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.

We report a case of otogenic fungal pachymeningitis in a diabetic patient who presented with multiple cranial nerve palsies and nasopharyngeal swelling.

We present a case report, we describe the investigations, management and clinical course of fungal pachymeningitis, and we present a review of the world literature on fungal and non-fungal pachymeningitis.

To our knowledge, this is the first report of fungal pachymeningitis with magnetic resonance imaging features suggestive of nasopharyngeal carcinoma. It is also the first reported case with aspergillus cultured from both a dural biopsy and the ear canal.

Fungal pachymeningitis is a rare condition which may present to otorhinolaryngologists. Its clinical and radiological findings can be confused with those of nasopharyngeal carcinoma; fungal pachymeningitis should thus be included in the differential diagnosis of nasopharyngeal carcinoma.

Dacryoliths are concretions formed in the lacrimal sac from cellular debris and proteins, which may calcify and cause further obstruction of the nasolacrimal pathway. Dacryoliths are often underlying contributors in cases of intermittent or chronic dacryocystitis (i.e. nasolacrimal sac inflammation, characterised by epiphora, pain, erythema, sac dilation and lacrimal punctum swelling).

We report an unusual case of dacryolith resulting in obstructive epiphora, managed via an endonasal endoscopic approach.

Case report and literature review pertaining to dacryolith.

A 54-year-old man attended the multidisciplinary nasolacrimal clinic due to recurrent epiphora. Obstructive epiphora secondary to chronic dacryocystitis was diagnosed. He underwent endonasal endoscopic dacryocystorhinostomy. Intra-operatively, a large dacryolith was found to be the cause of epiphora.

Dacryolith is an unusual cause of nasolacrimal duct obstruction. This case highlights this unusual cause, and the relevant diagnostic investigations. This case also illustrates successful endonasal endoscopic management, rather than an external, open approach.

To report a case of primary nasal tuberculosis, and to discuss the diagnostic difficulties encountered.

A teaching hospital in Norwich, UK.

Case report and review of the English language literature concerning tuberculosis affecting the head and neck region.

The diagnosis of nasal tuberculosis is based on: histological identification of granulomatous inflammation; positive testing for acid-alcohol resistant bacilli; and positive culture. Newer diagnostic tests have the advantage of speed and improved accuracy, but are not as yet completely evaluated for the diagnosis of extra-pulmonary tuberculosis.

It is important to consider nasal tuberculosis in the initial differential diagnosis. The quest to exclude a malignancy may lead to unacceptable delays in treatment.

To report an extremely rare case of gastroesophageal carcinoma presenting initially with salivary gland metastasis.

Case report and English language literature review concerning metastasis of adenocarcinoma of the gastroesophageal junction, with emphasis on clinical presentation.

A 66-year-old man presented to the ENT rapid-access clinic with a right-sided neck swelling located in the tail of the right parotid gland. Fine needle aspiration cytology suggested adenocarcinoma. An urgent Oesophago-Gastro-Duodenoscopy (OGD) and biopsy confirmed the presence of the primary tumour at the gastroesophageal junction.

To our best knowledge, this is the first report in the English language literature of a parotid mass as the presenting feature of gastroesophageal carcinoma.

Large defects of the anterior wall of the frontal sinus require closure using either autologous or foreign material. In cases of osteomyelitis, the reconstruction must be resistant to bacterial infection. Split-rib osteoplasty can be used in different sites.

Two patients with malignant sinonasal tumours underwent repeated treatment, and subsequently developed osteomyelitis of the frontal bone. After adequate therapy, a large defect of the anterior wall persisted. Reconstruction was performed using the split-rib method. The literature on this topic was reviewed.

Both patients' treatment were successful. No complications occurred. A PubMed search on the topic of rib reconstruction of the frontal sinus and skull was performed; 18 publications matched the inclusion criteria. From these sources, we noted that 182 reconstructions yielded good results with few complications.

Large defects of the anterior wall of the frontal sinus can be closed successfully using autologous split-rib grafting. Aesthetic outcome is good and donor site morbidity is minimal.

To review the existing diagnostic modalities and treatment for primary tracheal synovial sarcoma, and to report a case of primary cervical synovial sarcoma arising in the trachea.

Retrospective.

Head and neck surgery unit at a tertiary university centre.

One case of primary cervical tracheal monophasic synovial sarcoma diagnosed by SYT–SSX gene rearrangement.

This patient underwent surgical resection of the synovial sarcoma, together with tracheal resection and primary anastomosis assisted by laryngeal-releasing manoeuvres, without complication.

Clinical, radiographical, pathological and surgical information were collected.

One year post-operatively, there was no evidence of recurrence.

Synovial sarcoma arising in the trachea is very rare. Diagnosis is confirmed by demonstrating the SYT–SSX gene rearrangement. The first-line treatment is surgery.

We report the first UK case of supraglottitis secondary to Neisseria meningitidis.

Case report with review of the current literature on supraglottitis and its aetiology.

An 89-year-old woman was referred with worsening symptoms of dysphagia, hoarseness and neck discomfort. After nasopharyngoscopy and neck X-ray, supraglottitis was diagnosed. Prompt treatment comprised nebulised adrenaline, oxygen therapy and intravenous antibiotics. Microbiology samples grew N meningitidis, a notifiable disease in the UK. Public health officials were informed, and full precautions and prophylactic treatment initiated for those at risk. The patient made excellent progress and was discharged several days later.

Supraglottitis occurs in <4 per 100 000 population. Following a successful UK childhood immunisation programme, most cases occur in adults. Supraglottitis secondary to N meningitidis is exceptionally rare, with only seven other reported cases worldwide. Morbidity is exceptionally high; over 60 per cent of patients require airway intervention. To our knowledge, this is the first reported UK case of supraglottitis secondary to N meningitidis. This case highlights the important clinical, diagnostic and therapeutic interventions required to prevent complications associated with this potentially fatal condition.

We report a case of weakness of the buccal branch of the facial nerve after a canine fossa puncture procedure.

A case report and literature review are presented.

A 52-year-old woman diagnosed with right chronic maxillary sinusitis underwent canine fossa puncture during endoscopic sinus surgery. Immediately after the operation, she complained of motor weakness of the right upper lip and oral commissure, in the area innervated by the buccal branch of the facial nerve. Electroneurography revealed incomplete paralysis of the right buccal branch. However, facial weakness had recovered spontaneously by three months post-operatively, with no permanent disability.

This is the first reported case of an injury to the buccal branch of the facial nerve following canine fossa puncture. Although the incidence of this complication is very low, surgeons should inform their patients of the possibility, and should take care when choosing the puncture site.