Pharyngeal pouch surgery by the external approach has been shown to be effective but has a relatively high complication rate. We compared the outcome of 17 patients who had cricopharyngeal myotomy alone or combined with excision/inversion/suspension, simple pouch excision and Dohlman's procedure with 17 patients who had the relatively new Endo GIA-30 endoscopic stapling technique. Results were obtained retrospectively by postal questionnaire and medical records. We conclude that endoscopic stapling shortens the return to normal diet and in-patient stay. These patients also experience better swallowing and are generally more satisfied with the procedure. We have accepted endoscopic stapling as the method of choice for the treatment of pharyngeal pouches.

Only a handful of cases of de-novo malignancies of the vestibulocochlear nerve have been reported. Even rarer is the malignant transformation of a previously histologically diagnosed benign vestibular schwannoma. We present the case of a young adult who had combined operative/Gamma knife treatment for a benign vestibular schwannoma, followed by further surgery 2 years later. He represented 10 years after original diagnosis with facial numbness and ataxia, MRI showing gross tumor recurrence. After radical resection, histology showed malignant transformation to a malignant peripheral nerve sheath tumor. Within 3 months there was rapid, aggressive recurrence with brainstem compression, requiring further surgery for brainstem decompression. Histology confirmed further de-differentiation to an anaplastic sarcoma. While awaiting radiotherapy the tumor recurred again, the patient succumbing. The patient had no features of neurofibromatosis type 2. In the literature there are 13 other cases of malignant vestibular schwannomata. Only six had radiotherapy and of these only two had histological confirmation of a benign lesion preradiotherapy. Neither of these had neurofibromatosis. Three other cases had histological proof of malignancy postradiosurgery, but with no preradiotherapy histology; of these, two were positive for neurofibromatosis. The tumor biology of vestibular schwannomata as well as the radiobiology in the context of malignant transformation is discussed.

Epiglottitis in the adult can be fatal and should be treated with the same degree of concern and suspicion in respect of airway patency as in children. We present three cases of adult epiglottitis in which the airway was lost prior to or during the intervention of an anaesthetist. We suggest that an emphasis on conservative management is distracting and belies the serious nature of this disease.

Drooling can be a difficult problem for a child to endure, both physically and socially, especially if they are also having to cope with physical disabilities. Chailey Heritage Clinical Services and associated School look after a large number of severely physically disabled children and adolescents. This paper reviews the management strategy of the multidisciplinary oral-motor clinic at Chailey Heritage Clinical Services, and reviews the results of children treated between 1990 and 1996. The management ranges from oral-motor skills training through palatal training appliances to surgery. Seventy-eight children, ranging from 3 to 17 years, were treated and there were complete records for 73. Eighteen per cent responded to oral skills training alone. Thirty per cent of children had good results with a palatal training appliance and did not need any further intervention. Forty-seven per cent of patients underwent some form of surgery to control their drooling. Only 8% of children were treated with medication.

IntroductionOsteoradionecrosis of the mandible and temporal bones has been extensively reported in literature, but cases of avascular necrosis of the cervical spine following radiotherapy to the larynx appear to be extremely rare. A review of the English language literature has shown only one other case where radiotherapy treatment of a laryngeal carcinoma has resulted in osteoradionecrosis of the cervical spine.Case presentationWe present the case of a 65 year old male patient who suffered from osteoradionecrosis of the cervical spine 20 years after radiotherapy treatment for a T1aN0M0 laryngeal carcinoma resulting in quadriplegia.ConclusionsRadiotherapy carries a long-term risk of complications, including osteoradionecrosis which may present 20 years later with significant implications.