Osteoradionecrosis of the hyoid has been reported rarely in the worldwide literature. We present the case of a 56-year-old gentleman who presented with intractable neck pain, following surgery and radiotherapy for a T2N2cM0 tongue base carcinoma, to highlight the need to consider osteoradionecrosis of the hyoid rather than recurrence of the carcinoma as the cause of such symptoms. The previously unreported appearance of osteoradionecrosis of the hyoid on a magnetic resonance image (MRI) scan and the use ofthis investigation to aid diagnosis is discussed.

It is rare for a parotid gland tumour to arise bilaterally, the most common example being Warthin’s tumour. Furthermore, it is rare for a parotid gland cancer to occur bilaterally. Here, we describe a case of synchronous bilateral mucoepidermoid carcinoma arising in the parotid gland. A case of bilateral facial nerve dysfunction is presented in which aggressive surgery failed to save the life of a 48-year-old man. This is the first such case reported in the available English literature.

Teratomas affecting the head and neck are rare tumours of ambiguous origin. The benign form is seen in children and mostly affects the nasopharynx. Malignant tumours in the upper jaw have been reported rarely. They are almost exclusively seen in the adult male. They are highly aggressive tumours that are difficult to diagnose pre-operatively due to the varied histological patterns. Treatment options available are surgery, radiotherapy or a combination of both. Despite intensive treatment, the prognosis is still poor. A rare case of teratocarcinosarcoma of the nose, paranasal sinuses and nasopharynx in a 25-year-old male is presented. The tumour had a non-germ cell tumour origin. The clinical features, pathologic characteristics and treatment are detailed. It was managed by surgery, radiotherapy and chemotherapy.

Facial nerve paralysis associated with a parotid gland tumour classically denotes malignancy. Only a few case reports have indicated benign parotid tumours as a cause of facial nerve palsy. We present a new case of facial nerve paralysis secondary to Warthin’s tumour of the parotid gland. It is important for clinicians to be aware that, on rare occasions, facial nerve dysfunction may result from benign parotid disease.

Paragangliomas are uncommon and those arising from the vagal trunk are rarer. Pigmented extra-adrenal paragangliomas are still rarer and reported sites of occurrence are the uterus, spine, retroperitoneum, bladder, mediastinum and orbit. The presence of abundant pigment in a cervical paraganglion has not been reported previously. We report one such unusual case of pigmented vagal paraganglioma that arose from the vagal trunk below the nodose ganglion, had massive central necrosis and showed hypovascularity on angiography. The unusual features and difficulties in the diagnosis of such cases are discussed.