Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless, the treating physician should consider this condition within the differential diagnosis of a submandibular mass.

Case report of ectopic thyroid tissue presenting as a submandibular mass in a patient with hyperthyroidism, together with a review of the English-literature concerning ectopic thyroid tissue.

To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affecting the normal thyroid gland.

During neck dissection, the current practice is to preserve the internal jugular vein in the majority of cases. However, sacrifice of bilateral internal jugular veins is required in rare cases. Simultaneous excision of both internal jugular veins is known to frequently cause fatal complications. Even if staged, bilateral internal jugular vein sacrifice still occasionally leads to fatal complications (in 2 per cent). We report two different methods of unilateral internal jugular vein reconstruction, in two cases requiring excision of bilateral internal jugular veins, and we review the significance of this reconstruction procedure.

The first patient underwent conventional type A reconstruction (using Katsuno's classification): end-to-end anastomosis of the internal jugular vein to the external jugular vein. For the second patient, we anastomosed the internal jugular vein to the anterior jugular vein, preserving the flow of the external jugular vein. This method, termed type K, had two main expected benefits: facial drainage via the preserved external jugular vein; and provision of a built-in safeguard in the case of occlusion (via the preserved venous networks between the internal jugular vein and the external jugular vein, e.g. the facial vein).

In both cases, the reconstructed internal jugular vein was patent and the post-operative course was uneventful, with no severe complications.

The current and previous findings strongly indicate that the reconstruction of at least one internal jugular vein is highly recommended for patients requiring bilateral internal jugular vein sacrifice. Our type K method may represent a useful technique for this procedure.

To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours.

Case report and literature review.

We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction.

This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.

We present a rare case of primary mucosal melanoma of the middle ear imaged with 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT).

Clinical, radiological, intra-operative and histological findings are discussed.

An 88-year-old woman presented with intermittent otorrhoea of the left ear for several months. Otoscopy revealed a livid protrusion of the tympanic membrane. Melanoma was not suspected initially, but was established on transmembranous biopsy. Pre-operative 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography revealed a mass lesion in the left tympanic cavity with high fluoro-deoxyglucose uptake, as well as an ipsilateral intraparotid lymph node metastasis. The patient underwent surgical treatment. The diagnosis of melanoma was confirmed histologically.

In this rare case, clinical, radiological and surgical findings led to the diagnosis of a primary mucosal melanoma of the middle ear.

First bite syndrome refers to the development of pain in the parotid region after the first bite of each meal.

A man was referred to our institution with first bite syndrome as his only symptom. Magnetic resonance imaging of the head and neck revealed a deep lobe parotid mass in close contact with the external carotid artery. Computed tomography guided fine needle biopsy indicated adenoid cystic carcinoma. Total parotidectomy was performed, with en bloc resection of the infiltrated external carotid artery and a selective neck dissection of levels Ib to III. High-weight ion radiotherapy was administered post-operatively.

First bite syndrome has hitherto only been described following parapharyngeal space surgery. We present the first case of parotid gland adenoid cystic carcinoma presenting with first bite syndrome as the only symptom. The presence of first bite syndrome should prompt the clinician to investigate the parapharyngeal space and deep lobe of the parotid gland, especially in the absence of other signs or symptoms.

Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.

A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.

We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base.

To explore the pathology, diagnosis, therapeutic strategies and prognosis of primary temporal inverted papilloma.

We present one of the first reported cases of primary temporal inverted papilloma with premalignant change. The available data are reviewed.

To the best of our knowledge, only 10 evaluable cases of this tumour have been reported. The recurrence rate is higher for this tumour than for sinonasal inverted papilloma.

Primary temporal inverted papilloma is extremely rare, and its diagnosis should be made only following clinical exclusion of sinonasal papilloma. Therapy mainly comprises radical resection of the lesion, and long-term post-operative follow up is mandatory.

Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde–retrograde approach.

A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde–retrograde rendezvous technique is advisable.

In cases of complete obstruction of the oesophageal inlet, anterograde–retrograde dilatation represents a safe technique with which to restore enteric continuity.

This case series report aims to raise awareness of the association between supraglottic infection and abscess formation, which has been rarely documented.

We report a series of four patients who developed cervical abscesses following supraglottic infection. The diagnosis was confirmed by imaging in three patients, and by incision and drainage of pus at direct laryngoscopy in one.

All four patients were treated with intravenous antibiotics, steroids and humidification; two also underwent surgical drainage of pus. All made an uneventful recovery.

The factors that lead to neck abscess formation are poorly understood. Physicians should always be aware of this potential complication. If it is suspected, appropriate neck imaging should be undertaken, after excluding airway copromise; this will aid early diagnosis and treatment.

Vallecular cyst is uncommon in infants. We treated a female infant with vallecular cyst, and curious magnetic resonance imaging findings. We also review 51 other cases of vallecular cyst in infants reported over the past 23 years.

A three-month-old female infant presented with congenital inspiratory stridor and failure to thrive. Flexible laryngoscopy and ultrasonography revealed a cystic mass in the vallecula. Magnetic resonance imaging findings were initially curious because of artefacts from breathing and swallowing. Marsupialisation of the cyst was performed. Post-operatively, the patient was immediately free of symptoms.

Magnetic resonance imaging presents various difficulties in infants, but has the best diagnostic effectiveness. We recommend the use of magnetic resonance imaging, flexible fibroscopy and ultrasonography to enable extensive examination of suspected vallecular cysts in infants. Marsupialisation has a recurrence rate of only one in 39 cases, and its safety and effectiveness are well balanced. Thus, prompt marsupialisation of vallecular cyst is the recommended surgical procedure.

We report a case of leiomyosarcoma arising in the tonsil in a 73-year-old man.

Case report and review of the English language literature (using Pubmed, Ovid and Proquest databases).

To our knowledge, this is the first case of tonsillar leiomyosarcoma to be reported in the English language literature. Our patient presented with haemoptysis, unilateral odynophagia and an ulcerated, exophytic lesion of the tonsil. Histological examination confirmed the diagnosis of leiomyosarcoma, and the patient was treated with radical radiotherapy.

Leiomyosarcomas are extremely rare in the head and neck; the common sites of origin are the skin and sinonasal tract. The overall prognosis is poor.

Paratracheal air-filled cysts are rare. Tracheocoele or acquired tracheal diverticulum is the term given to these acquired abnormalities, which usually arise in adults. The majority is asymptomatic, being discovered as incidental findings on radiological imaging.

We report the case of a 72-year-old man with a previously identified tracheocoele which became symptomatic following an upper respiratory tract infection. A literature is presented and nomenclature is discussed.

The clinical presentation, differential diagnosis and management of paratracheal air-filled cysts are discussed.

While most of these rare abnormalities are discovered incidentally, this case illustrates the fact that significant symptoms can develop; excision should therefore be considered.

We report a unique complication arising from the use of a Hunsaker Mon-Jet ventilation tube during microlaryngeal surgery, and we briefly review the literature on the use of this tube for jet ventilation.

A case report on the safe and successful management of a potential airway compromise, and a brief literature review on using the Hunsaker Mon-Jet ventilation tube during microlaryngeal surgery.

A 46-year-old woman was scheduled to undergo removal of a vocal cord polyp under general anaesthesia. However, the polyp became stuck in the basket of the Hunsaker tube during intubation. The polyp and the Hunsaker tube were removed safely after a microlaryngeal tube was passed beyond the vocal cords. To our knowledge, this complication has not previously been reported.

This case highlights the potential risk of laryngeal growths, especially vocal cord polyps, becoming trapped in the Hunsaker tube during intubation. Both the anaesthetist and the operating surgeon should be aware of this possible complication and, more importantly, how to deal with such a problem.

To present a rare cause of facial pain, and the differential diagnosis of a lesion of the mandibular division of the trigeminal nerve.

A 19-year-old woman presented to a tertiary referral skull base centre with right periorbital pain and a progressive, right-sided deficit of the mandibular division of the trigeminal nerve. Clinical examination revealed right-sided hypoaesthesia in the mandibular division of the trigeminal nerve dermatome, mild trismus and some wasting of the right masseter muscle. Computed tomography and magnetic resonance imaging scans revealed a small area of mildly enhancing soft tissue centred within the foramen ovale, with concentric enlargement. Surgery was undertaken via an infratemporal fossa (Fisch) type D approach. A vascular lesion was found filling the foramen ovale, with no obvious nerve separate from the lesion. The lesion was removed en bloc. Histopathological analysis demonstrated a venous haemangioma within the nerve.

Facial pain is common, and may be wrongly attributed to trigeminal neuralgia. A thorough clinical examination must be performed to identify subtle neurological abnormalities, and appropriate imaging undertaken to exclude rare causes, such as this venous haemangioma of the mandibular division of the trigeminal nerve.

We report an extremely rare case of laryngeal lichen planus.

A case report and literature review of the aetiopathogenesis, clinical features and management of laryngeal lichen planus are presented.

A male patient presented with hoarseness and a history suggestive of squamous cell carcinoma of the larynx. However, characteristic histopathological findings demonstrated lichen planus. The patient responded very well to oral steroids, and at the time of writing had remained symptom-free for two years.

This is the first English language report of laryngeal lichen planus. Lichen planus is a diagnosis of exclusion and responds well to steroids. However, patients should be followed up regularly as malignant change is known to occur.

To demonstrate the successful treatment of laryngeal papillomatosis in a 32-month-old girl, using coblation (radio-frequency ablation) resection.

A 32-month-old girl was referred to the ENT out-patients clinic due to a hoarse cry and a very croaky voice since birth. Under general anaesthesia, fibre-optic airway endoscopy revealed a large papillomatous lesion involving the anterior glottis, which was reported as a laryngeal papilloma on histological analysis. This was later excised using an Evac 70Xtra wand. The patient made an uneventful post-operative recovery, and there were no signs of recurrence on repeated airway endoscopies at three and 18 months.

Coblation (radio-frequency ablation) is a promising surgical technique for the treatment of paediatric laryngeal papillomatosis. The main advantages of this technique include limited damage to underlying tissues and a bloodless field.

In the West, removal of the uvula is predominantly undertaken as part of palatal surgery, in cases of obstructive sleep apnoea. In the developing world, such as the Middle East and Africa, uvulectomy is a more common practice. The uvula is removed for curative or preventive purposes, or as part of ritual practice. Due to immigration from developing to developed world countries, and to Western doctors working abroad, such doctors are increasingly being confronted with unfamiliar traditional healing practices, within a medical context.

The Medline and Embase online databases were systematically searched for literature on traditional uvulectomy. We present a review of this literature. We also present the first report, to our best knowledge, of obstructive sleep apnoea as a late complication of traditional uvulectomy.

Traditional uvulectomy may be complicated by post-operative haemorrhage and local infections, among many other problems. We report cases of obstructive sleep apnoea and snoring caused by palatal stenosis resulting from traditional uvulectomy during childhood.

Cystic lesions related to the upper airway are an unusual cause of infantile stridor. Such a lesion may exert a mass effect, with subsequent airway compromise.

A six-month-old boy was transferred to our unit with a right-sided, level IV neck lump and a three-month history of chronic cough and, latterly, inspiratory stridor. Computed tomography revealed a large, unilocular, cystic, cervicothoracic lesion causing marked compression of the trachea. Airway endoscopy subsequently revealed the larynx to be displaced to the left, with severe external compression of the trachea from just below the subglottic level to immediately above the carina. The mediastinal lesion was excised via an external approach. The histological diagnosis was a bronchogenic cyst.

Bronchogenic cysts are a rare cause of infantile stridor, and should be considered in the differential diagnosis of cystic cervical and mediastinal masses. Surgical excision is the treatment of choice.