We report a typical case of cystic hygroma presenting in an elderly female patient. A review of the literature on this condition reveals that although rare in adults, it should form part of the differential diagnosis of a cystic swelling in the neck in this group of patients as well as in the more commonly observed juvenile population. The embryology and pathogenesis of lymphangiomata are discussed as well as the recommended management of a cystic hygroma in an older patient.

A case of severe airway obstruction due to laryngo-tracheal compression associated with achalasia is presented. Local anaesthetic tracheostomy has an important role in some cases.

We report an unusual case of a pilonidal sinus appearing on the nose. From the clinical and pathological findings, we find it difficult to believe that it is an acquired condition. En bloc excision by an external rhinoplasty approach was performed with no evidence of any recurrence.

Despite the abundance of minor salivary glands within the larynx, pleomorphic adenomas are rarely found. It is therefore not surprising that there are few reports of malignant mixed tumours in this site. We describe a case of carcinoma arising in a pleomorphic adenoma of the epiglottis which, to our knowledge, has not been described previously.

The patient underwent a horizontal partial laryngectomy and functional neck dissection and is well one year post-operatively. We feel this represents a suitable approach to treatment for this rare tumour.

Direct upper airway infiltration by thyroid neoplasia is a rare occurrence, a unique case of papillary thyroid neoplasia presenting as a pyriform fossa mass is described and the management of these problem patients is discussed, emphasising the controversy between radical and conservative surgery.

The possibility that the thyroid tumour resulted from previous radioactive iodine prescribed for thyrotoxicosis is also considered.

A patient with an intracavernous carotid aneurysm usually presents with symptoms and signs of a space occupying lesion, producing one of a variety of types of cavernous sinus syndromes (Jefferson, 1938). Epistaxis is an unusual feature in these patients and when present is nearly always associated with a traumatic aneurysm (Mahmoud, 1979). There are only two reported cases of non-traumatic intracavernous carotid aneurysms presenting with epistaxis and diagnosed during the lifetime of the patient (Troupp, 1962; Labayle and Legent, 1964). The authors present a third such case. The importance of considering aneurysms in the differential diagnosis of epistaxis is emphasised. The radiological investigations and management of these patients is discussed.

Epidermoid inclusion cysts are a relatively common finding following superficial trauma. Inclusion cysts have previously been reported following rhinoplasty, but these have been mucosal cysts and one case of a paraffinoma. A case of multiple recurrent epidermoid inclusion cysts, developing in relation to rhinoplasty, is presented.

Lipomas of the anterior neck are rare lesions with about 40 cases reported so far in the world literature. Though lipomas are known to change shape depending upon adjacent compressive forces, our case is unique in that the change in shape clinically mimicked an external laryngocoele. A possible explanation for the unusual behaviour of this lipoma is offered.

Primary mucosal melanomas of the upper aero-digestive tract are uncommon and represent only 1.7 to 3 per cent of all primary melanomas. The most frequent localization are the nasal fossae, the paranasal sinuses and the oral cavity where melanomas most often arise from the palate and alveolar ridge, buccal mucosa, lips, tongue and floor of mouth.

The authors describe a case of malignant melanoma of the uvula, review the literature and discuss the aetiology, pathology and diagnostic and therapeutic problems.

A case of adenosquamous carcinoma of the thyroid gland is presented. This rare form of cancer behaves in an aggressive manner similar to anaplastic carcinoma and is characterized histologically by the intimate blending of the squamous and glandular elements. The prognostic significance of identifying areas of malignant squamous epithelium within papillary carcinoma as opposed to the much more common benign squamous metaplasia, is highlighted. The pathogenesis, differential diagnosis and management of the condition are discussed.

CSF otorrhoea is not uncommon following head injury but late presentation is rare. In the case described an unsuspected temporal bone fracture presented after an interval of ten years with a conductive deafness due to fluid in the middle ear simulating serous otitis media.

Granular cell myoblastoma is an unusual benign tumour, which, when occuring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis.

These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma.

In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.

Two cases are described where infective complications, namely nasal septal abscess and parapharyngeal abscess, occurred after short-term (less than one hour) nasotracheal intubation. These conditions are serious as they can be life-threatening and in one case led to permanent physical disfigurement.

An exceptional case of obscure bleeding in the upper digestive tract caused by an arteriovenous haemangioma of the epiglottis is presented. The clinical details and surgical findings are described.

The diagnosis of submandibular lumps is usually straightforward, using a combination of history, examination and simple investigation. Most will turn out to be submandibular salivary gland enlargement or lymph node swellings. We present a case in which conventional investigation failed to help in the diagnosis, and was eventually found to be what we believe is the first capillary haemangioma described in the anterior belly of the digastric muscle.