Viscoaugmentation as a treatment for leakage around the Provox 2 voice rehabilitation system.

Tracheo-oesophageal puncture for voice restoration is a well-established technique post-laryngectomy. A number of complications can occur with the creation of a tracheo-oesophageal fistula (TOF) and in the subsequent management of the patient with an indwelling voice rehabilitation system. This article is the first to report the use of Hylaform, a colourless viscoelastic gel, to treat an intractable case of leakage around a Provox 2 voice prosthesis. The procedure which required no anaesthesia resulted in no further leak around the valve to the present day, now more than four weeks post-viscoaugmentation.

Nasal septum buttons: symptom scores and satisfaction.

Patients with symptomatic septal perforations require treatment, with many surgeons advocating primary treatment with an obturator if conservative measures fail. Twenty nasal Button Outcome Questionnaires were sent to patients who had undergone insertion of a septal button between 1990 and 2000 in our unit. Fourteen questinnaires were returned. This study reveals that despite a reduction in symptom score in nine patients, septal buttons are poorly tolerated by patients with only 45 per cent of obturators ultimately being in situ. In view of these findings, patients are now offered a choice between primary surgical and mechanical closure in our unit.

Delayed diagnosis of laryngeal foreign body.

Aspiration of a foreign body is a recognized cause of accidental death in children. Paediatricians are aware of the symptoms of inhaled foreign bodies in the lower respiratory tract. However, symptoms which suggest impaction in the larynx do not appear to raise the same index of suspicion of a foreign body. One case of laryngeal foreign body is described with a delay in diagnosis of five days. The clinical presentation, investigations and management are discussed.

Peripheral primitive neuroectodermal tumour (pPNET) of the cerebellopontine angle presenting in adult life.

We report a case of a peripheral neuroectodermal tumour (pPNET) of the cerebellopontine angle of a 67-year-old woman. The patient's age at presentation was highly unusual. This case highlights the difficulties encountered, both clinically and pathologically, in securing the correct diagnosis of such a rare condition presenting in this relatively inaccessible area. The development of the nomenclature and classification of neuroectodermal tumours is traced. Recent advances in immunohistochemistry and genetic typing have shown the close relationship between pPNET and the previously difficult to classify Ewing's sarcoma and Askin's tumour.

Endolymphatic sac tumours.

Endolymphatic sac tumours (ELST) are rare tumours of the petrous temporal bone. They may arise sporadically or be associated with von Hippel-Lindau disease. Their differential diagnosis is discussed. We present the clinical and histopathological features of two new patients with ELST and outline the management of their condition. In addition, we review a third case previously reported as a choroid plexus papilloma in which the histology has been re-assessed and the diagnosis changed to ELST. The controversy regarding the cellular origins of adenomatous tumours of the temporal bone is highlighted.

Bones of contention. The supply of temporal bones for dissection: the legalities, problems and solutions.

Temporal bone dissection is considered to be an important aspect of the otological training of the Specialist Registrar with dissection skills being formally assessed in the Intercollegiate Fellowship Examination. However the procurement of cadaveric specimens suitable for dissection may be fraught with difficulties. The authors take an historical perspective to clarify the existing legal issues and outline the means available to improve supply.

Anatomical variation of internal carotid artery presenting as pharyngeal mass.

OBJECTIVE: We describe a case of an internal carotid artery loop presenting as an oropharyngeal mass. METHOD: Case report and review of current literature. CASE REPORT: A 71-year-old woman presented with an asymptomatic oropharyngeal mass. This was an incidental finding by her general practitioner and was urgently referred as a suspicious lesion. A magnetic resonance imaging scan revealed an internal carotid artery tonsillar kink indenting into the pharyngeal wall. No further treatment was necessary. CONCLUSION: The internal carotid kink is an important anatomical variation which ENT surgeons should be aware of, as there are significant complications if blind biopsy is undertaken prior to appropriate imaging.

Endovascular management of the carotid blowout syndrome.

Bleeding from the carotid artery or its branches ('carotid blowout') is a well recognized complication following treatment or recurrence of head and neck cancer. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. The majority of such patients are currently treated conservatively with end of life supportive measures. We report the case of a young patient with recurrent supraglottic carcinoma complicated by carotid blowout on two separate occasions over a five month period, which was successfully treated endovascularly under local anaesthetic, without neurological sequelae. With the continuing development of interventional radiology, endovascular techniques are now emerging as a viable, low morbidity treatment option in selected patients.