Secondary tracheoesophageal puncture is sometimes difficult and has a higher complication rate. In the irradiated neck, where neck extension is difficult, the traditional tracheoesophageal puncture method of insertion with a rigid endoscope is not possible. We describe a simple, safe and effective alternative method of tracheoesophageal puncture using curved forceps (Kocher's curved intestinal clamp forceps or Mixter forceps).

The procedure is performed under local or general anaesthesia with equal ease. Maximum neck extension is achieved. The curved intestinal forceps are passed through the mouth into the oesophageal lumen. The instrument tip can easily be seen or felt at the posterior wall of the tracheostoma. A small incision is made in the mucosa to allow the forceps tip to emerge, and a guide wire is passed through this incision out of the mouth. The prosthesis can be guided over the guide wire, in retrograde fashion, to fit the puncture hole.

Secondary tracheoesophageal puncture was performed in five cases with severe neck fibrosis. In all cases, valve insertion was easily achieved after secondary tracheoesophageal puncture, without any peri-operative complications.

This is a safe, simple and effective method for secondary tracheoesophageal puncture. It can be performed easily in any setting and is not associated with any complications.

To highlight the possibility of misplacement of electrodes during cochlear implantation surgery, to stress the importance of routine neural response telemetry, and also to emphasise the value of conventional radiography in confirming electrode positioning in the immediate post-operative period.

A two-year-old boy presented with bilateral, profound, sensorineural hearing loss and underwent conventional cochlear implantation surgery. During insertion of the implant, there was doubt regarding the direction of passage of the electrode array. Instead of the usual smooth passage of the electrode, some resistance was felt. Neural response telemetry, performed at the end of the procedure, showed absent responses. A confirmatory X-ray in Stenver's view confirmed the extra-cochlear positioning of the electrodes in the superior semicircular canal. The wound was reopened, the electrode array removed and the cochleostomy was positioned a little more antero-inferiorly on the promontory with respect to the round window. Correct insertion of the electrode was then performed without difficulty.

The misplacement of electrodes during cochlear implantation surgery is rare but can occur. Neural response telemetry and conventional radiography are invaluable in assessing the placement of the electrode intra-operatively. Conventional radiographs are very cost-effective and aid in confirming the position of the electrode array.

Adult laryngeal rhabdomyosarcomas are rare tumours commonly treated by laryngectomy.

We present a case of subglottic laryngeal rhabdomyosarcoma in an elderly woman, treated by endoscopic resection.

Despite the fact that this tumour is traditionally treated aggressively, this approach is not supported by the literature. Due to the varying biological behaviour of this tumour in adults, we believe that conservative surgical procedures or combination therapies should be preferred, rather than total laryngectomy.

An unusual clivus mass is reported, following investigation of memory disturbance and headaches in a patient with β thalassaemia and sickle cell disease. This lesion proved to be a site of extramedullary haematopoiesis.

Computed tomography demonstrated a 2 cm mass at the base of the sphenoid. However, magnetic resonance imaging showed little bony expansion, and the differential diagnosis included chordoma, dermoid cyst and fibrodysplasia.

Examination of the biopsy showed the presence of bone marrow demonstrating erythroid hyperplasia and small aggregates of B-cell lymphocytes. The features were considered compatible with erythroid hyperplasia associated with haemolytic anaemia.

The patient was reassured that she did not have a neoplastic lesion, and was referred back to the haematologists for further management of her sickling β thalassaemia.

Extramedullary haematopoiesis occurs outside the reticuloendothelial system in response to haemolytic anaemia. Extramedullary haematopoiesis causing a clivus mass is an unusual ENT presentation. Such haematopoiesis is occasionally seen in the calvarial skull, but this is the first report of this process occurring in the anterior skull base, to our knowledge.

To assess the results of reconstruction of composite defects involving the nose which extend to involve the cheeks, eyelids or upper lip.

Retrospective observational study.

Sixteen patients with defects of the nose extending to the adjoining cheek, upper lip or eyelid.

A combination of flaps and grafts were needed to reconstruct these defects so that the aesthetic subunits were replaced and joined at their junctions wherever possible.

Where the defect required three or four flaps, there was some unpredictable cicatrisation at their junction that resulted in some asymmetry. This problem primarily occurred at the alar base, and was compounded if there was tissue loss of the premaxilla or maxilla.

If a defect that involves the nose, cheek and upper lip is repaired with a combination of cheek advancement, nasolabial, paramedian forehead and/or septal flaps, there can be unpredictable cicatrisation at their junction, particularly at the alar base. In these circumstances, we recommend replacing the nasal and other defects with a slightly more generous amount of tissue than would be taken to repair a similar, but solitary, defect. It is important to replace any loss of the facial skeleton, in order to provide support for overlying flaps.

We report two extremely rare cases of isolated sphenoid ‘fungal ball’ in conjunction with vision loss.

Case reports and a literature review concerning diagnosis and management of isolated sphenoid fungal ball in conjunction with vision loss.

A mycetoma or fungal ball resulting from isolated sphenoid fungal sinusitis is a rare disease. It is frequently difficult to diagnose, as patients present with nonspecific symptoms such as headache, visual disturbance and cranial nerve palsies. Diagnosis of the disease is typically not made until advanced imaging has been performed. We present two cases of patients with sphenoid sinus fungal ball who developed headaches and vision loss. One patient had symptoms of IIIrd cranial nerve palsy and the other partial visual field impairment. After a timely sphenoidotomy, both patients recovered fully, with resolution of all symptoms.

These two cases of sphenoid fungal ball in conjunction with vision loss suggest that the otolaryngologist should keep this disease in mind even when symptoms are nonspecific. Endoscopic surgery can be a safe and viable therapeutic approach for this condition.

We report an extremely rare case of coexisting, ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve.

We present a case report and a review of the world literature concerning ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve.

The presence of a coexisting, ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve is a very rare embryological aberration which is associated with a right subclavian artery originating from the aortic arch. We report a case of coexisting, ipsilateral nonrecurrent and recurrent inferior laryngeal nerves associated with this vascular anomaly.

The surgeon must be aware of the possibility of coexisting, ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve, and thus must trace the nerve in its entirety. Occasionally, what appears to be a nonrecurrent inferior laryngeal nerve will actually be a communicating branch between the recurrent inferior laryngeal nerve and the oesophageal or sympathetic ganglia. If such a neurological variant is present, the consequences of careless dissection could include not only vocal fold paralysis but also dysphagia (if the pharyngeal and oesophageal branches of nonrecurrent or recurrent inferior laryngeal nerve are injured).

We present the first reported case of persistent, posterior triangle lymphadenopathy in a child, caused by Castleman's disease.

A seven-year-old boy presented with a painless swelling in the posterior triangle of his left neck, with no compression of the surrounding structures. A histological diagnosis of Castleman's disease was made. Eventual treatment was by complete excision. At six-month follow up, there were no signs of recurrence.

The causes of persistent cervical lymphadenopathy in children are many. Most are not significant, but some are life-threatening. Castleman's disease should be considered as a possible diagnosis in persistent childhood lymphadenopathy.

The purpose of this study was to assess the presence of dendritic cell phenotypic antigens in the cervical lymph nodes of patients with hypopharyngeal and laryngeal carcinoma, and to assess the significance of such antigens in the tumour immune reaction.

Immunohistochemical staining of cervical lymph nodes was performed using antibodies against cell surface markers such as S-100 protein and cluster of differentiation 1a and 83 glycoproteins. Two hundred and seventy-four cervical lymph nodes obtained at surgery from 37 patients with hypopharyngeal carcinoma and 31 patients with laryngeal carcinoma were thus evaluated.

The number of dendritic cells positive for each phenotypic antigen was significantly greater in non-metastatic lymph nodes than in metastatic lymph nodes. In the metastatic lymph nodes, cluster of differentiation 1a glycoprotein positive dendritic cells were predominantly detected in the cancer ‘nest’, whereas mature dendritic cells staining for cluster of differentiation 83 glycoprotein were prominent in the peritumour area. In the metastatic lymph nodes, in contrast to the cluster of differentiation 1a glycoprotein positive dendritic cells, the degree of infiltration of cluster of differentiation 83 glycoprotein positive dendritic cells was significantly higher in the peritumour area than in the cancer nest. There was a significant difference in survival status, comparing patients with different degrees of dendritic cell infiltration for each type of phenotypic antigen.

Dendritic cells may play different roles in tumour immunity against hypopharyngeal and laryngeal carcinoma. The phenotypic antigens of dendritic cells may thus constitute important indices with which to predict the prognosis of patients with hypopharyngeal and laryngeal carcinoma.