A sterling silver tracheostomy tube broke in use resulting in the death of a child. The nature of the fracture in the brazed joint is described, and corrosion identified as the mechanism of degradation of the joint. The corrosion is due either to exposure to body fluids over a long period, or to the use of hypochlorite solutions for cleaning and disinfection. The silver braze used had inferior corrosion resistance. It is recommended that appropriate grades of silver brazing alloy be used in the future, and that the mechanical integrity of medical devices joined with silver braze be regularly checked to anticipate failure in use.

Since the introduction of antibiotics for the treatment of suppurative otitis media the incidence of complications from this disease has been greatly diminished. Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare. A case of Bezold's abscess is presented with special reference to the clinical presentation and pathogenesis of this now uncommon condition. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail. The difference between what is known today as a Bezold's abscess and the abscess that Bezold described in the early part of this century are presented.

Schwannoma, or neurilemmoma, is included in the differential diagnosis of masses in the parapharyngeal space. Schwannomata do not usually cause acute inflammation, and therefore do not tend to present as emergencies as in this case, in which there was acute respiratory embarrassment

A case of neurapraxia of the infraorbital nerve occurring as a result of maxillary sinus barotrauma in a diver is presented. Existing reports of a similar nature are reviewed and the pathogenesis of cranial nerve involvement in barotrauma is discussed. Guidelines for treatment are suggested.

One of the well known complications of radical neck dissection is a chylous fistula, which results from injury to the thoracic duct as it enters the left subclavian vein. Such fistulae may cause considerable increased morbidity to a patient who is already debilitated by malignancy and by the increased catabolic response to surgery. Further surgery may be appropriate for those with a high fistula output but conservative therapy is normally advocated for the remainder. Nutritional and electrolyte support for these patients is essential and poses potential problems in management.

We present three such patients. One was fed parenterally and two enterally and in all cases the fistulae closed spontaneously. We examine the known physiological stimuli to chyle production and conclude that the enteral feedings of these patients with fat or an isomolar enteral feed does not, contrary to current belief, increase chyle flow or delay the healing of these fistulae.

Haemophilus influenzae is a common cause of epiglottitis and meningitis in children and exacerbation of chronic bronchitis in adults. However, the ability of this organism to cause serious infections in adults is less well recognized. We report a case of a 34-year-old previously healthy female who presented with epiglottitis and later developed bilateral empyema; both blood and pleural fluid grew Haemophilus influenzae.

A case of Pasteurella multocida meningitis, following a mastoidectomy is presented. The association of close contact with pets, many of which harbour Pasteurella multocida as part of their normal buccal flora. This case confirms the potential benefit of taking an ear swab prior to mastoid surgery and in seeking an appropriate ‘pet’ history.

Analysis of 3,445 cases of cancer of the larynx witha follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.

Acanthoma fissuratum secondary to the use of spectacles is a rare clinical finding associated with an ill-fitting frame. An interesting case is presented to highlight such a problem. Surgical excision of such lesions is recommended with advice to the patient regarding the suitable fitting of spectacles.

A case of orf affecting the pinna is discussed. This is an unusual presentation of aninfection that is common in farming communities.

At the initial presentation the diagnosis was not suspected, the management therefore was inappropriate and probably gave rise to the secondary infection that ensued. The history described is classical.

Orf affecting the external auditory canal has been reported once, but orf affecting the pinna has not been described before.

Intraeordal Teflon injection is commonly performed for recurrent laryngeal nerve palsy. It is generally agreed that injection should not be performed for a period of six months from the onset of an ‘idiopathic’ paralysis. A case is presented in which recovery occurred late, after intraeordal injection, with unfortunate results. Successful removal of the Teflon is described. The advisability of a longer wait before surgery for ‘idiopathic’ recurrent laryngeal nerve palsy is considered.

Intralabyrinthine schwannomas are rare tumours which present with symptomssimilar to Meniere's disease. Preoperative diagnosis is rarely possible and most are foundincidentally during labyrinthectomy for persistent vertigo. A further case of this tumouris reported together with a review of the literature.

From 1974 to 1990, 31 patients underwent emergency laryngectomy for airway obstruction due to laryngeal carcinoma, in aneffort to avoid the complication of stomal recurrence. This group of patients had a greater proportion of multiregional tumours (35 per cent vs 13 per cent) than a comparison group of elective laryngectomies. In other respects the two groups were similar.

Early post-operative mortality (6.5 per cent vs 3 per cent), stomal recurrence rates (4.2 per cent vs 4.8 per cent) and survival (53 per cent vs 55 per cent) were not significantly different between the emergency laryngectomy group and the comparison group undergoing elective laryngectomy.

A 69-year-old female patient presented with symptoms characteristic of globus pharyngeus and barium swallow examination was normal. Her symptoms persisted and pharyngoscopy was undertaken; a post-cricoid polyp was found and removed. Histological examination revealed this to be a lymphangioma. Histological appearances, pathogenesis and treatment are discussed. The case illustrates that persisting symptoms presenting as globus pharyngeus should be further investigated to exclude rare lesions.

A rare middle ear tumour is reported. The clinical presentation was similar to that of a glomus tumour but the pathology that of an aggressive papillary middle ear tumour. This is a recently recognized subgroup of middle ear glandular tumours. Clinical findings, imaging, pathology and treatment are presented.

The administration of antibiotics in otitis media alters the natural course of the disease process. If the antibiotics used are inappropriate, or if dosage or duration of treatment is inadequate, an imminent intracranial complication may be masked.

A case of latent mastoiditis presenting with Pott's puffy tumour is described.

Immunohistochemical study of major salivary gland tumours was performed on 60 pleomorphic adenomas, five basal cell adenomas and 10 adenoid cystic carcinomas to determine the diagnostic value of each antigen. Immunoreactivity examined were intermediate filaments (keratin, vimentin, desmin and glial fibrillary acidic protein [GFAP]) and related substances (actin, S-100 protein and secretory component). In pleomorphic adenomas, there was positive immunoreactivity for GFAP which was not observed in normal tissue or other neoplastic tissues. Immunoreactivity of GFAP was closely related to myxomatous and early chondromatous differentiation in pleomorphic adenoma. It is considered that GFAP immunoreactivity should be assessed in the occasional differential diagnostic dilemma of pleomorphic adenoma versus adenoid cystic carcinoma and basal cell adenoma, because of its ability to show potential and definite myxochondromatous differentiation.

The close union achieved between pure grade titanium and healthy bone makes dislocation a rare event. We report the case of the total avulsion of an apparently well-integrated implant from a healthy mastoid bone.

Fibrous dysplasia is a benign localized bone disorder of unknown aetiologyin which endocrinopathies, abnormal pigmentation of the skin and mucous membranes may formpart of the disease. Five cases involving the facial and cranial bones are described to illustrate the various presentations and radiological appearances including computerized tomography and magnetic resonance imaging. Some of these cases demonstrate that serial radiology may be adequate for diagnosis and management without the necessity for histological confirmation. The place of limited surgical treatment for the craniofacial sites is debated.