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Penetrating neck injuries are becoming more common because of the increasing prevalence of knife and gun crimes. The immediate and long-term consequences of injury to the neck can be significant because of the close relationship of important anatomical structures in a confined space. Delayed recognition of major injury and inadequate treatment results in high morbidity and mortality. Developing a clear understanding of the underlying anatomy, common mechanisms of injury and principles of management will provide first responders, emergency doctors and trauma surgeons with confidence in appropriate evidence-based management. Early involvement of otolaryngologists or head and neck surgeons is advisable. Two cases of penetrating neck injury from the June 2017 London Bridge terror attack are discussed.

Objectives: Squamous cell carcinoma of the nasal vestibule is rare variant of skin cancer. The TNM classification for skin cancer has been used, whereas, Wang has devised an independent staging system, which he stated was more accurate. The purpose of this study was to analyse the prognostic indicators for survival in a patients with nasal vestibule cancer from the Princess Margaret Hospital, Toronto. Design: A retrospective review of case notes from the Princess Margaret Hospital archives was performed. Setting: The Princess Margaret Hospital/Ontario Cancer Institute is the tertiary regional Head and Neck Oncology Centre for ON, Canada. Participants: All patients with nasal vestibule cancer (ICD10 C300) were included. Main outcome measures: Univariate and multivariate analyses were performed and Kaplan–Meier survival curves constructed. Results: Eighty-four patients were identified. The mean age was 67, there was a male preponderance of 2 : 1. Primary radical radiation was used in 77% of patients. Age (P = 0.02), N stage (P = 0.0001) and Wang classification (P = 0.0001) were associated with prediction of overall survival using multivariate analysis. Grade, depth of invasion and N stage were associated with disease-free survival outcome. A 5-year overall survival rate of 58% and disease-free survival of 52% was seen. Conclusion: Nasal vestibule cancer behaves in a more aggressive manner than any other skin cancers affecting the head and neck. The Wangs’ classification appears to be a better prognostic indicator for overall survival then the TNM classification for skin cancer.

The purpose of this study was to determine the oestrogen and progesterone receptor status of a selection of salivary tumours. Using immunohistochemistry, we detected nine oestrogen receptor and six progesterone receptor positive tumours from a sample of 36. One acinic cell carcinoma and two mucoepidermoid carcinomas demonstrated positivity for both receptors. We suggest that there may be role for oestrogen manipulation in the management of some salivary tumours.

Background Primary adenocarcinomas of the parotid gland are rare and account for less than 5% of all head and neck malignant neoplasms. There is considerable variation in biological behaviour within this group; low-grade tumours exhibit slow growth rates with minimal or no local invasion. High-grade tumours, however, show a high incidence of local recurrence and distant metastasis. Aim The purpose of this paper is to analyse the important prognostic indicators for this cancer. Methods A systematic review was performed involving 19 published studies from 1987 to 2005 which included 4631 patients. T stage, grade of tumour, N stage and adjuvant radiotherapy on overall (5 year) survival were analysed as prognostic indicators. Results T stage ( p = 0.041, hazard ratio 1.8 (confidence interval 1.2–2.9)), N stage ( p = 0.05, hazard ratio 1.1 (0.2–1.8)), and high-grade ( p = 0.001, hazard ratio 2.1 (1.5–2.7)) were associated with a significantly worse survival. The effect of adjuvant radiotherapy was to improve overall survival: p = 0.002, hazard ratio 2.9 (1.5–4.7). The mean 5 year survival for advanced high-grade parotid cancer was 35%. Conclusion High-grade advanced parotid cancers are associated with a poor survival. Adjuvant radiotherapy is indicated in these tumours and this improves survival.

The aim of this study was to determine the relationship between glottic space and breathy voice. Using a new computerized method of analysing the glottic area of video images with the Vocim computer system, 16 patients with a vocal cord palsy and 31 with non-organic dysphonia were examined. The quality of the breathy voice was assessed and correlated with the size of the glottic space during phonation. There was a positive (r = 0.70) correlation between glottic area and breathy voice in vocal cord palsy. There was no correlation (r = 0.002) in non-organic dysphonia. Therefore in this study population, for vocal cord palsy, glottic area is the dominant feature in determining voice quality. This relationship is not maintained in non-organic dysphonia.

Laryngomalacia is the most common paediatric airway problem presenting as stridor in the neonate. This congenital anomaly is thought to be caused by inward inspiratory collapse of the supraglottic larynx due to a prolapsed, tall and tubular epiglottis with flaccid aryepiglottic folds. The natural history of this condition usually results in spontaneous resolution by the second year of life. Although acquired cases of adult laryngomalacia have been reported, a search of the literature has yet to show any cases of idiopathic laryngomalacia. We present two cases of idiopathic acquired laryngomalacia in adults.

Tissue adhesives have been available and in use for more than 40 years. They have, however, never been popular for ossiculoplasty because of the reported excessive inflammatory reaction and ototoxicity. The authors present a case of ossicular disruption successfully repaired with tissue adhesive and review the literature.

An audit of 334 patients who underwent magnetic resonance imaging (MRI) as investigation for a possible diagnosis of vestibular schwannoma was carried out to assess adherence to previously agreed screening guidelines. This represents one year's activity. A posterior fossa tumour was identified in 12 patients. Scan requests were judged to be inappropriate for 28 cases. The issues surrounding the screening for acoustic neuroma are discussed.