Descending necrotising mediastinitis can complicate oropharyngeal infection and has a high associated mortality. We present three cases treated in our department and propose a treatment algorithm based on our experience and literature review. The primary oropharyngeal infection was peritonsillar abscess in two cases and odontogenic abscess in one. Two patients underwent cervicotomy and later thoracotomy. The third underwent cervicotomy with transcervical mediastinal drainage and later required pericardial drainage via a subxiphoid incision. All recovered fully and were discharged within 6 weeks. To enable successful treatment, diagnosis needs to be prompt and surgical drainage adequate. Thoracic management of the chest is essential.

Bisphosphonate-related ear canal osteonecrosis is undoubtedly under-diagnosed. For such a commonly prescribed medication, the risks and side effects of bisphosphonate should be better known and long-term treatment should be avoided if possible.

The anterior tympanomeatal angle remains the main problem area in anterior marginal perforations with both conventional onlay and underlay techniques. Here we describe a variation of Gerlach's quilting technique to overcome the problem and this modification has proven to be both simple and effective. When the graft is prepared a small tag is fashioned anteriorly and later pulled through a small tunnel under the anterior-superior annulus. This prevents the graft falling away anteriorly without producing the blunting associated with more extensive undermining of the anterior annulus.

We present a case of extensive recurrence of a retro-pharyngeal liposarcoma following surgical removal 18 years previously. The surgery and pathology are discussed, and management strategies of head and neck liposarcomas are reviewed.