The management of oesophageal strictures in neonates and infants is often by bougie dilatation. We report two cases in which balloon dilatation was used successfully and suggest that this may be a preferable technique in this age group.

Life-threatening sequelae of Epstein-Barr virus infection are uncommon but may present as: local pharyngeal manifestations, splenic rupture, neurological and haematological disorders and altered hepatic function. We present a case of retropharyngeal haematoma with posterior hypopharyngeal wall necrosis, thrombocytopenia and altered clotting function as a result of Epstein-Barr virus infection. A review of the literature on retropharyngeal haematoma reveals this to be the only recorded case which can be directly attributed to Epstein-Barr virus infection.

Torsion of a pedunculated part of the palatine tonsil is extremely rare. This paper discusses the clinical presentation, differential diagnosis, treatment of such a case and reviews the existing literature.

Otolaryngological manifestations of factitious disorders are rare. The case of a health care worker who injected her face and orbits with air in order to masquerade as facial cellulitis is presented. The literature and treatment strategies are reviewed.

We report two cases of left vocal fold palsy following use of the laryngeal mask airway. In both cases anaesthesia was uneventful with a duration of about 60 minutes. It is proposed that high intra-cuff pressures induced during anaesthesia resulted in distension of the hypopharynx and subsequent neuropraxia of the motor branches of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.

Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.

A 51-year-old woman complained of hoarseness of two years duration. The patient's past medical history was significant for autoimmunological hepatitis and arthritis for which she had not received treatment. Laryngoscopy and laryngeal stroboscopy revealed ‘bamboo joint-like nodules’ on both true vocal folds. These nodules resembled rheumatoid nodules and were suggestive of a collagen disease. Previous reports have documented that the treatment for such conditions related to collagen diseases is surgical resection. However, we initially attempted to treat the laryngeal lesions systemically with prednisolone. The hoarseness and the bamboo-like nodules disappeared six months after the treatment. Furthermore, the liver function test returned to normal and arthritis completely resolved. Based on our patient's response to this treatment, we diagnosed atypical-SLE and a lupus laryngitis. This case suggests that studies of the larynx may be helpful in the early diagnosis of collagan diseases and that such conditions may respond to systemic treatment.

A case of cowpox infection presenting as a necrotising cellulitis of the nasal tip and vestibule is reported. Diagnosis was established by identification of the pox virus particles from tissue culture of the nasal biopsy using electronic microscopy and the characteristic lesions on chorio-allantoic membrane produced by the virus. Cowpox of the external nose and transmission of the infection from a dog have not to our knowledge been reported previously.

Lymphangiomas are uncommon benign congenital tumours. Most occur in the head and neck region and the vast majority present before the age of two. This paper describes the presentation and management of four cases presenting after puberty and involving the parotid gland. The cases are unusual in that all were intimately associated with the facial nerve and in an older population. The value of selective neck dissection and facial nerve exposure as an approach to these lesions is discussed.

The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.

Thyroid tumours can compromise the airway by extrinsic compression or invasion of the trachea or larynx and damage to the recurrent laryngeal nerve. In this report, the pedunculated extension of a large anaplastic thyroid carcinoma penetrated through the posterior hypopharyngeal wall causing a partial ball-valve type obstruction of the laryngeal inlet on inspiration. This unusual pattern of invasion has not been reported previously.

The position and dimensions of the jugular bulb and the venous dural sinuses vary considerably. While the anatomical variations of the jugular bulb have been extensively reported in the literature, that of the sigmoid sinus have been reported only rarely. We report a case of unusual anterior course of the vertical segment of the sigmoid sinus which was encountered during an attempted myringoplasty. Anomalies of the jugular bulb in general are also described.

Laryngeal neurofibroma (LNF) is an unusual tumour and only approximately two dozen cases have been reported previously. Isolated LNF not associated with von Recklinghausen's disease is even more unusual. According to a review of the available literature, the case presented is the first bilateral one and the first originating from the ventricles. The tumour was removed completely by microlaryngoscopy without tracheostomy. The macroscopic and light macroscopic findings are presented and a review of the literature on neurogenic tumours in the larynx is presented.

Giant polypoidal hamartomas of the pharynx and oesophagus are rare benign tumours of unknown origin, exceptionally arising from the oropharynx. We report the case of a 74-year-old man who developed sudden nausea and a foreign body sensation. Shortly afterwards he regurgitated a 25 × 3 × 1.5 cm pedunculated fleshy mass, still attached to the inside of his throat. The patient was anaesthetised, the mass traced to the right tonsillar fossa and adjacent oropharyngeal wall. The pedicle was clamped and the lesion excised. Histology was consistent with a giant oropharyngeal hamartoma. We discuss the pathogenesis and potential complications of this condition. The literature is reviewed.

An unusual case of an intra-parotid haematoma is presented. The history was misleading and the ultrasound and CT results apparently contradictory. The investigations are explained in the light of the natural process of haematoma evolution. It is recommended that all radiological investigations be correlated by a single radiologist, and suggested that repeated ultrasound scans, at appropriate time intervals, might be used to confirm the diagnosis and follow the process of clot resolution.

Chronic salivary aspiration can cause life-threatening pneumonia in a patient whose laryngeal function is completely lost. We report a patient who had laryngotracheal separation with cricoidectomy under local anaesthesia. The simplicity and reliability of the procedure were improved by using fibrin glue and the outcome was most satisfactory.

Head and neck tumours presenting as a neck abscess or cellulitis are extremely rare. We report two cases of supraglottic squamous cell carcinoma which presented as an abscess in the site of metastatic neck nodes, one of which was occult and a third case of squamous cell carcinoma of the pyriform fossa which presented as cervical cellulitis. Biopsy of the abscess wall at the time of drainage and careful follow-up may lead to an earlier diagnosis of occult carcinoma.

Acquired tracheo-oesophageal fistulae are uncommon in the paediatric age group. A case of such a fistula secondary to impaction of a button battery is reported below. Prompt management is essential to reduce morbidity and mortality in these cases.

Paraffin impregnated tulle is frequently used as a post-operative dressing after surgical repair of wounds, on skin-donor sites and in packing of tissue cavities. Historically, paraffin has been injected into various sites of the body and paraffinoma is a well-described complication. Despite this, nasal packing with paraffin gauze is still common after rhinoplasty. We report a case of paraffinoma occurring after rhinoplasty and discuss the avoidance of this rare but serious complication and suggest silicon mesh as an alternative dressing.