A 59-year-old man with long-standing chronic obstructive airways disease (COPD), became progressively dyspnoeic, and repeatedly blacked-out during forced expiration. Spirometry suggested the possibility of large airways obstruction, and failing to respond to aggressive bronchodilator and steroid therapy, the patient was labelled as being non-compliant. Finally, he was assessed by an otolaryngologist and a cause for upper airway obstruction was suspected. Bronchoscopy and computed tomography (CT) scanning demonstrated tracheomalacia and the patient underwent resection of this segment of abnormal trachea.

Tracheomalacia, although rare, results from the substitution of cartilage with fibrous tissue, leading to severe airway compromise.

This case emphasizes the fact that although many conditions are uncommon, the total incidence of rare conditions is surprisingly high, and that care needs to be taken at all times in the management of ‘labelled’ patients with chronic illness, in order not to overlook such life-threatening diagnoses.

Organophosphorous poisoning causing isolated laryngeal paralysis has only been rarely reported before. We describe a case of difficult extubation in a patient with organophosphorous poisoning, the cause of which was found to be bilateral vocal fold palsy. This is a type of intermediate paralysis that recovers with time. Such a condition should be thought of as a cause of dyspnoea or difficult extubation in patients with organophosphorous poisoning.

Granular cell tumour (GCT) of the larynx is an uncommon laryngeal tumour. It is always benign and commonly located in the posterior part of the larynx. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, histological differentiation is important because these tumours are normally managed conservatively. The origin of this tumour is a matter of debate, but most authors believe it to be neural in origin. The rarity of this tumour in the male population prompted reporting this case in the literature.

Aspergillosis is a rare infection. It varies considerably in its virulence depending on whether or not the patient affected is immunodepressed. The serious form is characterized by vascular invasion with haematogenic dissemination, tissue infarction andnecrosis. The most often affected site is the lung. A laryngeal localization is exceptional and usually results from dissemination from a lower airways portal of entry. Diagnosisis difficult: cultures are only positive in 50 per cent of cases, while in 60 per cent of cases the characteristic histological features reminiscent of sprigs of mistletoe are only found on postmortem examination. In view of the high morbidity and mortality in acquired immunodeficiency syndrome (AIDS) sufferers, this condition must be treated early and aggressively. Treatment is based essentially on amphotericin B and itraconazole.

Herpes simplex virus (HSV) infection in the neonatal period may be confined to the eyes, skin and upper aerodigestive tract or may be widely disseminated to other organs, with particular recognition of involvement of the central nervous system (CNS) causing herpes encephalitis (Whitley et al., 1980a, b; Andersen, 1987).

Primary laryngeal HSV infection is extremely uncommon. We present a case of acute neonatal stridor secondary to such localized disease and discuss its management.

We report a case of a 36-year-old woman who suffered a temporal bone trauma due to a bicycle crash. Computed tomography revealed parapharyngeal emphysema despite only minor temporal bone changes.

We report a case of post-operative frontal basal encephalocoele evaluated using a new magnetic resonance imaging (MRI) sequence, fast inversion recovery for myelin suppression (FIRMS). FIRMS was developed to enhance the differentiation between grey and white matter. In this case, the sequence was beneficial in distinguishing the encephalocoele from adjacent nasal mucosa and secretions.

In general, malignancies presenting as abscesses are uncommon. We report on a patient that presented with a neck abscess originating in a cluster of metastatic lymph nodes from a primary squamous cell carcinoma arising in the thoracic oesophagus.

We report a case of a 40-year-old man presenting with acute vertigo and deafness. Computed tomography (CT) scanning at initial presentation was normal. However, one year later he developed numbness on the right side of his face and examination revealed fifth, seventh and eighth cranial nerve palsies as well as cerebellar dysfunction. Magnetic resonance imaging (MRI) demonstrated a cerebellopontine angle lesion. He underwent near total excision followed by neuro-axis irradiation. The main mass of the tumour projected into the cerebellopontine angle. Histology showed this to be a medulloblastoma. All features of this case are unusual; hence we discuss the pathogenesis and management of this very rare tumour.

The presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.

The presence of a mass in a jejunal free flap that causes dysphagia less than two years after a pharyngolaryngectomy for carcinoma usually indicates tumour recurrence. We present a case of invasive candidiasis of a jejunal free flap presenting with dysphagia and a mass. To our knowledge this is previously unreported. Such a cause should always be considered in the differential diagnosis, as early recognition and treatment are likely, to result in a favourable outcome.

Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies in patients infected with human immunodeficiency virus (HIV); it occurs 25–60 times more frequently in HIV-infected patients than in the general population. This neoplasm in acquired immunodeficiency syndrome (AIDS) patients is a highly aggressive tumour with a poor prognosis and tends to develop in extranodal sites, such as the central nervous system, digestive tract and bone marrow. NHL involving the paranasal sinuses is rare in HIV-infected patients, and is likely to be confused clinically and radiographically with sinusitis; moreover, its optimal treatment is currently uncertain.

We present a case of NHL involving the left maxillary sinus in a patient with AIDS. The patient was treated with systemic chemotherapy (low dose-CHOP), but the malignancy did not respond. Subsequently, he was treated with local maxillary sinus irradiation which resulted in partial regression of the neoplasm and in decrease of local symptoms.

Recurrent epistaxes after head injury may rarely be dueto a traumatic intracavernous carotid artery pseudoaneurysm. The headinjury is usually associated with fracture of the skull base and the epistaxes are severe with the first episode generally occurring one to three months after the initial trauma. We present a case which illustrates the role of high resolution computed tomography (CT) scanningand also magnetic resonance angiography (MRA) in achieving the diagnosis.

Haemangiomas are the commonest benign tumours of the head and neck in childhood, but they are extremely rare on the palate. We report a case of a palatal haemangioma presenting with feeding difficulties in a young infant. Clinical diagnosis and pathological features are discussed and we suggest a classification which may help in the diagnosis of these cases.

We report a case of myasthenia gravis presenting to the department of otolaryngology with acute dysphagia on two separate occasions over a one-year period. Diagnosis of myasthenia gravis was made when the patient developed ventilatory failure after his second general anaesthetic for rigid oesophagoscopy. Our patient required emergency transfer to the intensive therapy unit for ventilation. He improved after treatment with corticosteroids, anticholinesterase and immunosuppressive medications. Our case was unusual in that cricopharyngeal spasm causing dysphagia and significant aspiration was demonstrated by a barium swallow and this was completely resolved after treatment of the myasthenia gravis.

Computed tomography (CT) provides an excellent map for the sinus surgeon aswell as providing information about the extent of disease and the presence of bony destruction. Surgeons need to be aware of the anatomical configuration of the sinuses and the presence of any structural changes such as a dehiscent lamina papyracea, asymmetric skull base, low level of posterior skull base or an Onodi cell, which place the patient at increased risk. Described here is a six-step guide to help the sinus surgeon avoid missing any of the radiologically important features.

The assessment of head and neck cancer has traditionally involved clinical examination and anatomical imaging by computed tomography (CT) or magnetic resonance imaging (MRI). We present a case where a problem of clinical confusion and inconclusive radiology was resolved by the use of positron emission tomography (PET) coregistered with CT.

Mycotic aneurysms of the extracranial carotid arteries are extremely rare. A case is reported of a false aneurysm of the left external carotid artery. This developed secondary to cervical lymphadenitis which did not settle with high dose antibiotic therapy. The diagnosis was made on investigation with carotid doppler ultrasound and confirmed with computerized tomography. Digital subtraction angiography was performed to highlight the vascular anatomy. In addition percutaneous balloon catheter control of blood flow in the external carotid artery was used as an adjunct to surgical management.

We report the case of a giant fusiform aneurysm of the petrous internal carotid artery in a 15-year-old patient who had presented with headache, hearing loss and Horner's syndrome. Definitive radiological diagnosis was made by non-invasive imaging techniques, including magnetic resonance angiography (MRA). The aneurysm was obliterated by endovascular balloon occlusion following successful tolerance of test occlusion of the internal carotid artery.

Extra-nodal non-Hodgkin's lymphoma (NHL) of the pinna has only been reported once in a patient with immunodeficiency. We report an unusual case of lymphoblastic lymphoma in a patient without any immunodeficiency, presenting as an inflammatory lesion of the pinna, which illustrates the need to biopsy any nonhealing lesion as soon as possible to ensure that such a treatable malignancy is diagnosed at an early stage.