Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Nasal sarcoidosis commonly affects the mucosa of the septum and the inferior turbinates. These patients may present with nasal discharge, crusting, obstruction, epistaxis or anosmia. We present an unusual case of nasal sarcoidosis involving the ethmoid sinus causing recurrent eyelid swelling and discuss its management.

We describe two cases where it was necessary to remove teeth to biopsy the larynx for malignant disease. Immediate reimplantation of the teeth proved successful.

A burning sensation in the throat is often complained of by patients, but this symptom has been neglected in the literature. To emphasize its importance, should we give the name ‘caloripharyngeus’ to the symptom of burning in the throat? A preliminary study of 30 patients with the sensation of burning in the throat is presented in this study. Of the patients studied 73.33 per cent had hyperacidity detected for the first time. Reflux was presented in only one patient; four patients showed oesophagitis in the lower one-third of the oeosphagus; 90 per cent of the patients responded to antacids. We suggest that one of the causes of burning in the throat is a referred sensation due to hyperacidity.

We present a previously undescribed site of a subperichondrial haematoma – the alar cartilage. Two children presenting acutely, following trauma, with the clinical appearance of a ‘blueberry’ within the nasal vestibule are described. We recommend early surgical drainage of this lesion, as delay in definitive treatment may give rise to a cosmetic deformity.

Congenital first branchial cleft fistulae, their embryology, anomalies, varied relationships to the facial nerve and surgical techniques for their excision have been well described in the literature. We report a case of a type II first cleft fistula in a three-year-old child which required a modification of the standard surgical approach to achieve safe and complete excision with identification and preservation of the facial nerve.

Sudden unilateral visual loss in children is usually caused by a complication of acute purulent sinusitis. Differential diagnosis must include malignant tumours of the orbit or the paranasal sinuses involving the optic nerve. Rapid and adequate diagnostic measures are required in this emergency situation. In comparison, acute or progressive bilateral blindness is a very rare disorder.

We report two cases of bilateral visual loss caused by malignant tumours and diagnostic and therapeutic strategies are described. Our reports show that these life-threatening disorders and their severe complications can be managed successfully if well-coordinated interdisciplinary cooperation is conducted from the beginning. If surgery is performed in this vulnerable region, it may be facilitated by computer-aided modelling techniques. During the last decade the prognosis for rhabdomyosarcoma and malignant lymphoma, the most frequent mesenchymal tumours of childhood, has improved dramatically. Thus, any loss of time causing a delay in correct diagnosis and the onset of adequate therapy must be avoided. Intensive cooperation with paediatric oncologists has to be enlisted from the beginning to avoid unnecessary, repetitive, invasive, or imaging diagnostics and to accelerate the onset of specific therapy.

A case of Coffin-Lowry syndrome is described. The child had the typical face and also soft and puffy hands with tapering fingers. His psychomotor development was retarded. Audiological tests revealed profound hearing impairment. Anomalous labyrinths were shown by CT scan of the temporal bones. It is inferred that deafness is one of the symptoms of this syndrome.

A case of hepatocellular carincoma with a solitary metastasis in the sphenoid sinus is described. The extreme rarity of the tumour and the problems of early diagnosis are underlined. The importance of endoscopic examination as a diagnostic procedure is emphasized.

Two cases of lateral sinus thrombosis in fit adults with no previous otological history are presented. One case occurred in association with Bezold's abscess and followed mastoiditis which was masked by previous antibiotic treatment. The other case occurred in association with an occipitoparietal scalp abscess and there was no obvious preceding middle ear infection. The causative bacteria were Streptococcus milleri and a variant Steptococcus intermedius. Lateral sinus thrombosis is discussed.

A patient with a slowly progressive mitochondrial myopathy is presented. Mitochondrial myopathies are a diverse group of disorders both clinically and at the cellular level. In common with other neuromuscular disorders, bulbar symptoms may occur. However, though pharyngeal symptoms have been documented in all forms of the disorder, no previous account has described problems at the laryngeal level. We discuss the clinical findings and comment on the therapeutic options.

A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfuctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.

Regional otolaryngological societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit subcommittee of the Scottish Otolaryngological Society over the last few years is reviewed and a description is given of the findings of an audit of the management of laryngeal cancer in Scotland. The data collection infrastructure currently employed is described and emphasis is placed on the importance of ‘ownership’ of audit by those participating.

An aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.

Internal jugular venous rupture after head and neck surgery is a rare but important condition to recognize. The Toronto General Hospital experience of this condition, together with its identification and management is reported.

Jugular vein rupture should be considered in patients undergoing primary tumour excision with modified or functional neck dissection complicated by a pharyngo-cutaneous fistula. Typically, bleeding is venous and occurs repeatedly. However, haemorrhage may be substantial and life-threatening. Treatment requires exploration and ligation of the venous system. The carotid artery should be assessed and protected at surgery, since there is a likelihood of a carotid blowout as the conditions have a common aetiology. It is important to distinguish jugular vein haemorrhage from carotid arterial rupture, since the former has a far better outcome if treated properly.

Recurrent lower motor neurone facial paralysis in successive pregnancies is a rare phenomenon of which there are few case reports in the literature. There have been two previous reports of recurrent Bell's palsy in two and three successive pregnancies respectively, but it is felt that these should have more appropriately been reported as recurrent lower motor neurone facial paralysis in pregnancy as, by definition, any facial paralysis that recurs should not be classified as Bell's palsy even though Bell himself commented on the association between facial paralysis and pregnancy. We report the first case of recurrent lower motor neurone facial paralysis in four successive pregnancies and review the literature.

This short communication describes the use of the Carden anaesthetic tube during surgery in and around a tracheostome. The technique, which greatly facilitates access to the operating field, is described along with it's indications and contraindications.

We would like to recommend extending the use of the Carden tube to operations around a tracheostome, thereby maximizing surgical access.

A child presenting with fever, unilateral nasal discharge and sinusitis was found to have an alkaline disk button battery in the right nostril causing severe mucosal damage and septal perforation. "Nje case is presented and mechanisms of injury discussed.

The current gold standard for diagnosing vestibular schwannomas is MRI with gadolinium-DTPA enhancement. This imaging modality is particularly useful in the detection of small intracanalicular tumours which can be missed by CT scanning. We present a case where MRI with enhancement suggested the presence of a 4 mm intracanalicular vestibular schwannoma. Surgical exploration of the internal auditory canal via a retrosigmoid approach, revealed no tumour, but inflammatory arachnoid matter around the vestibular nerve was found. A review of the audiological test results uncovered some results which did not correlate with the interpretation of the MRI scan. We would therefore caution against immediate surgical intervention in patients where the diagnosis of a small intracanalicular vestibular schwannoma is not totally supported by the audiological findings. In such cases rescanning with gadolinium enhancement after a suitable interval is recommended.

Abstract: A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise.

Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

The protean manifestations of child abuse continue to cause diagnostic difficulty. Recent observations of the high mortality in victims of Munchausen syndrome by proxy, and their siblings, reinforce the need for early diagnosis and appropriate intervention. We report the nasal manifestations which unmasked Munchausen syndrome by proxy in an infant who presented with intestinal and peri-orifical signs masquerading as Crohn's disease. The possibility of Munchausen syndrome by proxy should be considered in an infant with persistent nasal excoriation presenting as part of an undiagnosed illness.