COVID-19-related orbital abscesses: a case report.

Orbital cellulitis is a condition with a high risk of morbidity, including visual loss. It commonly originates from the paranasal sinuses. We present a case of multifocal intraorbital abscesses secondary to viral sinusitis in an adolescent with SARS-CoV-2 infection. This patient presented with classic symptoms of orbital cellulitis, but did not display classical symptoms of COVID-19. The patient initially underwent endoscopic drainage, followed by a combined approach which yielded no pus. He recovered without complication. This is the second report of its type showing a causative link between SARS-CoV-2 and orbital cellulitis.

Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review.

OBJECTIVE: Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques. METHOD: A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic. RESULTS: The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure. CONCLUSION: Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management.

INTRODUCTION: Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits. MATERIALS AND METHODS: A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance. RESULTS: Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1-2%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period. DISCUSSION: The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around £73 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is £56 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at £71 million with tonsillitis and its complications accounting for a further £8 million.

Abscess of the anterior belly of the digastric muscle: a case report.

Abscess of the anterior belly of the digastric muscle has not been previously described and could pose a diagnostic and interventional dilemma. This case summarises the clinical, microbiological, radiological and surgical issues encountered and suggests learning points for clinicians posed with similar presentations. We recommend timely assessment by an appropriately trained clinician in either ear, nose and throat or oral and maxillofacial surgery, admission to a closely observable environment with airway-trained nursing staff and with potential for escalation to high dependency or intensive care in the event of airway compromise, as well as early involvement of an anaesthetist. Multimodality imaging should be performed to identify and localise an abscess collection or phlegmon, including an orthopantomogram in anticipation of odontogenic source and dental extraction as a definitive intervention. Surgical intervention for the abscess collection should be considered with consideration of the important neurovascular structures in this region.

Recurrent Warthin's tumour of the larynx.

Warthin's tumours, or adenolymphomas, present commonly as masses of the parotid glands and salivary tissue. However, in the existing literature, few cases of laryngeal adenolymphomas are described. We report the case of a 60-year-old woman with a recurrent right-sided laryngeal adenolymphoma, and discuss the difficulties in diagnosis and management.

Managing chondrosarcoma of the epiglottis: a case report.

Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.