The importance of thyroid scanning in neck lumps--a case report of ectopic tissue in the right submandibular region.

We describe the case of a 50-year-old previously well female, who presented with a slowly growing mass in the right submandibular region. Imaging confirmed the absence of a normally placed thyroid and the presence of a lingual thyroid. The submandibular mass was excised and histological examination confirmed ectopic thyroid tissue. The embryological descent of the thyroid and the Sistrunk procedure are discussed as well as the importance of thyroid scanning in neck lumps.

Complications of superficial parotidectomy versus extracapsular lumpectomy in the treatment of benign parotid lesions.

A total of 46 patients with benign parotid gland tumours have been operated upon between 1979 and 1989 in the Department of Otolaryngology at Leicester Royal Infirmary. Thirty-one were pleomorphic adenomas, six Warthin's tumours and nine miscellaneous tumours or tumour-like lesions. Extracapsular lumpectomy without facial nerve preparation was used in 31 cases (67%) and superficial parotidectomy in 15 cases (33%). One case of permanent partial facial palsy and one recurrence occurred in patients who underwent superficial parotidectomy. Frey's syndrome occurred in 40% of patients undergoing superficial parotidectomy. No permanent palsy, recurrence or Frey's syndrome occurred after extracapsular lumpectomy. These results suggest that extracapsular lumpectomy may reduce the morbidity rate in carefully selected patients.

Tumefactive fibroinflammatory lesions of the head and neck.

The term 'tumefactive fibroinflammatory lesion' has been used to describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance. We report five patients, over a five year period, with such a lesion. The clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy. However, the histological appearance of an admixture of chronic inflammatory cells and fibrosis is consistent with a benign condition. We recommend surgical excision of the lesion as the mainstay of treatment; other studies report the use of steroids and radiotherapy.

Emergency laryngectomy.

Emergency laryngectomy is a laryngectomy carried out for malignant obstruction of the upper airway within 24 h of admission. This combines relief of the obstruction with definitive primary cancer surgery, and is thought to reduce the risk of post-laryngectomy stomal recurrence. During a 5-year period, 13 patients with upper airway obstruction from squamous cell carcinoma were treated in two departments by emergency laryngectomy. Total laryngectomy was carried out after the diagnosis of squamous cell carcinoma of the larynx (n = 11), or piriform fossa (n = 2), had been confirmed by laryngoscopy and frozen section biopsy. The actuarial 5-year survival was 47%, and no patient in this series developed stomal recurrence. The management of the airway obstruction, and the post-laryngectomy complications, did not differ from those encountered with more conventional treatment. Our experience with this approach suggests that emergency laryngectomy is a satisfactory method of managing airway obstruction due to squamous cell carcinoma of the larynx.

Use of the fibreoptic laryngoscope in pharyngeal pouch surgery.

A further new application of the fibreoptic laryngoscope as an adjunct to the excision of pharyngeal pouches is described. Its use facilitates the procedure and thus reduces the time of surgery. This is clearly advantageous, particularly as many patients with pharyngeal pouches are elderly and may be less than fully fit especially if overspill from the pouch has caused recurrent chest infections.

Nasal regurgitation as the presenting symptom of rhinolithiasis.

Rhinoliths are not common but like other rare conditions have an attraction and therefore will be familiar. This case report has been presented as a reminder that perforation of the hard palate by a rhinolith does occur occasionally, and in this instance was a pleasant surprise to all concerned.

Carcinoid tumour of the middle ear associated with systemic symptoms.

Carcinoid tumour is one of the rarest middle-ear neoplasms. We describe here a case of carcinoid tumour of the middle-ear cleft that presented with aural as well as systemic symptoms. Diagnostic difficulty was encountered using light microscopy, but electron microscopy revealed the neurosecretory granules.

Median nasal dermoid fistulae.

Two cases of median nasal dermoid fistulae are presented. This is an uncommon developmental abnormality which may present either to ENT Surgeons, Plastic Surgeons, or Dermatologists. Although the extent of the tract in our cases was small, careful pre-operative assessment is required as the tract may be extensive.

Role of antibiotic class in the rate of liberation of endotoxin during therapy for experimental gram-negative bacterial sepsis.

To evaluate the role of antibiotic class in the rate of liberation of endotoxin during therapy for sepsis caused by gram-negative bacteria, we obtained serial blood samples from rabbits with sepsis caused by Escherichia coli and treated with chloramphenicol, gentamicin, or moxalactam. The concentrations of viable bacteria, free endotoxin, and total endotoxin in each blood sample were measured. In rabbits treated with chloramphenicol, the geometric mean levels of free endotoxin remained proportional to the geometric mean levels of bacteremia, a result indicating the absence of antibiotic-induced endotoxin liberation. In contrast, levels of free endotoxin increased rapidly while levels of bacteremia declined after treatment with gentamicin or moxalactam, a result indicating antibiotic-induced release of endotoxin. Despite similar rates of bacterial killing, mean levels of free endotoxin were as much as 20-fold higher in rabbits treated with moxalactam than in paired rabbits receiving gentamicin (P less than .05). These results indicate that endotoxin liberation during therapy for sepsis caused by gram-negative bacteria is dependent upon the class of antibiotic administered and is not necessarily correlated with the rate of bacterial killing.

Metachranous chondrosarcoma and malignant melanoma of the nose.

A case is presented of chondrosarcoma of the right lateral nasal wall treated surgically in which a malignant melanoma arose eight months later. Review of the literature has revealed no other report of a second primary within the nose or paranasal sinuses following a chondrosarcoma. Neither chondrosarcoma nor malignant melanoma of the nose is radiosensitive and the treatment for these tumours is wide excision with confirmation of clear margins of resection by frozen section.

The prevention of wound infection after head and neck resections: a pilot study using gentamicin impregnated beads.

A pilot study of 16 patients undergoing major head and neck resections is presented. At the end of surgery gentamicin (Garamycin) chains are inserted into the wound prior to skin closure and left in place for 48 hours. The rate of wound infection is shown to be low (6.25% requiring antibiotics, 18.75% overall); there have been no complications from use of the chains.