A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.

The ‘minitracheotomy’ i.e. an indwelling narrow-bore endotracheal tube which is inserted via the cricothroid membrane to provide access for the removal of secretions from the tracheobronchial tree following major thoracic and abdominal surgery, has recently been developed. In order to investigate whether its use may be injurious to the larynx, a prospective study was carried out assessing laryngeal function pre- and post-operatively in 14 patients, No permanent changes in laryngeal function were found and it was concluded that, when used for shourt post-operative periods, the larynx is not adversely effected.

Each of the three types of ethmoidectomy: intra-nasal, trans-antral and external, has its supporters and detractors who argue about the efficacy and safety of the procedures. One hundred and five ethmoidec-tomies for nasal polyps are reviewed retrospectively. Regardless of the approach used, approximately half of these had recurrence of polyps and some patients had several revision operations. There were six complications specific to the surgery. None was serious but most occurred with external ethmoidectomy. The limitations of ethmoidectomy for nasal polyps, the reasons for the good safety record and the best means of training juniors in the procedures are discussed.

Inverted papilloma can be found in the lateral wall of the nose, the ethmoidal sinus, the maxillary sinus, the sphenoidal sinus and the frontal sinus. To our knowledge there are no reports of papillomas with intracranial extension. This case report describes the history of a patient with long-standing inverted papillomas, which eventually grew intracranially. The treatment of this patient and the treatment of inverted papilloma in general are discussed.

Two patients with Moebius' syndrome are described, a brother and a sister. In addition to bilateral congenital facial nerve paralysis, both had deafness, an external deformity of the auricles, and a latent squint. The deafness in both cases was sensorineural in type; although there was paralysis of the motor part of the facial nerve, taste and lacrimation were intact. This report shows that not all components of the facial nerve are always effected in this syndrome.

During the 10-year period 1917–1980, oesophagoscopy was carried out on a total of 3235 patients in the Department of Otolaryngology, Turku University Central Hospital, Finland. Oesophageal carcinoma was diagnosed in 258 patients, 113 (44 per cent) men and 145 (56 per cent) women. The diagnosis was verified in 228 cases (88.4 per cent) by using an optical rigid oesophagoscope and in 30 cases (11.6 per cent) by a fibreoptic endoscope. The most common and earliest symptom was difficulty in swallowing in 50 per cent of cases. In 44 per cent of patients the symptoms persisted over six months before diagnosis. Upper and middle thoracic portions of the oesophagus were the sites of origin of the carcinoma in 57 per cent of the patients. The macroscopic picture obtained by oesophagoscopy was regarded as malignant in 83 per cent of patients and extraoesophageal spread of the tumour was estimated to be present in 48 per cent of patients by the time of diagnosis. Histological studies showed the tumour to be squamous cell carcinoma in 62 per cent of patients and in 24 per cent well differentiated. Squamous cell carcinoma was seen more often in men than in women. In patients with carcinoma in situ, alcohol and tobacco were regarded as aetiological factors in 53 per cent of cases. The need for repeated oesophagoscopy in patients with symptoms related to swallowing is stressed.

Two cases are reported confirming and demonstrating the relationship between spinal puncture or injection and VIIIth nerve function as a result of intracranial pressure changes.

A series of of 24 patients wtih a documented diagnosis of non-Hodgkin's extranodal lymphoma (ENL) involving head and neck sites (excluding the cranial cavity) has been studied. In view of recent advances in the diagnosis of lymphoma, a retrospective histopathological review has been undertaken to place all patients in standardized classifications for morphology (the working formulation) and immunology (Kiel). This resulted in a change of diagnosis from non-Hodgkin's lymphoma in four. The histopathology of these four cases, and the implication of such changed diagnoses are discussed. Of the 20 patients confirmed as having non-Hodgkin's ENL, 16 had primary ENL and four had an ENL focus secondary to disease elsewhere. Three patients in this series had an initial diagnosis made of another malignancy, but histopathological review prior to treatment changed the diagnosis to ENL. Details of presentation, pretreatment evaluation, immunohistochemistry, treatment and course have been analysed. The principal treatment policy for primary ENL has been radiotherapy. Of the 12 patients who received this treatment ten achieved a complete response (83 per cent). Eight remain free of disease at the time of writing. The role of adjuvant chemotherapy is also considered.

Three cases of embryonal rhabdomyosarcoma in the middle ear and mastoid in children are presented. Diagnosis was confirmed by histopathology. A multidisciplinary approach employing surgery, chemotherapy and radiation therapy is the method of choice in the management of this rare and highly lethal condition.

Teratomas are congenital tumours arising from pluripotent cells and usually consisting of tissue arising from all 3 embryonic germ layers. Teratomas are quite uncommon in head and neck sites and to date only 150 such cases have been reported. A rate case of teratoma of the mastoid region in a newborn is reported. The methods of diagnosis and treatment are discussed and the literature is reviewed.

Epistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma.

We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.

In a nine-year period 50 nasopharyngeal angiofibromas, of whom 13 had recurrent tumour, were treated surgically at the All India Institute of Medical Sciences, New Delhi. A new staging system according to the regions involved was used; 31 patients in whom the tumour was limited to the nasopharynx (Stage I) and those with superior spread into the ethmoid or sphenoid sinuses (Stage IIA) had their tumours removed by a transpalatal route, alone or in combination with other approaches. Tumours with lateral extensions into the pterygopalatine or infratemporal fossae or the cheek (Stage IIB), and those with simultaneous superior and lateral spread (Stage HI) underwent a transmaxillary excision (19 cases). In two of the three cases with intracranial extension (Stage IV), the tumour was removed successfully from below. There was no mortality. The usefulness of the transmaxillary approach, especially in recurrent cases, is emphasized. No adjuvant modalities were employed in this series and blood loss was acceptable.

‘Benign metastasizing mixed tumours’ are enigmatic lesions of the parotid gland. The authors, through the illustrations of a case and review of the literature, conclude that the tumours are unrecognized and currently unclassified malignancies.

Brainstem auditory evoked potentials (BAEP) were recorded in two patients with nasopharyngeal carcinoma (NPC) irradiated 14 and three years ago respectively and compared with 15 healthy controls. The patients had features of post- irradiation myelopathy of the brainstem with reduced gag reflex, unilateral vocal cord paralysis and fasciculation of the tongue. The first patient had a blind left eye. The second patient had quadriparesis. All ears revealed post-irradiation otitis media changes and mixed deafness. BAEP was not recognizable in the left ear of the first patient and was normal in the left ear of the second patient. Simultaneous electrocochleogram and BAEP were recorded from the right ear of the first case. The wave I–V latency interval were rolonged in both right ears. In the absence of local recurrence and brain secondaries, these BAEP changes are attributed to the post-irradiation myelopathy of brainstem.