To present a previously unreported cause of frontal mucocele.

A patient presented with a frontal mucocele and maxillary sinusitis. Computed tomography revealed an ectopic maxillary tooth as the cause of her signs and symptoms. Removal of the tooth by a Caldwell–Luc procedure facilitated resolution of the mucocele. Conventional treatment of mucoceles by endoscopic sinus surgery, and other rhinological sequelae of ectopic teeth, are considered.

This is the first documented case of an ectopic tooth causing a frontal mucocele, and demonstrates how effectively the patient's symptoms resolved on removal of the tooth.

The 1998 National Health Service White Paper stated that anyone suspected of having a cancer would be seen by a specialist within two weeks. The ‘trigger symptoms’ prompting such referral have been nationally agreed by the National Institute for Health and Clinical Excellence. This study aimed to quantify the diagnostic yield of urgent referrals for suspected head and neck malignancy, and to identify reasons why patients ultimately diagnosed with malignancy may not have been referred via this pathway.

All patients referred to the trust with suspected head and neck malignancy in 2005 were included in the study. Data were obtained on date of referral, date of appointment, reason for referral and which National Institute for Health and Clinical Excellence guideline heading the referral fell under, clinical findings, and final diagnosis. Concurrently, all patients in the trust with a histological diagnosis of head and neck malignancy were identified using the computer records of the pathology department.

One hundred and seventy-seven patients were referred with suspected head and neck malignancy over the one-year study period. Of these, 169 were seen within two weeks. The commonest causes of referral were hoarseness and neck lumps. Of these patients, 22 (12 per cent) were ultimately diagnosed with malignancy. During the one-year study period, 39 patients were diagnosed hospital-wide with head and neck malignancy, 17 of whom had not been referred via the urgent referral pathway. No unifying theme was identified to explain why these patients had not been referred via this pathway.

In a group of patients with symptoms suggestive of head and neck malignancy, only 12 per cent were ultimately diagnosed with cancer. Of all the patients within the trust diagnosed with head and neck cancer, 44 per cent had come from outside the urgent referral pathway.

Despite multiple systemic manifestations, sudden sensorineural hearing loss in a patient with antiphospholipid syndrome is rarely reported.

A 46-year-old man with primary antiphospholipid syndrome had a sudden onset of hearing loss and tinnitus in the right ear in December 2005, because he discontinued use of warfarin and acetylsalicylic acid for a few days.

Audiometry revealed saucer-type sensorineural hearing loss with a pure tone average of 73 dB in the right ear, and flat-type hearing loss with a pure tone average of 25 dB in the left ear. Electronystagmography displayed multiple central signs and bilateral canal paresis, while a vestibular evoked myogenic potential test revealed bilateral delayed responses. After admission, the patient was re-treated with warfarin and acetylsalicylic acid. Follow-up audiometry showed recovery of right-sided hearing, with a pure tone average of 12 dB, three days after presentation.

Consensus exists on the effectiveness of anticoagulant agents in aiding a favourable outcome of sudden sensorineural hearing loss in patients with antiphospholipid syndrome.

The nasopharyngeal airway is a simple airway adjunct used by various healthcare professionals. It is the least invasive method of safely managing upper airway obstruction. The objective of this report was to describe a rapid and very simple method of securing a nasopharyngeal airway in an agitated patient.

We describe a simple method of securing a nasopharyngeal airway, using safety pins and tapes.

This technique has been used by the authors in several emergency situations and has been found to be quick and effective.

The nasopharyngeal airway is a simple piece of equipment that is cheap and easy to use. The technique described in this article is a simple, practical and effective method of securing a nasopharyngeal airway in an emergency situation.

Several studies have implied that patients' quality of life stabilises six months after undergoing total laryngectomy. However, these studies may well have overlooked persistent short term variations in patients' quality of life. The aim of this study was to assess the impact of seasonal change (i.e. summer vs winter) on the quality of life of patients following total laryngectomy.

A prospective, cross-sectional study of recurrence-free laryngectomy patients was performed, using the European Organization for Research and Treatment of Cancer (version three) QLQ-C30 questionnaires (EORTC QLQ-C30), during January 2004 (i.e. winter), August 2004 (summer) and January 2005 (winter).

Thirty-six patients were entered into the study. The response rate was 70.3 per cent. Patient's time elapsed since surgery varied from six months to 12 years. In all questionnaire domains, responses seemed remarkably consistent over time.

No statistically significant differences were found between summer and winter scores in all the domains analysed by the EORTC QLQ-C30.

Foregut duplication cysts are heterotrophic rests of foregut-derived epithelium which are usually found in the abdomen and thorax; rarely are they found in the head and neck.

We describe the case of a pharyngeal foregut duplication cyst presenting with airway obstruction in a neonate. We also review the pathology, investigation and management of this rare condition.

The occurrence of a foregut duplication cyst in the head and neck region mandates vigilance with respect to the airway. Magnetic resonance imaging is a useful part of pre-operative evaluation but cannot be relied upon for definitive diagnosis. Although foregut duplication cysts are benign lesions, definitive cure ultimately requires surgical excision, and this is often the means by which a definitive diagnosis is made. The prognosis for these lesions is excellent, with no reports in the literature of recurrence following excision.

Oral ulceration has many causes and is a common presenting symptom in otolaryngology.

This article presents an unusual case of dual pathology oral ulceration in an elderly patient. Oral malignancy was initially suspected, but the history, examination and investigation showed that the oral ulceration was caused by actinomycosis infection and by nicorandil use.

Cervicofacial acinomycosis is a rare, suppurative bacterial disease in which abscesses can form in the tissues and break through the skin, creating pus-discharging lesions. Nicorandil is a potassium channel blocker used in the treatment of ischaemic heart disease. It has been recently recognised as a cause of persistent ulcerative stomatitis.

This case highlights the importance of a high index of suspicion for unusual and reversible causes of oral ulceration, and of dual pathology as a cause. Such vigilance enables early recognition and treatment of potentially reversible conditions.

We report an extremely rare case of bilateral posterior nasal septal abscess in an otherwise healthy adult patient.

Case report and a review of the world literature concerning atraumatic nasal septal abscess and its management.

The development of an atraumatic nasal septal abscess is rare, but it has been reported in association with acute sinusitis, in patients with poor immunity and in children. The presentation, clinical course and treatment are discussed in the presented patient.

To our knowledge, this is the first report in the world literature of a bilateral posterior septal abscess associated with acute sinusitis in an otherwise healthy adult.

We report an extremely rare case of nasopharyngeal carcinoma presenting as a lateral neck abscess complicated by endogenous bacterial endophthalmitis. Endogenous bacterial endophthalmitis complicating a neck abscess has not been reported in the recent English literature. We discuss the possible pathophysiology of neck abscess as a presenting feature of nasopharyngeal carcinoma, and the relationship between the parapharyngeal abscess and endogenous bacterial endophthalmitis.

A middle-aged Chinese man presented with a left neck abscess associated with progressive vision deterioration and proptosis of the left eye. Incidentally, his random blood glucose was found to be elevated. Nasal endoscopy also revealed bilateral bogginess in the fossa of Rosenmuller. A diagnosis of left neck abscess with endogenous endophthalmitis associated with underlying diabetes mellitus was made. A computed tomography scan of the neck showed a left parapharyngeal abscess. Incision and drainage of the abscess together with biopsy of the nasopharynx was performed. Due to the non-salvageable condition of the left eye, evisceration was also performed. Pus culture studies from the neck abscess grew Klebsiella pneumoniae, and nasopharyngeal biopsy revealed undifferentiated carcinoma.

Nasopharyngeal carcinoma is endemic in South East Asia and can have multiple, varied presentations. Therefore, in this setting, the clinician should have a high index of suspicion, especially in a patient from the Chinese ethnic group.

Nasopharyngeal carcinoma can present with a variety of symptoms the most common being painless cervical lymph node metastases, epistaxis and conductive hearing loss.

We report a case of an 18-year-old male patient presenting to the ENT department with left sided carotidynia – severe pain in the neck radiating up to his ear. He had a small, exquisitely tender lump just below the bifurcation of the left common carotid artery. After the appropriate investigations he was diagnosed with nasopharyngeal carcinoma.

In a literature search on Medline and Pubmed we found no reported cases of nasopharyngeal carcinoma presenting with carotidynia, nor was carotidynia ever found to be associated with nasopharyngeal carcinoma.

We believe that this is the first reported case of such a presentation of nasopharyngeal carcinoma.

Carotid body tumours are rare lesions which are familial in 10 per cent of cases. In this paper, we demonstrate the clinical applicability of predictive genetic testing for familial carotid body tumours.

We report a case manifesting with multiple carotid body tumours, in which subsequent genetic testing demonstrated a germline mutation which could be traced across generations. We review the diagnosis and management of carotid body tumours in the familial setting, together with the strategies presently available to screen individuals from susceptible families.

The recent advent of a predictive genetic test for familial carotid body tumours offers a novel means of pre-selecting those at risk, so as to minimise screening costs and patient morbidity. Early diagnosis of lesions is essential to allow early intervention, reducing surgical morbidity and progression to malignancy.

To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.

A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.

All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.