We report an extremely rare variant of first branchial cleft anomaly.

A 15-year-old girl presented with a history of recurrent mucopurulent discharge from an opening in the left infra-auricular region, since birth. Computed tomography fistulography showed a tortuous tract measuring approximately 4.61 cm, extending anteroinferiorly and medially from the external inframeatal opening to the lateral nasopharyngeal wall (anterior to the fossa of Rosenmuller). The tract was connected to the deep lobe of the parotid gland and lay 0.67 cm anterior to the carotid artery and posterior to the medial pterygoid muscle.

This was an extremely rare variant of first branchial cleft fistula. To the best of our knowledge, this is the first case of its type to be reported. Computed tomography fistulography is the imaging modality of choice for the diagnosis of branchial cleft fistula, and will also assist surgical planning.

We report a case of lymphangioma circumscriptum of the tongue, a very rare site of occurrence, which was successfully managed with intralesional bleomycin therapy.

We present a case report and review of available literature regarding lymphangioma circumscriptum of the tongue and the role of bleomycin therapy.

The patient was a 19-year-old man with a long-standing lesion involving the tongue, who presented with spontaneous, episodic bleeding over the previous few months. A diagnosis of lymphangioma circumscriptum was established on biopsy. Intralesional bleomycin injection resulted in successful resolution, and the patient remained asymptomatic over more than one year's follow up.

Lymphangioma circumscriptum is usually seen in the extremities and genitals. This case had a very rare site of occurrence, the tongue, and was successfully managed with conservative treatment, using intralesional bleomycin alone.

We present a case of a patient who had undergone embolisation and resection of a left glomus jugulare tumour, who presented three weeks post-operatively with magnetic resonance venography confirmed symptomatic cerebral venous sinus thrombosis.

We present a case report and a review of the world literature concerning glomus jugulare tumours and cerebral venous sinus thrombosis.

A 42-year-old man presented with blurred vision and reduced Snellen visual acuity just three weeks after glomus jugulare tumour surgery. Fundoscopy revealed bilateral haemorrhagic optic disc oedema. Urgent magnetic resonance venography confirmed a left lateral venous sinus thrombosis. It was felt that this was responsible for inadequate cerebrospinal fluid drainage, resulting in raised intracranial pressure and papilloedema.

To the authors' knowledge, this is the first account of a magnetic resonance venography confirmed venous sinus thrombosis and secondary papilloedema following glomus jugulare tumour surgery. Patients undergoing surgery involving resection or manipulation of the internal jugular vein may be at higher risk of developing thrombosis superior to the level of resection, and magnetic resonance venography ought to be considered an important diagnostic adjunct.

Paediatric foreign bodies may present with vague and nonspecific symptoms. It is important to have a high index of suspicion when managing such cases.

We report the case of a nine-month-old infant who presented with a wheeze, cough and fever following ingestion of a needle.

This patient developed pericardial tamponade as a consequence of the needle ingestion, and required a thoracotomy for retrieval. We discuss the pathophysiology involved and the surgery required.

Pericardial tamponade is a rare but potentially fatal manifestation of an ingested foreign body.

The inhaled sharp foreign body is usually amenable to bronchoscopic extraction. When this fails, management poses a challenge. We present a logical approach to the inhaled pin inaccessible to the bronchoscope.

A 12-year-old girl presented to the accident and emergency unit after accidentally inhaling a pin. Multiple attempts with both rigid and flexible bronchoscopy failed to access the pin, which had lodged distally in the anteromedial basal segment of the left lung. Eventually, the pin was extracted at thoracotomy.

We discuss the reasons for extracting such pins, as opposed to leaving them in situ, and when to proceed from endoscopy to open surgery. Such knowledge is useful, not only to guide the multidisciplinary team in their combined approach to this unique challenge, but also to explain to the patient the rationale for the proposed treatment protocol.

To underline the importance of accurate clinical evaluation of major salivary gland obstructions, in order to choose the right surgical approach and to reduce the risk of complications.

We report a case of an unusual, previously unreported upper airway obstruction caused by massive swelling of the tongue following a successful sialoendoscopy, performed for treatment of submandibular sialolithiasis under general anaesthesia.

Sialoendoscopy has gained popularity and is an accepted method for diagnosis and treatment of most inflammatory conditions of the major salivary glands. It can be performed as an out-patient procedure under local anaesthesia, and is not usually associated with significant complications. However, in the presence of larger stones (>4 mm) of the submandibular gland, we suggest that interventional sialoendoscopy should be performed under general anaesthesia with optimal airway control, in order to manage the major risk of perforations and ductal lesions enabling spread of saline solution into the mouth tissues and causing life-threatening swelling of the floor of the mouth and tongue.

We report the rare case of an oesophageal foreign body which lodged above the site of oesophageal compression by a double aortic arch.

Case report and a review of the literature surrounding the classification, embryology, diagnosis and management of vascular rings and slings.

An eight-month-old male infant presented with symptoms of tracheal compression following ingestion of an oesophageal foreign body. Following removal of the oesophageal foreign body, the infant's symptoms improved initially. However, subsequent recurrence of respiratory symptoms lead to a repeat bronchoscopy and the diagnosis of a coexisting double aortic arch, causing tracheal and oesophageal compression.

To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.