The authors describe the case of a 29-year-old man presenting with left retrooccipital and cervical pain associated with left ear fullness and rhythmic tinnitus. Head rotation movements on the right side and the Valsalva maneuver increased symptoms. A CT scan identified hyperpneumatization of the left temporal bone extending to the occipital bone as well as pneumarthrosis of the atlantoaxial joint. Surgical treatment involving obliteration of the fistula with bone and fat grafts via a computer-aided transmastoid approach was proposed. The surgery resolved all of the patient's symptoms except for the ear fullness. In this case the authors described an original treatment for spontaneous atlantoaxial pneumarthrosis. Long-term follow-up is needed to evaluate the risk of the recurrence of abnormal occipital bone pneumatization and to assess joint function.

This is the first case report of an osteomyocutaneous submental flap for reconstruction of an inferior orbital rim defect.

Diagnosis of perilymphatic fistula is challenging, but enables effective treatment. On any suspicion, surgical exploration should be undertaken, being the only reliable guide to diagnosis and etiologically adapted management.

Mandibular swing is the approach of choice for resection of advanced oropharyngeal carcinomas without bone involvement. This approach requires a mandibulotomy, which is associated with complications. A prospective outcome analysis was performed for 21 patients operated without mandibulotomy for T3-T4a oropharyngeal carcinoma. Tumour size was categorized as T3 in 14 patients (66.7 %) and as T4a (33.3 %) in 7 patients. Twelve patients were N0 (57.1 %), 2 (9.5 %) were N1, and 7 (33.3 %) were N2. Surgical margins were negative in 18 cases (85.7 %), positive in 1 (4.8 %), and close in 2 (9.5 %). Average hospital stay was 14.5 days (range 10-22). Adjuvant treatment (radiotherapy or concurrent chemoradiotherapy) was administered to all but three patients previously irradiated. In all cases radiotherapy started within 42 days of surgery. The 3-year overall survival was 85.7 %, and relapse-free survival was 71.4 %. Oropharyngectomy without mandibulotomy has the same indications as mandibular swing. It provides good access to achieve satisfactory clearance of tumours, sparing patients the morbidity associated with mandibulotomy.

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