Introduction The incidence of deep neck space infection (DNSI) is rising and appears to be related to falling rates of tonsillectomy. The purpose of this study was to assess demographics of patients presenting with DNSI and the financial burden to the National Health Service (NHS). Methods Data were collected retrospectively on patients aged over 16 years admitted to NHS Greater Glasgow and Clyde with DNSI between 2012 and 2016. Demographics, aetiology and use of hospital resources were reviewed. The cost of hospital admissions was calculated using data from NHS Scotland's Information Services Division, the local diagnostics division and the British National Formulary. Results Seventy-four patients were admitted with DNSI during the study period. Forty (54%) were male. The mean age was 44.0 years (range: 16-86 years). The most frequent source of infection was the tonsil (n=30, 40.5%). The most common infective organism was Streptococcus constellatus (n=9, 12.2%). The mean length of stay was 11 days. Fifty-five patients (74.3%) required operative intervention. The mean cost of admission per patient was £5,700 (range: £332-£46,700). Conclusions This study highlights the high cost burden of DNSI to the NHS. The incidence of DNSI in Glasgow has risen over the study period; contributing factors may include the reduced tonsillectomy rate and a reduction in antibiotic prescribing. As the incidence of DNSI continues to rise, there will be an increase in cost to the NHS, which must be planned for.

Objectives The coronavirus disease 2019 pandemic has led to a need for alternative teaching methods in facial plastics. This systematic review aimed to identify facial plastics simulation models, and assess their validity and efficacy as training tools. Methods Literature searches were performed. The Beckman scale was used for validity. The McGaghie Modified Translational Outcomes of Simulation-Based Mastery Learning score was used to evaluate effectiveness. Results Overall, 29 studies were selected. These simulated local skin flaps (n = 9), microtia frameworks (n = 5), pinnaplasty (n = 1), facial nerve anastomosis (n = 1), oculoplastic procedures (n = 5), and endoscopic septoplasty and septorhinoplasty simulators (n = 10). Of these models, 14 were deemed to be high-fidelity, 13 low-fidelity and 2 mixed-fidelity. None of the studies published common outcome measures. Conclusion Simulators in facial plastic surgical training are important. These models may have some training benefits, but most could benefit from further assessment of validity.

Gastrointestinal stromal tumours (GIST) are rare tumours of mesenchymal origin. These can be associated with neurofibromatosis type 1 (NF1), which is an autosomal dominant disorder. The prevalence of GIST in NF1 is estimated at 3.9–25%. This paper describes the presentation of a GIST arising from the jejenum in a 75-year-old lady with NF1, who presented with gastrointestinal bleeding. This was diagnosed by CT angiography. She was managed with laparotomy, with resection of small bowel, and an ischaemic segment of large bowel with two primary anastomoses. Pathology showed GIST of spindle cell type (Figs 3 and 4), 90 mm in size, with complete local excision. The patient was discharged on the eighth post-operative day and is currently undergoing regular clinic follow-up after multidisciplinary team meeting discussion.

Keypoints Chronically discharging mastoid cavities can be troublesome and results of surgical management is variable  Cavity obliteration at the time of revision mastoidectomy in our centre shows dry ear rate of 93% (28/30)  This is the first study to show improvement in QoL in relation to otological symptoms using disease specific questionnaire (COMBI questionnaire)  The benefit to general quality of life is comparable with other otological procedures. The biggest improvement was noted in improvement of 'smelly ears', 'ear discharge' and 'Need to take eardrops'

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