Ameloblastoma: a rare nasal polyp.

Ameloblastoma is an odontogenic neoplasm of enamel organ type tissue which does not undergo transformation to the point of enamel formation. We present the second case in the English literature of maxillary ameloblastoma that presented with nasal obstruction and rhinorrhoea, and the first to be excised using a combined maxillotomy and endoscopic ethmoidectomy. The patient had no previous dental history. The unusual presenting symptoms, as well as the highly destructive nature of these lesions when arising in the maxilla, make them worthy of consideration in the differential diagnosis of nasal and maxillary masses. We discuss the clinical features, pathology and management of these lesions and review the literature.

Lacrimal gland abscess complicating acute sinusitis.

Infections of the lacrimal gland are uncommon, with suppuration and abscess formation being exceedingly rare. Acute bacterial dacryoadenitis may develop secondary to an adjacent infection, from blood-borne spread or after trauma. We report a paediatric case of lacrimal gland abscess thought to be caused by spread of infection from the paranasal sinuses. The possible mechanisms of spread of infection to the lacrimal gland are discussed as well as the management of this unusual complication of sinusitis.

Recurrent meningitis due to a congenital fistula of the stapedial footplate.

A rare case of a congenital fistula of the stapes footplate, in a 10-year-old girl, resulting in recurrent meningitis, is reported. A full ENT examination and a high index of suspicion, is essential if the diagnosis is to be made. Exploratory tympanotomy should be considered on clinical grounds, even if a high resolution CT scan of the temporal bones does not show any anomalies, in order to ascertain the definite diagnosis of a fistula and to seal it permanently.

Myringoplasty under local anaesthesia: day case surgery.

Eleven patients underwent fat graft myringoplasty, using EMLA cream local anaesthetic, as day cases. 10 of them were followed up, and 3 months post-operatively, 8/10 (80%) of the perforations were completely closed, with an average improvement of the hearing threshold of 11 dB. All the patients were satisfied with the procedure and it is concluded that fat graft myringoplasty under local anaesthesia as a day case is safe, simple, reliable and cost effective. It should be considered for closure of small perforations (30% or less) of the tympanic membrane.

Necrotizing fasciitis of the neck.

Necrotizing fasciitis (N.F.) is a rare but serious infection of subcutaneous tissues and deep fascia with resulting skin gangrene and septicaemia. It is due to mixed anaerobic and aerobic organisms. It has been reported under a variety of synonyms. We describe two cases of necrotizing fasciitis of the neck probably secondary to chronic dental infection, one was diagnosed early and the other late with very different outcomes. We highlight the importance of early and aggressive surgical treatment to complement parenteral antibiotics covering both aerobic and anaerobic organisms.

Transitional papilloma of the middle ear.

We present a rare case of a transitional papilloma of the middle ear, occurring several years after excision of a similar lesion from the nose. There was no continuity between the two lesions suggesting that these tumours can be multicentric in origin.