We prospectively studied the latest 60 patients who presented to the ENT Departments of St Mary's and St George's Hospitals with ingested foreign bodies. Localization of the foreign body by the patient was compared to the actual site of the foreign body at removal and graded accordingly. Localization was better the higher the object. When compared with objects above the cricopharyngeus muscle items impacted below this level were poorly localized (P < 0.0001) and lateralized (P < 0.0001). This suggests that for a patient who is able to lateralize a presumptive foreign body within the cervical region, then that object is likely to be above cricopharyngeus and on the side indicated. Further, it is likely to be visible on indirect laryngoscopy and amenable to removal in the casualty department. We hypothesize that the pharyngeal innervation by the vagus and glossopharyngeal nerves provides better sensation than in the oesophagus which is innervated less densely by the vagus and cervical sympathetic nerves.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.