Recanalization of the lateral sinus thrombosis is an expected outcome in patients who respond to treatment. We report a case of persistent lateral sinus thrombosis many years after treatment for peri-sinus infection.

Somatostatins are neuropeptides that have a downregulatory effect on various physiological processes. Their use in the management of certain endocrine tumours is well recognized. Their use in thyroid cancer is not established, although there is some evidence to suggest that they have a role in advanced metastatic disease. We report a case of a patient with advanced metastatic follicular thyroid cancer which demonstrated strong octreotide uptake with reduced avidity for I131. Treatment with the somatostatin analogue octreotide, however, failed to achieve a significant response. We feel this case is important as it suggests that although octreotide provides a useful further imaging modality in differentiated thyroid cancer, it has no therapeutic role.

Hyalinizing clear cell carcinoma (HCCC) of the salivary gland is new disease only recognized in recent years. It is rare and the standard treatment is still under investigation. This is a report of a 42-year-old female with HCCC who presented with a painless submucosal hard palatal mass of three years duration. Wide excision of the tumour and the underlying palatal and maxillary bones was performed. Pathological examination revealed typical clear cells arranged in anastomosing trabeculae, cords, nests, or solid sheets with a hyalinizing stroma. These clear cells were positive for the periodic acid-Schiff (PAS) reaction but were negative for the mucin stain. Immunohistochemically, these neoplastic cells were positive for cytokeratin, but negative for actin. No recurrence nor distant metastasis was found during the eight-month follow-up period.

Narghile (water-pipe) smoking requires the generation of significant negative intrapharyngeal pressure, which may be transmitted to the middle ear through the Eustachian tube. A total of 80 ears from regular narghile smokers were examined otoscopically and by tympanometry. Seventy ears from heavy cigarette smokers were similarly examined and served as a control group. There was a highly significant increase in the prevalence of atticretractions (P < 0.01) in the narghile smokers. The tympanometric changes were not significantly different between the two groups (P > 0.05).

Tracheal abnormalities are extremely rare and can occur as a single congenital anomaly, as part of a wider spectrum of abnormalities [such as the syndrome of vertebral defects, anal atresia, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal defects (VATER), and the syndrome of vertebral defects, anal atresia, cardiovascular defects, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal and limb defects (VACTERL)] or in tracheomalacia. Congenital complete and near-complete tracheal rings are the more common morphological abnormalities that occur.

A case of a long segment of bow-shaped, as opposed to horseshoe-shaped, tracheal rings is presented, along with a review of tracheal anatomy and embryology. This abnormality presented when, during repeated attempts at endotracheal intubation, the anaesthetist was consistently unable to ventilate the patient, whereas they were able to do so with a facemask. Bronchoscopy showed the posterior tracheal wall prolapsing into the airway, and radiology demonstrated this to be due to wide tracheal rings without any intrathoracic abnormality.

The laryngeal mask airway is a widely used, non-invasive, general purpose airway. We report the case of a temporary vocal cord palsy following the use of such an airway. The development of inappropriately high cuff pressures secondary to nitrous oxide diffusion into the cuff is proposed as the most likely cause. Knowledge of the existence of nerve injuries complicating laryngeal mask use is particularly important when counselling certain patients. Mandatory intraoperative cuff pressure monitoring should lower the risk of subsequent voice problems.

Glomus tumours of the skull base are rare, and most frequently present with symptoms of hearing loss and tinnitus. Diagnosis is often delayed due to the slow growth of the tumour. We describe the previously unreported occurrence of a glomus tumour presenting with a unilateral accessory nerve palsy.

Spontaneous enophthalmos unrelated to trauma or surgery is rare. The term ‘silent sinus syndrome’ has been used to describe this process where, in particular,there is an absence of any sino-nasal symptoms. The enophthalmos and hypoglobus that occurs inthese subjects is caused by atelectasis of the maxillary antrum, which itself appears to be due to chronic maxillary hypoventilation. We report a case of silent sinus syndrome that arose following insertion of a nasogastric tube. Whilst acute paranasal sinusitis is a well-described sequela of nasal intubation, this association with a rare, and as yet unexplained, phenomenon may go some way to explain its aetiology.

Life-threatening conditions following dental infections have been rare since antibiotics were introduced into the world of medicine. However, infections spreading through the soft tissues of the head and neck are encountered occasionally and mortality is still reported as a result of sepsis or airway embarrassment. A case of Ludwig’s angina from odontogenic infection that progressed into mediastinitis and pericarditis is presented. The steps adopted in the management of this case highlight the significance of early recognition and diagnosis of the source of deep cervical infections, the importance of securing the airway, effecting surgical drainage and aggressive intravenous antibiotic therapy.

Retropharyngeal space swelling is a rare occurrence following minor head and neck trauma. Upper airway obstruction is a potentially life-threatening sequela. The authors present a case of retropharyngeal space haematoma following minor blunt head and neck trauma. Management was conservative with gradual spontaneous resolution of the haematoma. The literature is reviewed and the management and treatment principles presented.

Pyomyositis (PM) is an uncommon cause of acute bacterial infection occurring in skeletal muscle. This disease is rare in non-tropical areas, and PM caused by Mycobacterium is very rare in a non-immunocompromised person. The presence of temporal area swelling may lead to a differential diagnosis toward more common pathologies, such as a complication of mastoiditis or a neoplasm of the temporal area. This article describes a case of tuberculous pyomyositis in a non-immunocompromised woman, the diagnosis of which was confirmed by sonographically guided fine-needle aspiration.

Aneurysms of the extracranial portion of the internal carotid artery are rare, particularly in young patients. They usually develop following trauma, or secondary to infection involving the parapharyngeal space that extends to the vessel wall. This is a case of an internal carotid artery aneurysm presenting acutely following chiropractic neck manipulation with hypoglossal and glossopharyngeal nerve palsy. The imaging findings and subsequent operative management are described.

The authors report a case of acute vagus nerve paralysis that appeared during a course of chemotherapy. The drugs had been administered through a totally implantable venous access device (TIVAD), whose catheter tip had migrated into the right internal jugular vein (IJV) and was surrounded by a complete venous thrombosis. The supposed aetiology of this paralysis was a leakage of the cytotoxic drug (5-fluorouracil) from the vessel wall into the surrounding carotid space, because of the stagnation of the chemotherapeutic agent above the thrombosis. Four months after cessation of chemotherapy, the laryngeal paralysis was still evident.

A 77-year-old euthyroid man developed atrial fibrillation on the fourth post-operative day following a total laryngectomy and right radical neck dissection including a hemi-thyroidectomy for a squamous cell carcinoma of the larynx with nodal metastases. The episode of atrial fibrillation coincided with an elevated serum free thyroxine of 3.36 ng/dl (43.3 pmol/L) (reference values: 0.71–1.85 ng/dl or 9.1–23.8 pmol/L), normal total triiodothyronine of 104 ng/dl (1.6 nmol/L) (reference values: 46–137 ng/dl or 0.7–2.1 nmol/L) and a suppressed thyroid-stimulating hormone (TSH) of 0.05 mIU/L (reference values: 0.35–5.0 mIU/L). These values, in relation to those prior and subsequent, suggested a surgery-induced thyroiditis. The limited literature about this controversial entity is reviewed.

A case is presented where a left jugulotympanic paraganglioma (JTP) extended to the nasopharynx and the patient presented with recurrent epistaxis. Although initial biopsy of an aural polyp had been suggestive of the diagnosis several years previously, the diagnosis was not confirmed until the patient presented with recurrent epistaxis and severe anaemia. Tothe best of our knowledge, this is the first case reported of such a presentation of JTP.

Patients diagnosed with malignancy often undergo combined positron emissiontomography (PET) and computerized tomography (CT) to investigate possible metastases. This report presents a case in which, in the investigation of suspected pulmonary malignancy, combined PET and CT images suggested a malignant lesion at the level of the vocal fold. Biopsy of the lesion, however, confirmed the clinical diagnosis of a Teflon granuloma. The case highlights the potential for a false positive report during scanning of patients who have had vocal fold injection.

A case of lobular capillary haemangioma of the trachea is presented. The patient gave a history of foreign body sensation in the throat and multiple episodes of haemoptysis. The chest X-ray was normal. A spiral computed tomograph (CT) with three-dimensional reconstruction revealed a small tracheal mass in the antero-lateral wall of the trachea, which was excised by endoscopy. The histopathological diagnosis was lobular capillary haemangioma, a rare, benign tumour of the trachea. A high index of suspicion with the spiral CT finding was responsible for early diagnosis of the tumour.

We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.

Primitive neuroectodermal tumour/extraskeletal Ewing’s sarcoma (PNET/EES) is a rare disease of the head and neck region. We report a case of a 74-year-old man with a laryngeal Ewing’s sarcoma. This is the first reported case of extraskeletal Ewing’s sarcoma of the larynx in an elderly male patient. The patient was successfully treated with surgical resection and post-operative radiotherapy.

Several internal auditory canal (IAC) anomalies have been reported. To our knowledge, only one case with an abnormal direction of the IAC has been reported in an infant with Pierre Robin syndrome. In this paper, we present the first report of two non-syndromic cases with abnormal IAC direction.