<p>Lemierre’s syndrome is a type of necrotizing fasciitis of the head and neck that is an uncommon rapidly spreading infection involving the skin, subcutaneous tissue and the fascia leading to life-threatening complications like septicaemia, bone marrow suppression, disseminated intravascular coagulation and multi-organ failure. The management of this disease, especially in COVID-19 pandemic is a challenge as it is associated with high morbidity. A 46-year-old male presented to us with complaints of swelling in the neck with discoloration of skin in the neck and chest. Computed tomography (CT) scan of the neck revealed thrombosis of the right internal jugular vein (IJV) and diffuse abscesses on both sides of the neck. A high index of suspicion is required for the diagnosis of Lemierre’s syndrome in the absence of typical clinical features. The rapid, unpredictable dissemination of infection and occult thrombus within the IJV make both diagnosis and management a challenge especially, during COVID-19 times.</p>
<p class="abstract"><strong>Background:</strong> Despite major advances in the design of endotracheal tubes and developments in the management of difficult airways, endotracheal intubation remains by far the most common cause of laryngotracheal injuries (LTI). These LTI are challenging to manage and are associated with significant morbidity and mortality. Hence, the present study was done to find out the incidence, types of LTI and to study the factors affecting the same.</p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted on patients who were intubated for more than 48 hours and admitted in medical intensive care units in a tertiary referral hospital, for a period of 1 year. All patients following extubation were evaluated for LTI by x-ray neck (antero-posterior and lateral view), rigid endoscopy and flexible naso-pharyngo-laryngoscopy. </p><p class="abstract"><strong>Results:</strong> Thirty patients were included in the study. Majority of the patients (56.6%) were found normal while 43.2% patients were having LTI following extubation in the form of bilateral vocal cord fixation, subglottic stenosis, granulation tissue in the posterior commissure and in the trachea. Majority of these patients were aged less than 45 years, with duration of intubation for more than 10 days, with tube size more than 7 mm. Organo-phosphourous (OP) poisoning was the etiology for LTI in 69.2% cases.</p><p class="abstract"><strong>Conclusions:</strong> A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes. Adequate training of the emergency personnel in the intubation technique and its subsequent care is important especially in a tertiary referral center.</p>
<p class="abstract">Malignant oncocytoma is an extremely rare neoplasm of the salivary gland accounting for 0.5% of epithelial salivary gland malignancies and 0.18% of epithelial salivary gland tumors. We report a case of malignant oncocytoma of left parotid gland in a 61-year old female patient. Patient presented with a 6-year history of painless swelling in the left parotid region. Fine needle aspiration cytology of the swelling was suggestive of pleomorphic adenoma. A computed tomography scan performed did not reveal any features suggestive of malignancy. Patient underwent left superficial parotidectomy. However, histopathological examination of the specimen turned out to be malignant oncocytoma. Malignant oncocytoma of salivary glands have rare incidence and may have similar morphologic features with other neoplasms. Despite the tumor being large and malignant in this case, there was no facial palsy preoperatively. As histopathology is often diagnostic, the possibility of malignancy always must be kept in mind preoperatively even when there is no facial palsy or fine needle aspiration cytology not showing up malignancy.</p>
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