We report an extremely rare case of rhinosporidiosis with involvement of both larynx and trachea, together with coexisting nasal, nasopharyngeal and oropharyngeal lesions, in a 32-year-old man.

Case report and review of the world literature concerning laryngotracheal and disseminated rhinosporidiosis.

A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities. Fibre-optic laryngoscopic examination revealed reddish masses with whitish surface specks, involving the glottis, subglottis and trachea. Computed tomography revealed soft tissue opacities involving both nasal cavities and the nasopharynx and extending to the oropharynx, with involvement of the larynx and trachea. Direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions was performed.

Rhinosporidiosis is a chronic, granulomatous disease which usually affects the mucous membranes of the nose and nasopharynx. Lower dissemination into the trachea is extremely rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges, due to the potential risk of bleeding and aspiration. In the presented case, local spread of rhinosporidiosis, due to direct spillage of spores from the nasopharynx into the larynx during episodes of bleeding or previous surgery, may have resulted in laryngotracheal involvement, although systemic spread cannot be excluded.

To report a rare case of severe laryngeal fracture treated by supracricoid laryngectomy. Previously, a few cases of major laryngeal trauma treated by reconstructive laryngectomy have been briefly described. This paper aims to comprehensively document a rare case of severe laryngeal fracture for which this difficult treatment choice represented an acceptable option.

A 33-year-old woman sustained very serious blunt laryngeal trauma. The complexity of the laryngeal injuries led us to opt for supracricoid laryngectomy, rather than to attempt laryngeal repair.

The post-operative course was normal. The patient's post-operative voice was breathy but functional. No airway stenoses occurred.

For severe laryngeal fractures, reparative procedures and stenting constitute the standard treatment. However, in selected and especially critical cases, a primary partial or reconstructive laryngectomy is justifiable.

Deformities of the carotid artery are rare. Tortuosity, kinking and coiling of the internal carotid artery may be observed with advancing age. A tortuous internal carotid artery may cause an abnormal sensation in the throat. In the early twentieth century, there were several reported cases of fatal haemorrhage during pharyngeal surgical procedures, because this condition went undetected.

We present two cases of tortuosity of the right internal carotid artery. Both women complained of abnormal throat sensations. Endoscopic studies and radiological examinations revealed tortuous right internal carotid arteries presenting as pulsatile masses. A literature review revealed that, in most reported cases, this deformity occurred on the right side. We believe that the defect and its right-sided predominance can be attributed to anatomical influences and factors affecting blood pressure.

In most reported cases of tortuous internal carotid artery, the defect occurred on the right side and patients complained of an abnormal sensation in the throat. This information is useful in the diagnosis of this condition. It is important for otolaryngologists to recognise this anomaly, because fatal haemorrhage can occur in patients with this condition during surgical procedures on the pharynx.

Small cell carcinoma has the worst prognosis of all laryngeal neoplasms. In order to further characterise this tumour, with a view to development of new therapeutic approaches, we report the results of KIT gene and platelet-derived growth factor receptor α gene expression analysis, for two extremely rare cases of primary small cell carcinoma of the larynx.

Case reports, including immunohistochemical study, and review of the literature.

We present two patients with laryngeal small cell carcinoma, who died from tumour metastasis to the lungs and brain despite aggressive treatment. Immunohistochemical studies revealed positive reactions for KIT gene expression and platelet-derived growth factor α gene expression in patient one, and for KIT gene expression in patient two. Molecular genetic analysis, using polymerase chain reaction direct sequencing, identified no mutations of the KIT or platelet-derived growth factor receptor α genes.

Although further investigation is necessary regarding KIT gene expression and platelet-derived growth factor receptor α gene expression in laryngeal small cell carcinoma, the reported results suggest that these genes may be significant in the development of molecular targeted therapy.

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.

We report two patients presenting with spinal stenosis and cord compression secondary to cranio-vertebral tuberculosis, who were successfully decompressed via an endoscopic, endonasal approach.

Two case reports.

Both patients were successfully decompressed via an endoscopic, endonasal approach which provided access to the cranio-vertebral junction and upper cervical spine.

An endoscopic, endonasal approach is feasible for the surgical management of cranio-vertebral junction stenosis; such an approach minimises surgical trauma to critical structures, reducing post-operative morbidity and the duration of hospital stay.

To review previous reports and to discuss the management of branching polycystic and giant thyroglossal duct cysts.

We present two cases of thyroglossal duct cyst: one a branching, polycystic thyroglossal duct cyst in an 11-year-old boy, and the other a giant thyroglossal cyst in a 41-year-old man. Such cysts are rare. Both patients were operated upon according to the methods of Sistrunk and Horisawa, and both had a satisfactory post-operative course.

We discuss the most important aspects of such cyst removal procedures.

Our experience suggests that surgery to remove an anomalous thyroglossal duct cyst should be performed using a technique based on the anatomy of the hyoid bone region.

We report a case of spontaneous pneumomediastinum presenting with chest and anterior neck pain.

The clinical findings, differential diagnosis and selection of radiological investigations are discussed.

Spontaneous pneumomediastinum is an uncommon condition usually presenting in young patients. Presentation to the otolaryngology department occurs due to the presence of symptoms such as neck pain. Differential diagnoses must be considered and excluded, using the clinical features and the results of radiological investigation. Once the diagnosis is confirmed, conservative management is undertaken.

Spontaneous pneumomediastinum is uncommon and the clinical features are variable. The recommended investigation is a computed tomography scan with orally administered, water soluble contrast to exclude important differential diagnoses and thus enable definitive diagnosis.

To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis.

A 62-year-old man presented to his general practitioner with a severe, right-sided, temporal headache. He was diagnosed with temporal arteritis and treated with systemic steroids. After five days, he developed right proptosis, ophthalmoplegia and ptosis. He was referred to the neurologists. After an urgent computed tomography head scan and computed tomography angiogram, a diagnosis of carotido-cavernous fistula was made. However, this was subsequently excluded after a negative cerebral angiogram. A review of the scans enabled diagnosis of right cavernous sinus thrombosis secondary to left sphenoiditis. The patient was referred to the otolaryngology team. After an urgent endoscopic sphenoidotomy and medical treatment, all symptoms and signs improved dramatically.

Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.

We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess.

Case report and review of the world literature.

A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up.

This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.

We report a case of a multinodular goitre developing in a lingual thyroid.

Case report, and discussion of the embryology and treatment of lingual thyroids.

A 66-year-old woman presented with dysphagia secondary to a multinodular lingual goitre. A previously silent lingual thyroid had undergone multinodular change to cause dysphagia and eventually airway compromise. The goitre was excised via a midline, mandible-splitting approach.

Lingual thyroids have an incidence of one in 3000 to 10 000. There has not previously been a reported case of such an ectopic gland undergoing multinodular changes and presenting in later life.

We report the case of a recurrent familial malignant carotid body tumour presenting with metastasis to local ipsilateral lymph nodes; the rarity of both recurrence combined with nodal spread is emphasised in this article.

We present a case report, and a review of the world literature concerning the diagnosis and management of carotid body tumours in the familial setting.

A woman with a family history of succinate dehydrogenase complex subunit B gene mutation presented with right vocal fold palsy. A causative carotid body tumour was excised. Fifteen years later, the patient developed a right-sided swelling in the jugulo-digastric region, together with shooting pains towards her right ear. Imaging revealed right posterior triangle lymphadenopathy. Fine needle aspiration cytology of the node was equivocal. Computed tomography of her neck revealed, in addition, a mass within the right side of the larynx. Excision biopsy of the lymph node demonstrated metastatic paraganglioma. A carotid angiogram revealed a right-sided carotid body tumour. This was embolised prior to neck exploration and excision of the carotid body tumour with en bloc resection of adjacent nodes. Histological analysis confirmed the presence of lymph nodes containing metastatic paraganglioma.

This case report demonstrates the need for extra vigilance to enable early disease detection in the familial setting of carotid body tumour, in order to reduce the surgical morbidity associated with disease progression. In addition, our report highlights the atypical aspects of presentation in the familial setting, together with the difficulty and lack of standardisation regarding monitoring of the disease.

To consolidate the key features of carcinoma showing thymus-like element, including its management.

We present our experience of the difficult diagnosis and management of this rare tumour. We also present the results of an extensive literature search, documenting those aspects of the clinical picture, natural history and management of carcinoma showing thymus-like element which are relevant to head and neck surgeons.

Intrathyroidal, epithelial carcinoma showing thymus-like element is a rare, malignant tumour of the thyroid gland, with histopathological features similar to squamous cell carcinoma but a more favourable prognosis. It is usually treated surgically using a combination of total thyroidectomy and selective neck dissection, with radiotherapy and chemotherapy in selected cases.

Carcinoma showing thymus-like element of the thyroid gland is a rare condition. Head and neck surgeons with a thyroid interest should be aware of this tumour, because of its close histological resemblance to other, commoner malignancies of the thyroid gland.

We present the first report of agenesis of the middle nasal turbinate.

We present a case report and briefly discuss the world literature.

A 57-year-old man presenting with sinonasal symptoms was evaluated clinically and radiologically. Agenesis of the patient's left middle turbinate was detected. Coronal computed tomography images showed a septal spur replacing the absent left middle turbinate.

The lateral nasal wall has complex anatomy, and several anatomical variations have been reported. The most common anatomical variation of the middle nasal turbinate is concha bullosa. Unilateral agenesis of the middle nasal turbinate has not previously been reported; the presented patient represents the first reported case.

Ectopic cervical thymus is a rare anomaly, and 50 per cent of cases occur in children. The aim of this report was to remind clinicians of this rare condition, which is part of the differential diagnosis of a paediatric neck lump.

Case report together with literature review of the pathogenesis and management of ectopic cervical thymus.

The ectopic cervical thymus is a rare cause of a benign neck mass, and is thus usually misdiagnosed as lymphadenopathy or neoplasia. We discuss its embryology, aetiology, presentation, histopathology, radiology and management, with reference to the reported case.

Ectopic cervical thymus should always be considered in the differential diagnosis of a paediatric neck lump. The diagnosis can often be confirmed by cytology and radiology prior to surgical excision.