Lesions in the skull base may present difficulties in diagnosis primarily because the access needs to be invasive and one has to rely on imaging that may still be misleading. The case presented here illustrates this example in that the patient had abnormalities on computed tomography (CT) and magnetic resonance image (MRI) scans quite convincing of malignancy but which with time proved, essentially through clinical judgment, to be skull base osteomyelitis secondary to malignant external otitis (OME).

This is a modified subtotal laryngectomy. On the tumour-free side of the larynx, some posterior structures, with their neurovascular supply are preserved. The endolaryngeal mucosa is tubed in continuity with the trachea below and projects into the pharynx above. Thus a myomucosal shunt is formed. Air is directed into it by finger occlusion of the tracheal stoma.The voice production is highly satisfactory. Aspiration is prevented by constriction of the thyroarytenoid muscle which provides a valved upper end of the tube.The possibility of leaving tumour in the laryngeal remnant is eliminated by careful selection of patients, and re-confirmation of tumour extent intra-operatively and a frozen section.Eleven such operations have been performed since October 1983 for squamous cell carcinoma, some previously irradiated. None of the patients had local recurrence. Only one had an aspiration problem which later resolved. All acquired a satisfactory voice

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