We present a case of diabetes insipidus in a young man caused by Langerhan's cell histiocytosis of the sphenoid sinus with involvement of the pituitary gland. Diagnosis and management of this rare condition is discussed, along with a brief view of the literature.

An extremely rare case of intravagal parathyroid adenoma is presented. The tumour caused fusiform swelling of the left vagus nerve was shelled out. Post-operatively the left recurrent nerve palsy was recovered in the two months. Serum calcium level returned to normal on the tenth day after the surgical operation without symptoms of hypocalcaemia.

An unusual case of a patient presenting with left sided pulsatile tinnitus is presented. This was later shown to be due to a dural arteriovenous malformation involving the lateral venous sinus. The diagnosis was suspected by the presence of a bruit over the mastoid process and confirmed by a CT scan and angiography. Management involved pre-operative embolisation and neurosurgical excision. The differential diagnosis of pulsatile tinnitus and the management of a dural arterio venous malformation is discussed.

Warthin's tumour arising from minor salivary glands of the nasopharynx is described in a patient with eosinophilic rhinitis and nasal polyposis. The microscopical features of this lesion were indistinguishable from those of Warthin's tumours of the parotid gland. The present case supports the histogenetic theory that the epithelial component of extraparotid Warthin's tumours represents reactive oncocytic metaplasia and hyperplasia induced by chronic inflammation rather than genuine neoplasia. It is suggested that the term Warthin's tumour is preferable to designations indicating neoplasia of these extraparotid lesions which are indistinguishable histologically and ultrastructurally from parotid and juxtaparotid adenolymphomas.

Multiple carcinoma of the upper aerodigestive tract is an increasingly recognized problem, and a concept of ‘field cancerization’ has been proposed to explain this phenomena. The initial assessment of a patient with an isolated aerodigestive carcinoma must be extensive so as not to miss any synchronous lesions, and may include radiography and endoscopy. Treatment cannot be standardised but must be tailored to suit individual problems and because of the high incidence of metachronous tumours, follow-up must be both thorough and ‘lifelong’.

A case of three primary synchronous squamous carcinomas of the upper aerodigestive tract is presented. The relevant literature is reviewed.

Pedunculated squamous papillomas usually arise from the soft palate, tonsil or the epiglottis. These lesions can sometimes prove to be fatal. A case of peduculated squamous papilloma, arising from the laryngopharynx, in a young, mentally retarded female, is presented here. The clinical presentation, the site of origin and the size of the lesion were quite unusual. The narrow base of the pedicle made the intra-oral excision possible.

Three cases of left recurrent laryngeal nerve palsy following heart-lung transplantation are described. In each case, within twelve hours of extubation, the left vocal cord was injected with Teflon, and the paralyzed vocal cord thus displaced to the midline. Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration. Augmentation under general anaesthesia as soon as possible after discovery of vocal cord dysfunction is advocated. Suitable materials for injection are discussed. To our knowledge, this is the first reported series of vocal cord augmentation in the acute phase following heart-lung transplantation.

The thick oily and pigmented skin present in majority of tropical patients makes rhinoplasty challenging surgery. Rhinoplasty by the external approach though gaining increasing acceptance all over the world is yet to gain popularity in this country. Hypertrophied scars are not uncommon in coloured skin and the reluctance to give an external incision for a cosmetic procedure is natural. We started the external rhinoplasty approach with some reservations, however in a series of over seventy cases, no significant problem has been encountered, with the columellar scar. Accurate approximation of the columellar wound is probably a more important factor in wound healing than the skin colour. Our experience of external rhinoplasty is presented.

A case of a glial teratoma occurring in the tongue of a twelve week old male child is presented. This lesion was thought clinically to be a lingual thyroid. Histopathological examination revealed the true nature of the lesion. The mother had noticed the lesion since birth but only sought medical attention when the child developed difficulty in breathing.

Teratomas in the head and neck region are uncommon and are commonly diagnosed wrongly as lingual thyroid. These lesions are usually benign.

A case is presented of a 3-year-old girl with no previous history of ear disease or developmental defects who bled profusely upon (right) myringotomy. The haemorrhage could only be stopped with the aid of an ear insert and a nasopharyngeal balloon catheter. The balloon catheter was removed the following day but the girl had to use an ear insert for a total of 76 days following myringotomy because of repeated haemorrhage from the ear. The subsequent investigation using CT and angiography revealed an aberrant internal carotid artery in the middle ear.

It is concluded that the one most important factor in the handling of these cases is to be aware of the existence of aberrant internal carotid arteries and to have a high degree of suspicion when encountering any abnormal clinical or radiological findings which might point in the direction of vascular abnormalities. The failure to detect this condition before any surgical intervention on the affected ear can have disastrous consequences.

The method of choice in handling these cases is one of avoidance of middle ear manipulation in order not to cause haemorrhage from the aberrant artery.

Malignant Fibrous Histiocytomas (MFH) are uncommon in the head and neck and extremely rare in the nasopharynx. We report a case of MFH arising in the nasopharynx and describe its diagnosis and management. The literature is reviewed and the likely origins of the tumour and its behaviour are discussed.

Septic arthritis of the temporomandibular joint is an uncommon condition. As a complication of otitis externa it is extremely rare. Two cases are reported and the aetiology, diagnosis and management discussed.

Carcinoid tumours belong to the rarer neoplasms of the middle ear. In 1980, Murphy et al. described the first case of a carcinoid tumour of the middle ear. Only five cases could be traced in the literature. The light and electron microscope features of a primary atypical carcinoid tumour of the middle ear are presented and compared with those described in the literature. Primary carcinoid of the middle ear appears to be derived from the epithelial lining of the middle ear. Distant metastases have not been reported. The duration and nature of the symptoms are of little diagnostic value. An atypical carcinoid tumour in the left ear of a 33-year-old woman is described.

An unusual case of symptomatic enlargement of the hyoid bone is reported. The patient's main complaint was of pain on swallowing and opening of the jaw.

Partial excision of the greater cornu of the hyoid on each side, resulted in a complete remission of the symptoms.

Total or segmental agenesis of the internal carotid artery is a rare anomaly. The cervical portion of the internal carotid artery was absent in the right side of the patient who was carried out radical surgery due to recurrent oropharyngeal cancer. Post-operative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Otolaryngologist-Head and Neck surgeon should know such a vascular anomaly and avoid a disastrous result on dividing external carotid artery.

Malignant melanoma of the larynx is a rare tumour. Only 31 cases of primary laryngeal melanoma have been reported in the literature. Cady et al., (1968) found only four cases in a group of 2,500 cases of laryngeal cancer seen over a 25-year period.

A case of primary malignant melanoma of the larynx is presented along with a review of the literature. Problems associated with histological diagnosis are discussed. This patient was regarded as a poor risk for laryngectomy and appears to have control of local disease following application of Carbon dioxide laser.

Thrombosis of the internal carotid artery is a rare complication of soft palate injury, only 16 cases having been previously documented. We present the case of a 51/2 year-old-boy who sustained an apparently trival laceration to the right aspect of the soft palate. However, 48 hours after injury, a right cerebral infarct occurred with subsequent left hemiparesis. On supportive and rehabilitative management he made a good recovery over a period of one year.

The youngest patient reported to date with granular cell tumour of the larynx is presented, with a review of other reported cases in childhood. The basis of histological diagnosis of granular cell tumour is described.

A case of laryngeal chondrosarcoma in a 63-year-old woman is presented. The report illustrates most of the features of this rare neoplasm, the difficulties in the histopathological evaluation and supports the previous ones that recommend an initial conservative attitude towards low grade laryngeal chondrosarcomas.