Otolaryngologists are increasingly performing thyroid surgery and are responsible for optimising parathyroid function postoperatively. The aim of this study was to establish an evidence-based algorithm for the management of postoperative calcium levels and to try and answer some relevant postoperative management issues. These include the following: (1) What is the risk of hypocalcaemia both temporary and permanent? (2) When should calcium replacement be commenced and in what form? (3) What is the best method for calcium replacement without suppressing a recovering parathyroid? (4) How to identify recovering parathyroid function if the patient is already on calcium replacement? A systematic review of the literature was carried out supported by a retrospective analysis of postoperative calcium levels obtained from clinical records of patients undergoing thyroidectomy under our care (n = 167). We present an evidence based, user-friendly algorithm for the management of the serum calcium in patients undergoing thyroid surgery.

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at th e apex of th e posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic ‘sulphur granules’ in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobi c culture of pus and biopsy specimens should be performed in addition to Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.

Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.

A case of multiple ganglioneuroma arising along the entire length of the cervical sympathetic chain of one side of the neck is described. This is a distinctly unusual site and distribution of the disease and computed tomography proved invaluable to demonstrate its extent, in addition to excluding involvement of more caudal regions.

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.

No abstract

AbstarctThis paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0–7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9–2.1) years after our surgery. There were two postoperative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Hodgkin's disease is a neoplasm of lymphoid tissue defined histopathologically by the presence of Reed-Sternberg cells in an appropriate cellular background. Hodgkin's disease extends only rarely into the skin. Sinus and fistula formation has been reported in very occasional cases. We now report a case of a 34-year-old woman presenting with a cutaneous lesion surrounding a discharging blind-ending sinus in the neck, subsequently diagnosed as Hodgkin's disease. To our knowledge this form of presentation of Hodgkin's disease has not been reported in the English literature before, and at the same time we would like to outline the difficulties in diagnosis encountered with these cutaneous lymphoid lesions.