No abstract

A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.

A 27-year-old elite-level professional cyclist presented to the emergency department with a 6-hour history of chest pain and vomiting after prematurely aborting a competitive event. ECG demonstrated anterior ST segment elevation myocardial infarction, and blood tests revealed a grossly elevated high-sensitivity troponin T. Emergent coronary angiography confirmed the presence of a thrombus in the mid-left anterior descending artery with possible spontaneous coronary artery dissection. The patient recovered well following balloon angioplasty and thrombus aspiration, despite delayed recognition, invasive investigation and intervention.

Historically, if the risk of occult nodal disease is >20%, elective neck dissection was advised for surgical management of squamous cell carcinoma (SCC). 1,2 A recent meta-analysis in the salvage laryngectomy setting (n = 1141) reported an occult nodal positivity rate (cN0pN+) of 11%, 3 which was higher in advanced local supraglottic (24%) or transglottic (17%) disease. Therefore, in high-risk patients undergoing salvage laryngectomy, neck dissection is generally recommended.The cN0pN+ disease rate in the contralateral neck in salvage total laryngectomy remains unclear and studies have shown neck dissection does not improve locoregional control or overall survivial. [4][5][6] The primary aim of this study is to report the rate of nodal metastases in the contralateral neck for patients undergoing salvage laryngectomy and to identify predictors of occult neck disease. | MATERIAL AND ME THODS | Ethical considerationsData were collected with Caldicott guardian approval (ref 16111). The South East Scotland Research Ethics committee waived the need for formal ethical approval due to the retrospective nature of data collection.