We report a rare clinical presentation of breast carcinoma metastasis to the ethmoid sinuses, orbit and cavernous sinus in a 70-year-old lady with unsuspected breast carcinoma who presented with clinical features of acute ethmoiditis, orbital cellulitis and cavernous sinus thrombosis. The patient underwent endoscopic ethmoidectomy and histology of the necrotic tissue from the ethmoidal cells was positive for endovascular neoplastic emboli. Subsequent examination revealed a large mass in the left breast, tethered to the skin, which was histologically confirmed to be a carcinoma. The patient died 2 months post-diagnosis. To our knowledge, this is the third case manifesting with combined features of ethmoiditis, orbital cellulitis and cavernous sinus syndrome from an unsuspected breast carcinoma. This case highlights the importance of imaging and thorough physical examination when a dramatic clinical picture presents in the paranasal sinuses of an otherwise healthy individual. Such manifestation of breast carcinoma is difficult to diagnose, and therefore, a high index of suspicion should be maintained. Skull base metastases from breast carcinoma behave aggressively and if diagnosed early, treatment may prolong survival and improve quality of life.

Nasal airway resistance due to uncomplicated DNS was examined in 43 patients, and the results compared with those obtained following corrective surgery. The patients were examined independently by the two authors using a strict examination protocol. Rhinomanometry was carried out pre- and post-operatively at rest and after exercise assessing the worst and the better breathing nostrils separately. The results show that both resting and post-exercise nasal resistance was reduced following septal surgery.

A case of spindle cell carcinoma of the nasopharynx is reported and its current management is reviewed. Surgical excision of the nasopharyngeal tumour may be the treatment of choice in some cases.

A rare case of an atypical lipoma in the pyriform sinus is described with an unusual presentation and some difficult histological features. Excision was performed endoscopically, there has been no evidence of recurrence for over a year. External surgical excision is reserved in case of recurrence of the tumour.

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P. A. H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years.Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.