Four cases of hyoid bone fracture with laceration of the pharynx are presented. The emergency treatment must aim at an exploration of the neck in an attempt to suture the lacerations of the pharyngeal musosa.The fractured hyoid bone may be left untouched in most cases.

The most common causes of fractures of the hyoid bone were previously considered to be violent strangulation and hanging.In the last two decades however, road accidents seem to have become the most important cause in patients who survive the initial impact of collision.

The biodynamics of injury to the pharynx and larynx in road accidents hava been adequately described by Nahum and siegel(1967). They concluded that the driver was the most commonly collides.

It is very easy to miss a fractured hyoid bone duing the urgent admission of a patient injured in a accident, since the more dramatic injures in a traffic in a traffic accident, since the more dramatic injuries are treated first and and a tracheostomy is often often perfomed to provide an airway.

A CASE of granulomatous vasculitis affecting vessels in the left temporal area of the skull, and also vessels in the right and left axillary areas, is described. Initially, the patient responded favourably to antibiotic therapy, raising the possibility of a microbiologic agent as the causative factor of this puzzling disorder. Finally she has responded very favourably to steroids, thereby indicating a possible immunologic basis for the condition, as has already been postulated by several authors.

AN unusual case of otalgia with severe, piercing, almost constant, shock-like pain localized deep in the ear of a girl of 12 years is described. Clinical examination and investigations failed to demonstrate any organic pathology in the ear, nose, para-nasal sinuses, fauces, pharynx, larynx, teeth, jaws, temporomandibular joint, salivary glands, neck or posterior cranial fossa. Medical treatment and infiltration of local analgesics around the cutaneous nerves brought no relief. The pain was relieved temporarily by chorda tympani neurectomy and permanently by section of the nervus intermedius, thus leading to a diagnosis of nervus intermedius neuralgia.

Pain is a warning signal against potential or actual damage to tissue cells. The middle ear is one of those areas which is sensitive to pricking, scratching, cutting, pressure or extremes of heat and cold.

Earache is a very common complaint. Pain may be felt in the ear but the cause may lie elsewhere. Such patients with referred otalgia often present to the otologist; rarely, they present with otalgia of neuralgic quality, with piercing, shock-like pain, without any demonstrable or detectable cause in the distribution of the cranial nerves supplying the ear. One such condition is the otological type of geniculate neuralgia, in which the pain is centered within the ear and may radiate to the deeper structures of the face; the attack may be paroxysmal or continuous.

The following case of otalgia is reported because of its rarity, its juvenile age of onset, and the problem posed in treatment. The patient was relieved only by surgical treatment.