The present study evaluates histological characteristics of the soft tissue response to long-term implantation of Apaceram™ discs composed of dense hydroxyapatite in rats. Discs were implanted into the subcutaneous tissue of 76 rats for six to 20 months. Decalcified histological sections stained with haematoxylin and eosin (H & E) and Mallory's azan were examined. Different cell types surrounding implants were counted. The greatest proportion of macrophages was found at six months (13.5 per cent). This proportion gradually decreased to four per cent at 20 months. Small numbers of lymphocytes and foreign body giant cells were observed in every group, but neither neutrophils nor osteogenesis were observed in any specimens. Results of the present study and previous related studies indicate that despite reappearance of a small number of macrophages six months after implantation, Apaceram™ is useful for reconstructive surgery.

Temporalis fascia, placed as an underlay graft, is commonly used to repair tympanic membrane perforations. Graft failure, however, is a well recognized complication. Grafts are often allowed to dry out during the procedure and, therefore, are often positioned in a dry or partially dehydrated state and only become fully rehydrated after placement. This study looked at how the size of the temporalis fascia alters with its state of hydration. The size of 20 temporalis fascia grafts was measured when fresh, after flattening and allowing them to dry, and finally after rehydrating the grafts with 0.9 per cent saline solution. Significant shrinkage was demonstrated. It is therefore proposed that a cause of increased failure rates, particularly in anterior myringoplasties, is loss of underlay due to graft rehydration and shrinkage. Thus graft shrinkage should be considered when positioning the graft.

The complications of sinusitis have been well described. The most common classifications used for orbital complications have been that of Chandler et al. (1970) and Moloney et al. (1987). With the ready availability of high-resolution computed tomography (CT) scanners, limitations of these classifications have become apparent. The aims of this study were to determine the relative frequency of the various complications associated with acute sinusitis, to determine which groups of sinuses were most frequently involved and to correlate the orbital signs with a new proposed classification of orbital complications. Over a five-year period, 87 consecutive patients were admitted with acute sinusitis. Sixty-three patients (72.4 per cent) had one or more complications. When orbital complications were classified under the proposed classification, all patients with proptosis and/or decreased eye movement had post-septal infection. Visual impairment occurred only in the post-septal group. Most complications had a combination of sinus involvement with the maxillary/ethmoid/frontal combination being the most common. The authors propose a modification of Moloney's classification for orbital complications of acute sinusitis that allows a clear differentiation between pre- and post-septal infection and a radiological differentiation to be made between cellulitis/phlegmon and abscess formation. The latter is of importance when a decision is made on whether surgical intervention is appropriate or not.

Nasopharyngeal carcinoma (NPC) is one of the most difficult diseases to diagnose at an early stage. The clinical presentation of 122 patients with confirmed NPC is described and the findings analysed. The common modes of presentation and cases where detailed nasopharyngeal examination need to be performed are highlighted. We emphasize the importance of health education and training for primary care physicians for early detection of these cases.

Between October 1987 and October 1993, 92 patients with squamous cell carcinoma of the supraglottis were treated by supraglottic laryngectomy and neck dissection in our department. There were 33 T1, 46 T2, six T3 and seven T4 cases. All patients with N+ necks and T3 or T4 tumours received post-operative radiotherapy (5,000–6,500 cGy). The patients were followed for a minimum of 36 months or until death. The incidence of local recurrence was 7.6 per cent. Neck recurrence was observed in 13 per cent of patients. Decannulation was achieved in 93.4 per cent of the cases with three patients undergoing gastrostomy because of aspiration. The average hospital stay was 26 days. The overall three-year survival was 83.6 per cent, with eight patients dying of unrelated causes. There was a significant difference in recurrence rate between patients in the N0 and the N+ stage.

Tonsillectomy is frequently associated with a considerable post-operative morbidity. In some cases reactionary or secondary haemorrhage occurs and all patients suffer a degree of post-operative pain. The use of bipolar diathermy excision has become popular because it reduces intra-operative blood loss, but all diathermy inevitably produces a degree of damage to adjacent normal soft tissues. In turn this inadvertent injury must act to increase the post-operative pain.

Monopolar dissection using a fine tungsten diathermy needle (the Colorado needle) allows sharp dissection at low power levels and in previous studies has been shown to produce a reduction in collateral tissue damage. In this prospective study the morbidity associated with tonsillectomy using this needle was compared to that following a standard bipolar dissection.

Using the monopolar needle produced no enhanced risk of reactionary or secondary haemorrhage while causing significantly less post-operative pain and a reduction in eschar. We believe that excision using this needle preserves the advantages associated with bipolar dissection while reducing local soft tissue damage.

Nasendoscopy is an essential tool in assessing the dynamic function and structure of the velopharyngeal sphincter during speech and swallowing.

Flexible fibre-optic nasendoscopy has been used by the cleft palate team at Withington Hospital, Manchester since 1989. Seventy-six patients were referred between 1989 and 1994 for evaluation of velopharyngeal function during speech. Flexible nasendoscopic evaluation was attempted in 50 patients, and successfully carried out in 43 patients. The age range was four years to 77 years (mean 21 years). The patients were divided into two groups: Group 1 consisting of patients with cleft palate and Group 2 comprised of patients with non-overt cleft palate-related velopharyngeal dysfunction of various aetiologies; such as, submucous cleft, post-tonsillectomy, post-adenoidectomy, neurological and post-traumatic.

Based on the findings on nasendoscopy, videofluoroscopy and clinical speech/voice analysis the following treatment options were recommended: 17 (40 per cent) for pharyngoplasty, five (11 per cent) for revision pharyngoplasty, 15 (35 per cent) for speech therapy, four for an obturator and one for tonsillectomy. Two previously undetected submucous clefts were diagnosed.

Wegener's granulomatosis is a systemic vasculitis that may present with a Variety of findings and be difficult to diagnose. We report a case of a patient who presented with serous otitis media and subsequently developed a suspected primary lung tumour. Thoracotomy and pulmonary mass excision were required to establish the diagnosis. Otological manifestations of Wegener's granulomatosis, differential diagnosis, pathological findings and c-ANCA test role are discussed.

A case of a penetrating oral foreign body presenting with an aural polyp is described. The possibility of a penetrating oral injury should be considered whenever a child's fall is unwitnessed, as it is easily overlooked. An underlying foreign body should be considered in cases where an aural polyp fails to respond to standard therapy. MRI may be the best imaging technique to identify plastic foreign material.

We present a case of tuberculous otitis media in which a facial palsy occurred after the start of appropriate chemotherapy. To our knowledge this circumstance has not been described previously. It has been argued that radical surgery is completely unnecessary if chemotherapy is commenced early in the disease. We would suggest that this is not always the case, and would advocate a more measured approach.

Fluctuant and progressive hearing impairment in a patient with a wide vestibular aqueduct has been called the ‘large vestibular aqueduct syndrome’. Recently reports of magnetic resonance imaging (MRI) studies describe enlargement of the endolymphatic sac and duct in patients shown to have large vestibular aqueducts by computed tomography (CT). A patient with progressive deafness was shown to have borderline or slightly enlarged vestibular aqueducts by re-formatted sagittal CT. However, MRI in axial and sagittal planes gave a more satisfactory demonstration of both aqueduct and endolymphatic sac enlargement.

The pathophysiology of otitic hydrocephalus remains controversial. It has been argued that involvement of the superior sagittal sinus, by, at least, a mural thrombus is a necessary component of this disease.

We present a case of otitic hydrocephalus where on magnetic resonance imaging (MRI) normal luminal and mural flow within the superior sagittal sinus is demonstrated. The presence of thrombus in the lateral venous sinus alone appears sufficient in this case to impede venous drainage of the intracranial contents into the neck and produce a rise in the cerebral venous pressure and a subsequent increase in the CSF pressure. The presence of a superior sagittal sinus mural thrombus is not required.

The ciliary beat frequency measurements taken from a nasal polyp from a cystic fibrosis patient were similar to that of the control nasal polyps. The addition of a ciliotoxic lectin produced by Pseudomonas aeruginosa stopped the beating of the cilia as in the controls. This reaction could be blocked by the pre-incubation of the lectin with its inhibitor fucose. As in the control, the addition of fucose after the cilia had slowed resulted in a return to normal ciliary beating within 24 hours. This shows that the delta F508 CF mutation observed in this patient does not affect ciliary beating and suggests that treatment with fucose in the early stages of a Pseudomonas aeruginosa infection could be advantageous for cystic fibrosis patients.

Post-radiation necrosis of the larynx is a major complication after irradiation and has become rare. Recently, combined chemotherapy and radiation therapy has been introduced for head and neck tumours. The authors report a case of laryngeal necrosis after combination therapy for a patient with cervical lymph node metastases of nasopharyngeal carcinoma and review the literature on late laryngeal necrosis. Although radiation-induced laryngeal necrosis has become a rare complication, the combination of chemotherapy and radiation therapy may increase its incidence. We should always consider it as a possible late complication and treat it appropriately.

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

We present the first case report in the English literature of an intramuscular haemangioma of the geniohyoid muscle. This occurred in a 24-year-old female and the diagnosis was not made prior to resection. Haemangiomas are uncommon tumours of the head and neck and intramuscular haemangiomas account for fewer than one per cent of the total. Diagnosis of the vascular nature of the tumour is often missed. Recurrence is common and usually due to incomplete excision. A review of the literature and a case report of theselocally destructive lesions is presented.