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Background:The aetiology of maxillary mucosal cysts is uncertain. Chronic rhinosinusitis has been proposed as a probable aetiological explanation for their formation.Method:We recruited 500 consecutive patients who had undergone computed tomography scanning of the paranasal sinuses for possible chronic sinus disease. We identified 110 (22 per cent) cases of maxillary mucosal cysts.Results:Patients' mean age was 42.65 years, with a female to male ratio of 0.69:1 (45:65). The mean cyst size was 14.27 mm, and most were located on the inferior surface of the antrum. Only in two cases did the cyst obstruct the sinus ostium. Of patients with antral cysts, 52.7 per cent had computed tomography evidence of sinus disease, whereas only 41.3 per cent of noncyst (control) patients had sinus pathology. The total Lund–Mackay score was significantly greater in the cyst group (n=390) compared with the noncyst group (Mann–Whitney; pConclusion:Chronic rhinosinusitis plays an important role in the aetiology of maxillary mucosal cysts.

Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus.

A 71-year-old lady underwent successful excision of a haemangioma of the frontal sinus, via an osteoplastic flap approach. Haemangioma of the paranasal sinuses is an extreme rarity. A case is presented and the literature reviewed.

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minuteslater. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.

The principal reason for performing investigations in patients with globus pharyngeus is to detect a pharyngeal or upper oesophageal malignancy presenting this way. There is uncertainty regarding both the necessity for investigation in globus patients and the first line investigation of choice in the screening of such patients. The authors therefore undertook a retrospective study of 699 patients who presented with globus sensation. Of these, 451 patients (64.5 per cent) had a typical history and in these patients, outpatient examination, including fibre-optic nasendoscopy was able to detect all pathologies, except one insignificant pharyngeal pouch, which required no intervention and one patient with a distal peptic stricture. In patients with atypical symptoms the combination of fibre-optic nasendoscopy and barium swallow identified all pathologies (five aerodigestive tract malignancies) except one distal peptic stricture. The authors concluded that if out-patient examination is adequate, no further investigation of typical globus symptoms is required. Such a policy would produce significant savings for both out-patient and radiology services.

Cervical necrotizing fasciitis is a rare, rapidly progressive, severe bacterial infection of the soft tissues of the neck. Uncommonly, it may descend into the mediastinum. We describe a case of descending necrotizing mediastinitis in a young man, where there was diagnostic confusion and delay, with an eventual fatal outcome. A steroid injection for neck pain is thought to be the source of infection. In this case, the signs of mediastinitis were initially masked, and the diagnosis delayed until cardiopulmonary arrest occurred. Early recognition with a low threshold for computed tomography (CT) scanning is essential. Aggressive multidisciplinary therapy with mediastinal drainage is mandatory.

Acoustic rhinometry readings are very position dependent, and it was hypothesized that this accounts for its relative lack of reproducibility on a day-to-day basis. Multiple readings on each visit were taken to investigate their impact, if any, on improving the day-to-day reproducibility of the method. Measurements of the minimal cross-sectional area of the nose as measured by acoustic rhinometry were studied in 10 subjects following nasal decongestion. For each individual, acoustic rhinometry was performed ten times. The ten recordings were repeated again, in an identical manner on a separate day. The subjects were repositioned and the nasal probes reinserted between each measurement. The mean coefficient of variation for minimal cross-sectional area readings in all 10 subjects was calculated as 9.92%. This is comparable to the day-to-day variability of acoustic rhinometry as measured by other workers and thus supports the hypothesis that the high measurement error of the device (rhinometer) is a function of positional variation during data acquisition. We were able to demonstrate a minimal gain in intervisit reproducibility by doing multiple recordings per person, with a plateau effect of reproducibility after 7 repeat readings.

We present the first case report in the English literature of an intramuscular haemangioma of the geniohyoid muscle. This occurred in a 24-year-old female and the diagnosis was not made prior to resection. Haemangiomas are uncommon tumours of the head and neck and intramuscular haemangiomas account for fewer than one per cent of the total. Diagnosis of the vascular nature of the tumour is often missed. Recurrence is common and usually due to incomplete excision. A review of the literature and a case report of theselocally destructive lesions is presented.

Internal jugular vein thrombosis is an uncommon potentially life-threatening disorder caused by various conditions. Non-spontaneous internal jugular vein thrombosis is an uncommon condition associated in the preantibiotic area with deep-neck infections. Currently iatrogenic trauma to the internal jugular vein from catheterisation and repeated intravenous injections by drug abusers are the leading causes of thrombosis. Spontaneous internal jugular vein thrombosis may occur when there are no apparent pre-disposing mechanical or inflammatory causes although a few of these patients may harbour an occult malignant neoplasm. Hence, careful investigation and follow-up are vital. Thrombosis in Trousseau's syndrome is usually confined to the vascular system of the extremities and the viscera. However, secondary to the paraneoplastic hypercoagulable state, thrombosis can occur in the large veins of the head and neck region. We understand this to be the first case where spontaneous internal jugular vein thrombosis and ipsilateral recurrent laryngeal nerve paralysis were the only initial manifestations of an occult malignancy.

Cross sections for evaporation residues following the complete fusion of the 12 C + 12 C, 14 N + 12 C and 15 N + 12 C systems have been measured with a E − ΔE counter telescope in a wide range of incident energies. They are fairly well reproduced by evaporation calculations based on the statistical theory. The total fusion excitation function of the 12 C + 12 C system shows strong structure, which is compared to the predictions of the reaction cross sections derived from coupled channel calculations and to the integrated inelastic cross sections. Critical angular momenta have been obtained from the fusion cross-section data and these values are discussed in the framework of compound nucleus and entrance channel effects. A striking difference is observed between the fusion cross sections of the 14 N + 12 C and 15 N + 12 C systems and shows the importance of the valence nucleons of colliding ions in the fusion process. A possible interpretation might be the influence of the yrast line of the compound nuclei.

The fusion cross sections of systems leading to s-d shell compound nuclei reveal a strong dependence upon the number of valence nucleons of the colliding ions. This striking feature is discussed in terms of entrance channel and compound nucleus effects.

States in 20 Ne have been studied through the 12 C( 14 N, 6 Li) 20 Ne reaction. Excitation functions have been measured from 20 MeV to 60 MeV in steps of 5 MeV at different angles for 20 Ne states up to 10 MeV excitation energy. States of 24 Mg have been also populated using the 12 C( 14 N, d) 24 Mg reaction; excitation functions of 24 Mg states up to 9 MeV excitation energies as well as angular distributions at 35 MeV bombarding energy have been obtained. Comparisons of data with Hauser-Feshbach calculations show clearly that the compound nucleus mechanism is the main process for both 12 C( 14 N, 6 Li) 20 Ne and 12 C( 14 N, d) 24 Mg reactions. Strong evidence has been provided for inhibition of the 26 Al compound nucleus formation for angular momenta higher than critical values. The location of the yrast line in the 26 Al nucleus is discussed.