Upper airway obstruction is an uncommon but recognized complication of infectious mononucleosis. The management depends upon the degree of airway compromise. In the case described, severe airway obstruction was treated by securing the airway with awake fibre-optic endoscopic intubation and then proceeding to tonsillectomy. Bilateral inferiorly loculated quinsies were encountered unexpectedly and drained. This is the first report of ‘bilateral’ quinsies, associated with infectious mononucleosis and severe airway obstruction. The association, pathogenesis and significance of this finding are also discussed.

The internal jugular vein is derived embryologically from the anterior cardinal veins. Developmental abnormalities may result in a cavernous venous varicosity, which may be the cause of massive primary hemorrhage during tonsillectomy. An index of suspicion is required for diagnosis, which may be confirmed by retrograde venography techniques.

Background: We describe our experience of a recently reported endoscopic stapling technique for the treatment of pharyngeal pouch. Methods: In contrast to other endoscopic procedures, which only divide the common wall between oesophagus and diverticulum, the linear cutting stapler also tightly seals the divided edges of mucosa and muscle. Results: The procedure was performed without complications in three patients with complete resolution of pre-treatment symptoms. Conclusions: To our knowledge this is the first report of the use of this procedure in Australia. This endoscopic stapling operation appears to be safe, simple and cost-effective and offers advantages over previously used techniques.

Background: Three patients who presented with recurrent cervical abscesses were found to have a branchial sinus arising in the piriform fossa. Each patient had previously had cervical abscess drainage procedures. Methods: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out. Results: In each case, imaging and endoscopy identified a sinus tract from the left piriform fossa. Neck exploration with hemithyroidectomy and excision of the sinus tract was performed without further recurrence of abscess. Conclusions: We believe these cases to represent a fourth branchial sinus. The relevant embryology and anatomy of the branchial apparatus is discussed and the pathways for the sinus and fistulous tracts of branchial sinus origin are reviewed. Branchial sinuses are uncommon, but should be considered as the underlying aetiology in patients who present with recurrent cervical abscesses.

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