This is a report of a case of a rare congenital midline cervical cleft and a description of the surgical approach.

Congenital midline cervical cleft is a very rare developmental anomaly. It represents a failure of the branchial arches to fuse in the midline and presents at birth with a ventral midline defect of the skin of the neck. Associated clinical features could include mandibular spurs, cleft mandible, microgenia, thyroglossal cyst, cleft lip or bronchogenic cysts.

The authors present a case of a midline cervical cleft that was diagnosed and managed at an early age. They discuss the clinical presentation and embryological development of this rare condition. The operative findings, surgical excision and repair of the long vertical defect by Z-plasty are discussed in detail.

The authors report a very satisfactory result following excision and Z-plasty closure of this rare congenital anomaly.

Carotid artery pseudoaneurysms are rare lesions and are increasingly treated by endovascular means. This paper reports the case of a patient presenting with haemorrhage due to a left external carotid artery pseudoaneurysm seven weeks after total laryngectomy for carcinoma. The lesion recurred and rebled after technically successful emergency endovascular occlusion. Subsequent aneurysmectomy and carotid sacrifice resulted in fatal hemispheric infarction. The aneurysm was demonstrated to be infected on white cell study and subsequent histopathology. We propose that infection within the aneurysm itself was a significant factor in its recurrence and rebleeding after endovascular occlusion. If infection is proven or suspected then consideration should be given to early surgical rather than endovascular intervention.

Sarcoidosis is a multi-system, non-caseating granulomatous disease of unknown aetiology that may affect any organ. The oral involvement of sarcoidosis is rare and usually an initial manifestation of the disease. In this case report the authors present a 25-year-old African-American woman with palatal sarcoidosis treated successfully with intra-lesional corticosteroid injections.

The oral manifestationsof sarcoidosis are relatively uncommon and may be the only manifestation of the disease. Suspected cases of oral sarcoidosis should be biopsied and subsequently referred to a physician to rule out systemic involvement.

Two cases of subcutaneous emphysema of the neck as a result of abuse in infancy are presented to add to the variety of findings associated with the maltreatment of infants. Pharyngeal perforations as a result of abuse are rare. These cases are presented as a reminder to the attending clinician that although most cases of subcutaneous emphysema may resolve without any complications a detailed examination for the cause should be performed and the history carefully verified.

Head and neck swellings are common referrals to the otolaryngology department, with a wide range of aetiologies. Internal jugular vein thrombosis presenting as swelling in the neck is a rare occurrence. The authors report a case of bilateral internal jugular vein thrombosis secondary to malignant lymphadenopathy of unknown origin. The patient presented with a short history of a diffuse swelling in the neck with neck stiffness. Examination revealed palpable cervical and axillary lymphadenopathy. Causes of spontaneous internal jugular vein thrombosis were discussed.

Tuberculous mastoiditis is a well-documented entity with decreasing incidence in recent years. Tuberculous osteitis of the skull is even rarer. The case of a 58-year-old male with tuberculous mastoiditis complicated by extensive tuberculous osteitis of the skullis presented. This case serves to demonstrate both the difficulty in establishing the diagnosis of tuberculosis and the potentially disastrous consequences of the disease.

The case is described of a boy who presented at age six months with symptoms and signs of a thyroglossal cyst, which seemed to be confirmed by ultrasound findings. The cyst slowly increased in size, and eventually the patient underwent Sistrunk’s procedure at age four years. Histology showed that the cyst was in fact a mixed thyroglossal and dermoid cyst. This casts doubt on the doctrine that thyroglossal cysts and dermoid cysts are anatomically and histologically separate entities, and strengthens the view that these cysts should be more appropriately named ’thyroglossal abnormalities’.

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.

An unusual case of epistaxis resulting from post-transplant lymphoproliferative disorder is described.

A 30-year-old woman who had undergone renal transplantation 12 years previously presented with profuse, posterior, unilateral epistaxis. The initial findings, workup and treatment are presented. A post-nasal space (PNS) mass was detected and biopsy showed this to be an Epstein-Barrvirus-positive polymorphous B-cell post-transplant lymphoproliferative disorder. Computed tomography findings showed a polypoid lesion protruding from the sphenoethmoidal recess and filling the left PNS.

Post-transplant lymphoproliferative disorder is well known to involve tonsil tissue. Commonly, this is the first presentation of the disease in children. However, until now post-transplant lymphoproliferative disorder has not been described in the PNS or nasal cavity presenting as epistaxis. We conclude that all transplant patients presenting with epistaxis should be followed up for an accurate examination of the PNS and nasal cavity after the acute episode.

Temporal lobe abscess as a complication of parotid abscess is not described in the English literature. In this case report a 66-year-old gentleman is described who presented with a left-sided parotid abscess, which extended to other deep neck spaces, and advanced to develop a temporal lobe abscess and subdural parietal empyema. Treatment included intravenous antibiotics, incision and drainage of parotid abscess, and burr hole aspiration of the temporal lobe abscess. The importance of imaging to evaluate the extent of deep neck abscess and brain abscess is highlighted in this report.

Lower oesophageal foreign body meat bolus obstruction is potentially life-threatening. We report a case in a 94–year–old woman in which conservative measures and flexible oesophagoscopy were unsuccessful. Rigid oesophagoscopy was considered technically difficult and so clearance by interventional radiology was attempted. Through the mouth a radiologically guided balloon catheter was introduced. It was passed beyond the bolus to dilate the site of obstruction, before being withdrawn and inflated above the bolus, pushing it into the stomach. Although successful in this case, the technique is previously unreported and so its complication rate is unknown. It is therefore presented only to be considered when other treatments are neither effective nor possible.

This documents the case of a 55-year-old female presenting with a solitary polypoidal tumour of the pharynx. Histological examination revealed features consistent with a gastrointestinal stromal tumour. Although well described elsewhere in the gastrointestinal tract, from our literature search, this is the first reported case of such a tumour occurring in the pharynx

Neurilemmomas are slow growing, benign neoplasms of neural crest Schwann cell origin. They arise from any peripheral, spinal or cranial nerve except the olfactory and optic. Presentation is usually asymptomatic but focal neurological signs and symptoms may be associated with nerve compression. With approximately one third of all documented cases presenting in the head and neck region, we report a case of a submandibular neurilemmoma misdiagnosed pre-operatively. The diagnostic difficulties are discussed and the current literature reviewed. Thiscase highlights the importance of inclusion of nerve sheath tumours in differential diagnoses of soft tissue lesions in the head and neck.

Spontaneous cervical haematomas are rare occurrences for which a wide variety of aetiologies have been reported. Although the pathogenesis of this condition can be quite diverse, all known cases have emanated from a cervical source. The authors report the first case of a spontaneous cervical haematoma arising from an intrathoracic source. A case review and Medline search from 1962–2003 was carried out.

No prior experience with intrathoracic sources for cervical haematomas has previously been reported. Transcervical haematoma evacuation confirmed the intrathoracic origin and a median sternotomy was required to gain control of this haemorrhage.

Thoracic sources should be considered in the differential diagnosis of a spontaneous cervical haematoma. Preparations for a combined procedure with a thoracic surgeon can be predicted pre-operatively based on imaging studies.

In this paper two cases are reported in which spontaneous entry of air into the head appears to have occurred through a hypercellular mastoid air cell system. In both these cases forceful sneezing and nose blowing were considered contributory factors. They underwent surgical repair of the bony defects which, combined with less vigorous nose blowing, has affected a successful repair. The aetiology of pneumocephalus is discussed and a review of the pertinent literature is also presented.

A previously undescribed association of Reidel’s thyroiditis with Tolosa-Hunt syndrome is reported. A 33 year-old Caucasian female presented with a two-year historyof painful progressive goitre, histologically a Reidel’s thyroiditis. She underwent left partial thyroidectomy. Post-operatively she developed severe right retro-orbital pain, right temporal headache and a partial right occulomotor nerve palsy. A diagnosis of Tolosa-Hunt syndrome was made. Some important aspects of this case are discussed.

Migrated ingested foreign bodies from the upper digestive tract have the potential to cause life-threatening complications. Cases of spontaneous expulsion to the skin of the neck are very rare. We present an unusual case of an ingested foreign body that migrated out of the upper digestive tract and self-extruded via the skin of the neck. An approach to the safe management of such seemingly innocuous foreign bodies is discussed. This report highlights the message that unfound ingested foreign bodies should be treated seriously due to the possibility of migration and resulting complications.