This paper reviews the progress in the rapidly expanding scientific discipline of tissue engineering, which may have an integral role in the future of otorhinolaryngology. This article seeks to inform on the current concepts and principles of tissue engineering, and describe the state of the art research and developments in this exciting field as applied to ENT and head and neck surgery.

In order to carry out a comprehensive review of the literature spanning the past 30 years, a search of relevant publications was performed using the Web of Knowledge, Medline and PubMed databases.

This search identified 85 scholarly articles, which were utilised as the basis of this review.

Given the current rate of development of tissue engineering research, it is likely that tissue-engineered implants will be widely used in surgical practice, including ENT and head and neck surgery.

Review of the literature on the role of surgery in the management of head and neck cancer in the era of organ preservation.

Literature search based on the essential practice guidelines set out by the US National Comprehensive Cancer Network.

Despite the increasing popularity of non-surgical treatment options, the surgeon remains a key figure in the multidisciplinary head and neck cancer team, along with the radiation oncologist, the medical oncologist and the speech and swallowing therapist. Even when organ preservation is successful, early and late toxicity may cause serious complications, including laryngeal dysfunction with a ‘frozen larynx’. When organ preservation fails, salvage surgery is often associated with increased complications and reduced survival.

There is a definite need to apply more rigorous standards to the use of organ preservation strategies, and to re-evaluate the role of surgery in head and neck cancer treatment.

The major lymphatic vessels may be damaged during neck dissection or other cervical surgery, resulting in chyloma or chyle fistula. While commonly considered to be predominantly a complication of left-sided surgery, the thoracic duct may be damaged on either side of the neck due to the extreme variability in the anatomy of the central lymphatic system.

This paper reviews the variable anatomy and embryology of the thoracic and right lymphatic ducts, particularly aspects relevant to head and neck surgery.

There are many well-known aetiological mechanisms of presbyacusis, and free radicals have been shown to play an important role. This study aimed to evaluate the effect of antioxidant agents on the hearing threshold of patients with presbyacusis.

One hundred and twenty individuals were divided into four groups and received one of the following treatment schemes: ginkgo biloba dry extract, α-lipoic acid plus vitamin C, papaverine chlorhydrate plus vitamin E, or placebo. All participants were evaluated at recruitment and after six months, using pure tone audiometry (at isolated and average frequencies), speech recognition threshold and percentage index of speech recognition.

The various treatments had no effect on any of the evaluated measures of hearing, either between groups or over time.

There was no statistically significant change in the hearing threshold after treatment with any of the tested drugs, during the study period.

Deafness may be one of the factors that leads to a change in sexual function. This study aimed to assess sexual function, in particular erectile dysfunction, in male patients with hearing loss.

We studied two groups: (1) adult men with acquired, bilateral, sensorineural hearing loss, and (2) healthy, adult, married men demonstrated to have normal hearing levels, as the control group. Sexual function was assessed using the International Index of Erectile Functions questionnaire, and quality of life using the 36-Item Short-Form Health Survey.

There was a statistically significant difference between the groups regarding the International Index of Erectile Functions questionnaire results (p <0.001), both for each of the five questionnaire domain scores and for the total score.

Our results indicate that men with mild or moderate sensorineural hearing loss have poorer sexual health.

To evaluate the safety of low-dose transtympanic methotrexate in a rat model.

Experimental animal study.

Tertiary training and research hospital.

Twenty-four rats were randomly divided into three study groups. Diluted methotrexate solution was administered transtympanically to fill the middle-ear cavity, twice a week in group one and three times a week in group two. Ringer lactate solution was administered transtympanically three times a week in the control group.

Main outcome measures: Local and systemic effects of low-dose transtympanic methotrexate.

In the methotrexate groups, middle-ear mucosal oedema was present in all animals. Auditory brainstem response thresholds indicated no inner-ear dysfunction in any group. Liver function and serum haemoglobin levels showed no statistically significant difference in any group. However, liver biopsies from groups one and two showed mild portal hyperaemia.

These findings are encouraging, and support further investigation of the topical application of methotrexate in autoimmune hearing diseases, as an alternative or adjunct to transtympanic steroids.

Proteases of the disintegrin and metalloproteinase family (also known as ADAM proteins) are involved in various physiological and pathological processes. This study assessed the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma.

The study evaluated cholesteatoma specimens from 19 patients, and external ear canal skin samples from 7 of the same patients (as controls), for the expression of disintegrin and metalloproteinase family proteins 10, 12 and 17, using immunohistochemical methods.

The study observed over-expression of proteins 10 and 17 in blood vessels, and over-expression of proteins 12 and 17 in cholesteatoma stroma. Immunostaining scores for proteins 10, 12 and 17 in epithelial and inflammatory cells from cholesteatoma specimens versus control specimens showed no statistically significant differences.

Over-expression of disintegrin and metalloproteinase family proteins 10, 12 and 17 in cholesteatoma may be related to cholesteatoma pathogenesis. These proteins deserve further study as they may represent potential targets for cholesteatoma treatment.

We examined our experience of image guidance surgery in rhinology, and compared image guidance surgery cases with non-image guidance cases. We also audited our practice against the American Academy of Otolaryngology–Head and Neck Surgery image guidance surgery guidelines.

The study employed a single institution retrospective approach comprising 174 image guidance surgery patients (106 males and 68 females) and 134 non-image guidance surgery patients (75 males and 59 females).

In the image guidance surgery group, tumour operations represented 45 per cent of cases (55 per cent were non-neoplastic). Basic, intermediate and advanced (structured classification) procedures represented 19 per cent, 24 per cent and 61 per cent, respectively. Five minor complications were recorded. In non-image guidance surgery, tumour operations represented 8 per cent of cases (92 per cent were non-neoplastic). Basic, intermediate and advanced procedures represented 73 per cent, 12 per cent and 15 per cent, respectively. One minor complication was observed.

We report the largest series of image-guided ENT surgical procedures in the UK. In the cases we examined, image guidance surgery was predominantly used in advanced procedures and tumour surgery.

To compare narrow-band images of nasopharyngeal carcinoma with those of normal adenoidal tissue.

Patients with a nasopharyngeal mass were evaluated using both conventional white light and narrow-band light. Biopsies were performed and Epstein–Barr viral serology was tested for all patients.

Thirty consecutive patients were recruited. Twenty-one patients had normal adenoidal tissue and seven had nasopharyngeal carcinoma. One patient with papillary adenocarcinoma was excluded. The features of narrow-band imaging in normal adenoidal tissue were: (1) a regularly arranged follicular pattern, and (2) each ‘follicle’ comprising a pale centre with surrounding dark periphery. The features of narrow-band imaging in nasopharyngeal carcinoma were: (1) absence of surface patterns (n = 7), and/or (2) ‘reverse’, haphazard follicular pattern comprising a dark brown centre and pale periphery (n = 3).

Narrow-band imaging of the surface of adenoidal tissue and nasopharyngeal carcinoma appears to identify distinct, characteristic features as described. Narrow-band imaging may be a useful adjunct in differentiating normal adenoidal tissue from malignancy. Further studies are needed to evaluate its diagnostic accuracy.

Kimura's disease is a rare, localised, chronic inflammatory disease. This benign disease involves subcutaneous tissues, the major salivary gland, and lymph nodes primarily in the head and neck area.

Clinical details and stained slides of all cases reported as Kimura's disease over a 10-year period were reviewed.

There were eight cases of Kimura's disease. The mean age of patients was 22.8 years. One case showed associated nephrotic syndrome and two cases were associated with peripheral blood eosinophilia. All cases showed the typical histopathological features of Kimura's disease.

Kimura's disease was first reported in China in 1937. The cause of Kimura's disease is unknown and many theories have been proposed. The eight cases reported here illustrate some of the variations in the mode of presentation and in the histological features of Kimura's disease. Kimura's disease should be considered in the differential diagnosis of patients who present with head and neck swellings and lymphadenopathy, and investigated accordingly.

To review our experience with freehand core-needle biopsy in the assessment of unexplained head and neck masses.

A total of 770 patients with head and neck masses (referred over a 22-month period) were evaluated. A retrospective chart review was performed on 53 of those patients who underwent core-needle biopsy for an unexplained mass.

Correct sampling of the target tissue was achieved in all 53 patients (100 per cent) using a freehand core-needle biopsy technique. The diagnostic accuracy for providing adequate tissue samples for histopathological diagnosis was 96 per cent; the test sensitivity was 92 per cent. Four patients (7 per cent) required open surgical biopsy prior to commencing definitive treatment.

Out-patient freehand core-needle biopsy can be carried out safely on select patients with head and neck masses, and provides high quality histopathology specimens with high diagnostic utility.

Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator.

This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis.

Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent.

It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome.

Anecdotally, infectious mononucleosis is considered a more severe infection than bacterial tonsillitis, requiring a longer hospital stay. However, there is little in the literature comparing the epidemiology of the two conditions. This study aimed to compare the epidemiology of bacterial tonsillitis and infectious mononucleosis, in particular any differences in the length of in-patient stay.

The hospital in-patient enquiry system was used to analyse patients admitted with bacterial tonsillitis and infectious mononucleosis between 1990 and 2009 inclusive.

There was a total of 3435 cases over the 20 years: 3064 with bacterial tonsillitis and 371 with infectious mononucleosis. The mean length of stay was 3.22 days for bacterial tonsillitis and 4.37 days for infectious mononucleosis. The median length of stay for each condition was compared using the Mann–Whitney U non-parametric test, and a significant difference detected (p < 0.001).

Patients with infectious mononucleosis have a significantly longer stay in hospital than those with bacterial tonsillitis.

We report the case of a patient with extensive pneumocephalus extending into the lateral ventricles from a brain abscess arising from a cholesteatoma-induced defect in the skull base.

A 70-year-old man with cholesteatoma presented with right-sided otalgia, otorrhoea and progressive headaches. Computed tomography showed a tegmental defect (approximately 2 × 2 cm) at the right mastoid antrum. A T1-weighted, gadolinium-enhanced magnetic resonance imaging scan showed pneumocephalus in both lateral ventricles, which was directly connected to the mastoid cavity via a brain abscess and a bone defect in the skull base. Radical mastoidectomy was performed to remove the cholesteatoma. The roof of the mastoid cavity was covered extensively with fascia and a pedicled temporalis muscle flap. One week post-operatively, computed tomography and magnetic resonance imaging showed no pneumocephalus.

Pneumocephalus arising from a cholesteatoma-induced brain abscess and extending into the lateral ventricles is an important entity, with an atypical appearance on computed tomography and magnetic resonance imaging.

We describe a rare case of sudden onset of unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease, which is characterised by progressive stenosis of the intracranial internal carotid arteries and their proximal anterior cerebral arteries and middle cerebral arteries.

Case report and review of the world literature regarding moyamoya disease with hearing loss.

The reported patient had moyamoya disease that initially presented as sudden, unilateral sensorineural hearing loss. Magnetic resonance imaging showed occlusion of the anterior cerebral, middle cerebral and distal internal carotid arteries bilaterally. The possible mechanism of this patient's sudden sensorineural hearing loss may have been vascular occlusion resulting from thrombotic narrowing or blockage by plaque.

The described patient represents the first reported case of sudden onset, unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease. The possibility of a vascular lesion such as moyamoya disease should be considered in patients with sudden sensorineural hearing loss, especially children, young adults and Asian patients. Due to this disease's poor outcome, early diagnosis and treatment are important to prevent stroke.

To outline the management options and neurological complications associated with repeated traumatic falls that cause intrusion of bone-anchored hearing aid abutments.

A three-year-old boy with coloboma, heart defects, atresia of nasal choanae, retarded growth, genital abnormalities, ear defects and deafness was fitted with a bone-anchored hearing aid for severe conductive hearing loss and congenital ear malformations. Six months later, a traumatic fall caused an intrusion injury which rendered the bone-anchored hearing aid abutment unusable. Without removing the original abutment, a second abutment was inserted on the same side to aid his hearing. Two years later, the child fell again and damaged his second bone-anchored hearing aid abutment. Having been offered a surgical option to repair the area, the parents opted to keep the abutments in situ.

Direct trauma to the fixture of a bone-anchored hearing aid is a relatively common long-term complication in children which can disrupt osseointegration and disable the implant. For young children who are either prone to falling or have behavioural problems, a bone-anchored hearing aid Softband may be more appropriate to non-invasively aid hearing.

Ceruminous mucoepidermoid carcinoma of the external auditory canal is extremely rare. This paper highlights the impact of concurrent chemoradiotherapy on the outcomes of this disease.

A 47-year-old female presented with a 2-month history of otalgia and a mass in her right ear. Biopsy revealed high grade ceruminous mucoepidermoid carcinoma. She underwent surgical excision of the right external auditory canal and right upper neck dissection. Pathological analysis of tumour–node–metastasis staging revealed a T2 N0 (stage II) tumour. One year later, computed tomography scanning of the temporal bone showed tumour recurrence. Biopsy revealed recurrent ceruminous mucoepidermoid carcinoma. The patient underwent salvage resection. Pathology revealed that the tumour was diffusely invading nearby structures, with perineural invasion, lymphatic spread and extracapsular extension. Pathological analysis of tumour–node–metastasis staging revealed a T3 N1 M0 (recurrent stage IV) tumour.

The patient subsequently received concurrent chemoradiotherapy. There was no evidence of disease at 37 months' follow up.

The trimodality approach, using surgery plus concurrent chemoradiotherapy, provided reasonable loco-regional control with tolerable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.

To report a patient with maxillary pneumosinus dilatans and facial deformity treated by reduction osteoplasty and reconstruction.

This study describes the successful management of facial deformity in a 17-year-old male with maxillary pneumosinus dilatans. The patient's facial deformity of the maxillary sinus, which had been slowly progressing over a 10-year period, was managed by reduction osteoplasty and reconstruction using the maxillary bone, conchal cartilage and Tutoplast-processed fascia lata via a sublabial approach. This treatment yielded satisfactory functional and aesthetic outcomes.

As pneumosinus dilatans of the maxillary sinus is uncommon, there is no established surgical treatment protocol. This surgical technique was less invasive than other described procedures and revealed good cosmetic results.

There have been few reports of lingual dermoid cysts with a congenital discharging fistula. We report such a case, which mimicked lipoma on computed tomography, and we discuss relevant clinical and radiological features.

We present a case report and a review of the English language literature concerning lingual dermoid cysts either mimicking lipoma or with a congenital discharging sinus.

A 35-year-old man presented with a lingual mass associated with a congenital fistula in the midline of the tongue dorsum, which discharged abnormal secretions. Computed tomography images showed that the lesion was well defined and contained homogeneous fatty tissue giving computed tomography attenuation values of −120 Hounsfield units.

Lingual dermoid cysts may develop with a midline discharging fistula, and may exhibit radiological similarity to lipomas on computed tomography.