviewed.

This disease must be kept in mind by the otolaryngologist because of the diagnostic and therapeutic problems that may arise.

Direct injection of methyl-prednisolone sodium succinate is suggested as a treatment of eosinophilic granuloma in the temporal bone.

A 36-year-old male with a primary chondroid is presented. This tumour arose from the base of the temporal bone and extended to the mastoid cavity. It involved the facial nerve and was adherent to the internal jugular vein and internal carotid artery. The tumour was excised and the patient has been carefully followed up for 10 years. He has shown no evidence of local recurrence, intracranial extension of the residual tumour and distant metastasis.

A 20-year-old man developed a malignant fibrous histiocytoma in the right maxilla 19 years after irradiation for bilateral retinoblastoma.

The incidence of second tumours in patients who survived bilateral retinoblastoma treated with radiation was 8.5 per cent. Malignant fibrous histiocytomas which arise in a site of prior radiation are fatal. The present case is presumed to have the autosomal dominant retinoblastoma gene, not associated with deletion of the q 14 band of chromosome 13. The patient succumbed to the second tumour.

Pain in the neck, radiating towards the ear, together with a foreign body sensation in the throat is a common complaint. A less common finding upon physical examination is an elongated styloid process, palpable in the tonsillar fossa and provoking the symptoms for which the patient is seeking medical advice. The diagnosis of this so-called Eagle's sundrome is described and the case history and treatment of four patients are presented.

Two cases of schwannoma originating in unusual sites in the head and neck are reported. To the best of our knowledge ours is the first case of schwannoma in the nasopharyngeal area to be described. Schwannomas in the parotid area must be kept in mind in the differential diagnosis of parotid tumours. The pertinent literature is reviewed.