Draffin's rods or bipods are now a well-known, internationally accepted ENT instrument. Before their invention in 1951, the attendant anaesthetist or nurse was obliged to support the mouthgag during tonsillectomy.

Research into the life of their originator, David Alexander Draffin, reveals that in addition to his evident design skills, he was a surgeon of courage, wit and great charm.

Widespread controversy exists concerning the treatment of traumatic tympanic membrane perforations. To elucidate the issue, a reference value for the rate of spontaneous tympanic membrane closure in man, to which the healing rates following different techniques of early surgical repair should be compared, was established on the basis of a review of more than 500 texts covering a century's literature on the traumatically perforated tympanic membrane. The spontaneous healing rate appeared to be close to 80 (78.7 per cent) in 760 evaluable cases of traumatic tympanic membrane perforations of all sorts diagnosed within 14 days post injury. A relative, causal-related variation of spontaneous healing could be demonstrated, and a pathogenetic classification of direct traumatic tympanic membrane perforations into ruptures induced by air-pressure changes, heat or corrosives, solids, and water pressures, is of proved clinical value and may have medico-legal validity. There is an obvious need for clinically controlled studies on the spontaneous healing of all kinds of traumatic perforations of the tympanic membrane in humans, and important elements in the design of future studies are advocated.

Twenty two patients presented with otogenic tetanus. Seventeen patients had acute histories with only a single episode of otitis media with otorrhoea. Fifteen patients had unilateral central perforations, five had bilateral central perforations and two had no perforations but had acutely congested tympanic membranes which were bulging suggesting the presence of purulent fluid behind them. All patients with perforations had a purulent pulsatile discharge. A coexisting aerobic infection was seen in 85 per cent of the cultures and 59 per cent of these were due to staphylococcus aureus (versus 25 per cent in the controls). Only one patient had received partial immunization. Tetanus resulting from otitis media is not an indication for surgery.

A middle ear effusion is a common complication of nasopharyngeal carcinoma both before and after radiotherapy. An effusion was found in 38 per cent of patients before radiotherapy and 9 per cent developed an effusion after the start of radiotherapy. Surgical treatment by myringotomy with or without grommet insertion was associated with a high incidence of otorrhoea (26 per cent) which was often refractory to treatment. In view of the frequency of this complication and the fact that a middle ear effusion may not be of concern to an adult patient with nasopharyngeal carcinoma, a ‘wait and see’ policy may be appropriate in the management of a middle ear effusion in these patients.

The midfacial degloving approach was first described by Casson et al. in 1974 but despite a number of papers in the American literature advocating its use, it has not gained popularity in Europe. The advantages and application of the technique are presented in 36 patients, ranging from 7–78 years of age. The approach is ideally suited for extensive benign lesions in the nasal cavity, ethmoid and sphenoid sinuses and enables access to the nasopharynx and infratemporal fossa whilst avoiding an external incision. These lesions have included angiofibroma (13 cases), inverted papilloma (five cases), a variety of cysts (three cases) and six miscellaneous cases of benign pathology. Malignant lesions which have not breached the anterior cranial fossa may also be removed, up to and including bilateral maxillectomy (nine cases) and this can be combined with orbital clearance. The approach may be repeated if necessary and is associated with few significant complications though vestibular stenosis, oro-antral fistula, nasolacrimal damage and upward rotation of the nasal tip may occur. Strategies to avoid these problems can be undertaken and long-term cosmetic results are excellent.

The results of pre-operative radical radiotherapy and subsequent maxillary resection are reported in 54 consecutive patients with carcinoma of the maxillary antrum treated at The Royal London Hospital from 1965 to 1989. The actuarial two and five year survivals were 50.3 per cent and 38.5 per cent respectively. Patients with adenocarcinomas fared better when compared with squamous and undifferentiated carcinomas (log rank p = <0.01). Undifferentiated carcinoma and involved regional lymph nodes were both very poor prognostic factors. In those patients who were either unfit for or refused maxillary resection, radical radiotherapy alone was still an effective treatment, with only a slight disadvantage in terms of local control and survival.

A prospective study was undertaken to compare the efficacy of calcium sodium alginate fibre (Kaltostat®) to petrolatum gauze impregnated with bismuth tribromophenate (Xeroform®) for the control of epistaxes that require hospital admission.

Forty patients presenting with severe epistaxis requiring hospital admission were treated with either Kaltostat®r Xeroform® nasal packs. Allocation to either treatment group was made randomly. The composition of each group in terms of age, sex distribution, aetiology of epistaxis and severity of bleed was not significantly different.

There was no significant difference in the efficacy or patient acceptability of either therapeutic agent. It is concluded that calcium sodium alginate fibre should be considered as an acceptable alternative to traditional gauze packing.

During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis. Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital.

Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway. Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children.

The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis.

The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation. As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b.

A case of fistulae in the inner canthus arising from the ethmoidal air cell sinuses is presented.

This type of complication is very rare, and to the best of our knowledge no similar case has been reported in the literature.

Clinical findings, imaging, pathology and treatment are presented and discussed.

Isolated nasopharyngeal tuberculosis is a rare disease with very few cases having been reported in recent years. We report a case presenting in the United Kingdom with unilateral otalgia and otorrhoea.

A mesenchymal chondrosarcoma of the nasal region in a neonate is described. Problems of histological interpretation and management are discussed.

Nasal polyps are multifactorial in aetiology but are associated with respiratory diseases, particularly late onset asthma. Several members of a family may be affected with nasal polyps but there is little evidence for a genetic basis for this. Some evidence to support a genetic predisposition comes from the development of polyps in identical twins.

Cavernous haemangioma of the temporal bone is a rare lesion and nearly always of limited extent. A case of a large and rapidly progressive temporal bone haemangioma in a child is presented.

Negative angiography led to biopsy at which profuse and troublesome haemorrhage was encountered. Subsequent Red Blood Cell labelled scan demonstrated blood pooling in the lesion. The combination of positive RBC labelled scan and negative angiography can only occur in lesions in which blood pooling takes place, enabling biopsy with its hazards to be avoided.

The tumour was resected using a skull base, infratemporal approach. Morbidity was minimal. There was no evidence of recurrence at a 15 month follow-up.

A case of early marked calcification of the arytenoid cartilages is presented in a patient with a suspected pharyngeal foreign body. The calcification on X-ray had the appearance of the expected foreign body. Calcification of the arytenoid cartilages is discussed.

We present a case of a patient who sustained a bullet wound to the mouth and face resulting in impaction of the foreign body in the neck. This was initially managed conservatively until migration into the supralaryngeal area occurred. This resulted in airway obstruction, dysphagia, and dysphonia necessitating resuscitation and per-operative intrapharyngeal removal.

Bullet wounds are uncommon in this country and experience with these cases is lacking. This paper discusses the various management options and the mechanism of how the bullet became lodged in the tissues of the neck.

Parenchymatous parotid tuberculosis diffusely affecting the entire gland is very rare. We present a case, associated with a primary pulmonary focus, that was confirmed after positive identification of alcohol and acid-fast bacilli in gastric washings. Both sites of infection resolved with quadruple anti-tuberculous chemotherapy.

Only one case of osteomyelitis of the cervical spine following laryngectomy for carcinoma of the larynx has been reported in the literature to date. We report an unusual case of osteomyelitis of the cervical spine following treatment of laryngeal carcinoma by radiotherapy (RT) and subsequent laryngectomy and discuss the relevant literature.

Premature cartilaginous calcification and nasal hypoplasia following first trimester exposure to warfarin are known as the Foetal Warfarin Syndrome (FWS). There are over 40 cases reported in the literature, many of which describe breathing and feeding difficulties in the first few months of life. We report a case where a child had had difficulties breathing and feeding in the first months of life. These had been attributed to nasal hypoplasia. After proper ENT assessment the child benefitted from adenoidectomy.

ENT surgeons should be aware of the syndrome as more women of child bearing age are taking warfarin following cardiac surgery and treatment of thromboembolic disease. ENT surgeons may be asked to review these children who often present with airway and feeding problems which have been attributed to nasal hypoplasia.