Neurological complications following turbinate surgery are relatively rare. We present here an unusual complication of unilateral partial oculomotor and trigeminal nerve palsy after bilateral inferior turbinectomies. The probable aetiological mechanism is discussed.

Two cases of laryngeal smooth muscle tumours are reported: one a benign leiomyoma, the other a malignant leiomyosarcoma. These tumours may present diagnostic difficulties and immunocytochemistry is helpful in distinguishing smooth muscle tumours from other connective tissue neoplasms and spindle cell squamous carcinoma. Primary treatment in both cases should be surgical resection with small (T1, T2) malignant tumours suitable for partial laryngectomy. Postoperative radiotherapy may have a role in allowing a more limited surgical resection.

Pseudoaneurysms of the extracranial carotid arteries are rarely seen following irradiation for cancers of the head and neck. We present a patient with a pseudoaneurysm of the common carotid artery following a radical neck dissection and irradiation for thyroid carcinoma 20 years earlier. Following oesophagoscopical examination, a pseudoaneurysm of the right common carotid artery ruptured into the piriform sinus. The common carotid artery was embolized with multiple coils and the bleeding was halted. The relationship between the carotid artery aneurysm and irradiation, and the treatment of carotid artery aneurysm, is discussed.

Recurrent pleomorphic adenoma of the parotid usually occurs in the distribution of the primary procedure. There are numerous reports of widespread local recurrence and a few reported cases of distant metastases. Extensive seeding throughout the entire ipsilateral neck is rare. Treatment involves a combination of radical surgery and radiotherapy. The potential for malignant transformation demands close follow-up of younger patients particularly.

Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of the trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patient's symptoms and physical signs do not necessarily correlate with the severity of the injury as this case report highlights. X-rays, CT scans, barium swallows and endoscopies are recommended for evaluation of such injuries. However, direct laryngoscopy and fibre optic bronchoscopy are the most accurate.

Although a thyroglossal duct cyst (TDC) is a common cyst occurring in the neck, carcinomas arising in the TDC are a rare event. To date, approximately 100 cases have been reported, the majority of them being papillary carcinomas. Squamous cell carcinomas (SCC) are very rare, and Only nine cases have been reported so far in the literature.

We present a 55-year-old female patient with a SCC in a TDC to highlight the clinical and pathological features of this condition.

Occult papillary thyroid carcinoma is generally associated with an excellent prognosis. Distant metastasis of this tumour is extremely rare. A case of occult papillary thyroid carcinoma with metastases to the lungs, cervical lymph nodes, skeleton, and the brain is reported. The tumour expressed itself in extremely aggressive clinical behaviour and responded only partially to aggressive therapy. The controversial methods of treatment for occult papillary thyroid carcinoma are also discussed.

Microcystic adnexal carcinoma (MAC) is known as an infiltrating but non-metastasizing tumour of the skin, that derives from sweat glands or follicular epithelium. We report on a rare case of MAC of the tongue. The patient had noticed the tumour for two years with slowly increasing dysphagia but no other symptoms of an oropharynx carcinoma. Histological and immunohistochemical analyses showed a similarity between the tumour derived from Ebner's glands of the tongue and MAC of the sweat glands.

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly. in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

We present a case of an 82-year-old lady with recurrent swelling and a history of intermittent stridor who subsequetly developed a contusion over her lower neck and upper chest. The patient collapsed on her way to have to have a CT scan and died 24 hours later of a leaking aortic aneurysen. At initial presentation the complete resolution of poorly localizing symptoms and signs almost allowed her discharge from hospital.

We present the case of a 47-year-old woman with left otalgia, rotatory vertigo, sensorineural hearing loss and acute facial nerve palsy. An enhanced magnetic resonance imaging (MRI) scan showed discrete enhancement of the facial and vestibulocochlear nerves in the left internal auditory canal as well as of the labyrinth. This appearance was compatible with that in Ramsay Hunt syndrome and acyclovir was started prior to the appearance of any vesicular eruption. The diagnosis was subsequently confirmed serologically. She regained full facial function but the sensorineural hearing loss persisted. The literature pertaining to the role of the MRI in acute facial palsies is reviewed.

The differentiation of a peritonsillar abscess from peritonsillar cellulitis, although difficult on physical examination, is required in order to determine the appropriate treatment. Peritonsillar cellulitis can be treated with antibiotics alone, while a peritonsillar abscess should be drained. Computed tomography (CT) of the neck is often performed to identify the formation of a deep abscess in the neck, but is rarely used to diagnose peritonsillar infections. We report a patient in whom CT was a useful diagnostic tool for distinguishing peritonsillar abscess from peritonsillar cellulitis.

Polycustic disease of salivary glands is a rare condition which hitherto has been reported only glands. We report a case in which and accessory salivary gland had evidence of plycystic disease.

Grisel's syndrome is a rare condition of uncertain aetiology characterized by atlanto-axial subluxation following an infection in the head and neck region. The condition most frequently affects children and characteristically presents in the post-operative period with cervical pain and torticollis. We describe three cases and discuss the aetiology and pathogenesis. A high index of suspicion may lead to early diagnosis in its natural history thereby preventing potentially serious complications.

An unusual case of post-radiation primary intranodal leiomyosarcoma of the cervical lymph node is presented. The patient was a 32-year-old white man who was treated in 1986 with hemiglossectomy and right neck dissection, followed by radiation therapy, for squamous cell carcinoma of the tongue. Six years later, he presented with an enlarged left cervical lymph node which on biopsy showed a high grade spindle cell malignant neoplasm. Immunohistochemistry and electron microscopic study verified the smooth muscle origin of the tumour.

Extensive work-up for a second primary lesion was negative. Primary intranodal leiomyosarcoma is extremely rare. We briefly discuss the histological differential diagnosis of spindle cell lesions of lymph nodes, leiomyosarcoma of the vessel wall and radiation-associated sarcoma.

Development of malignant lymphoma in Hashimoto's thyroiditis is well documented. A case of tracheal invasion by a lymphoma which accompanied Hashimoto's disease is described. The clinical and diagnostic difficulties which were encountered are presented. The magnetic resonance imaging (MRI) findings which have not been reported previously are outlined.

We report the first case of generalized cytomegalovirus (CMV) disease in an AIDS patient who presented with an acute Sjogren-like syndrome and was diagnosed by parotid gland biopsy. All symptoms disappeared after a few days of intravenous ganciclovir therapy.

A case of a five-year-old child with a greatly enlarged jugular fossa and high jugular bulb with associated progressive sensorineural hearing loss is presented. While various forms of this anatomical variant have been described by many authors, this is an extreme example, and progressive symptoms are most unusual.

We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.

The case of a massive benign thyroid goitre extending from the arch of aorta to the nasopharynx presenting with acute aerodigestive obstruction is reported. The management of the case is discussed and also a review of the relevant literature.