Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

Penetrating injuries of the paranasal sinuses due to foreign bodies are rare, especially as a result of a traffic accident. Here we report a patient with a ballpoint pen lodged in his left eye following a traffic accident. The pen extended from the medial aspect of the left orbit, through the left ethmoid sinus and the nasal septum, to the right sphenoid sinus. We removed the pen uneventfully using endoscopic sinus surgery. There are no similar reports in the English literature and we therefore present this case because of its rarity.

Penetrating injury to the larynx is uncommon. We present two cases resulting from the recent Bosnian conflict. It is possible to achieve good laryngeal function by appropriate conservative management once the airway is secured. Progress should be monitored by repeated endoscopic examination and imaging techniques.

A 10-year-old schoolboy presented with a penetrating wound to the neck after a children's slide accident. A CT scan and endoscopy showed a traumatic oesophageal-cutaneous fistula. Neurologically the child deteriorated over a period of 34 hours and finally succumbed to a respiratory arrest.

Post-mortem findings showed a hypoplastic right vertebral artery. In the left suboccipital triangle a venous clot had blocked the dominant artery thus leading to cerebellar and brainstem infarction.

This extraluminal compression leading to obstruction of an otherwise non traumatized vertebral artery is unique in the literature.