Papillary carcinoma arising in a thyroglossal duct cyst is a rare finding. Less than 100 cases have been reported in the English literature. In most cases the diagnosis is only established after excision of a clinically benign thyroglossal duct cyst. The aetiology of such tumours is unclear but de novo origin and spread from a primary thyroid gland tumour has been suggested. This has important implications for therapeutic approaches. A further case of thyroglossal duct carcinoma is presented and the management is discussed on the basis of the current rationale for treatment of thyroid cancer.

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The aim of this study was to determine which anaesthetic and vasoconstrictor preparations UK Otorhinolaryngologists use for rhinological surgery, with particular reference to cocaine and adrenaline. The incidence and types of adverse reactions to cocaine were also recorded. A postal survey of all BAO-HNS consultant members was performed. Of the 360 consultant surgeons included in the survey, the majority still use peri-operative cocaine on a regular basis, 66 per cent use cocaine and adrenaline together and more than 40 per cent use cocaine in paediatric patients. Sixteen per cent of respondents did not use cocaine. Only 11 per cent of surgeons had experienced cocaine toxicity in their patients, with only one recorded case of mortality. Most surgeons in the UK use cocaine because of the superior operative field it provides and because they consider it to be safe even with adrenaline. The actual incidence of adverse reactions to cocaine is low, with serious complications being less common than the risks from general anaesthesia. Cocaine remains a valuable agent in the armamentarium of the rhinologist.

We present the case of a 71-year-old man with anaplastic thyroid cancer. On presentation, his thyroid function was normal, but he subsequently developed sudden, rapid thyrotoxicosis. Thyrotoxicosis in anaplastic thyroid carcinoma is very rare, but in all previously reported cases the patient was thyrotoxic at presentation. Our case is unusual as our patient presented euthyroid, and thyrotoxicosis developed subsequently. We challenge current ideas regarding the biochemical pathophysiology of rapid thyrotoxicosis in anaplastic thyroid carcinoma and provide an alternative explanation.

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Facial lesions are commonly referred to ear, nose and throat surgeons. Almost all are amenable to excision under local anaesthetic as a day case. However, in the UK, there is still a significant delay between referral by the general practitioner (GP) and final surgery. To address this delay, a one stop see and treat consultant led clinic was set up in the community. The aim of this study was to assess the impact of the one stop clinic on waiting times and to ascertain the satisfaction of patients with the treatment they received in this clinic. Patients with facial skin lesions were referred by the GPs to the ENT department in the usual manner. The referral letters were screened by two consultants, the appointments were booked by telephone and the patients were seen and treated in a single visit. The clinics were held in a minor surgery unit of a centrally located GP practice. Patients were seen, assessed and if the facial lesion was considered amenable to excision under local anaesthetic, the patient was consented and the procedures carried out immediately. The clinic was audited over a 1 year period. Waiting times were compared before and after the start of the project. Patients were asked to fill in a questionnaire immediately after surgery. The attendance rate was 96%. The waiting time was reduced from 121 to 47 days. Patients rated the clinic experience as excellent (88%) or good (12%) indicating a very high satisfaction rate. During the study period, 160 lesions were excised of which 22% were malignant. Patients with malignant lesions did not show any sign of recurrence at a follow up of 9 months, except in one case with basal cell carcinoma. This was operated on and removed completely. Our project shows that the aims of reducing waiting times and improving patient care were achieved with this community model of a one stop facial lesions clinic. This clinic is now an integral part of the service provided by the ear, nose and throat department at Ipswich hospital, UK.

Coronal computerized tomography (CT) scanning is imperative in the preoperative work-up for functional endoscopic sinus surgery (FESS). This study describes additional information provided by lateral CT reconstruction with special attention to the (naso-) frontal recess. Thin axial scans were taken from 10 patients suffering from chronic rhinosinusitis. This procedure avoided artefacts from dental fillings on the computerized reconstructions. The common landmarks of the lateral nasal wall as described in the surgical anatomy of FESS were easily identified on sagittal views. The average angulation of the sagittal plane from the midline required to obtain optimal images of the frontal recess was antero-posteriorly 8.7 degrees (SD, 2.4), cranio-caudally 7.7 degrees (SD, 2.6). Size and condition of the frontal recess could be demonstrated. Variations of the angle between frontal sinus and ethmoid infundibulum appeared to depend on the anterior projection of the frontal sinus and may give an indication as to the optimal endoscopic angle for visualization of the frontal ostium. Sagittal reconstructions provide information for better spatial orientation particularly in the plane of the surgical approach and may help to diagnose underlying functional changes of chronic frontal sinusitis.

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