Chronic oral ulcer in patients with rheumatoid arthritis is a diagnostic challenge in primary health care. The possible causes include the disease itself, side effect of treatment, malignancy and infections. This is a case of a 63-year-old woman with underlying rheumatoid arthritis presented with chronic solitary oral ulcer. She was on oral methotrexate (MTX) and high dose folic acid for five years with good compliance. Tissue biopsy showed marked inflammatory cells infiltration and nuclear hyperchromatism with no evidence of malignancy nor infection. The ulcer was resolved after completing antifungal treatment for six weeks following failure of improvement after empirical antibiotic, elimination of possible trauma and discontinuation of MTX. The fungal staining was negative. There are possibilities of false negative results, thus broadened diagnosis with repeated and further investigations are recommended in cases who did not respond to conventional treatment.

Introduction: An aberrant carotid artery has distinct terms and may exhibit a submucosal mass in the posterior pharyngeal wall. While it is primarily asymptomatic, an extreme aberrancy doubles the risk of dissection, a cerebrovascular accident (CVA) and an injury intraoperatively. Case Report: We report a case of ‘kissing carotid artery’ in a 65-year-old lady who presented with a foreign body sensation felt in the throat for one week. A finding of flexible nasopharyngolaryngoscopy (FNPLS) showed a bilateral paramedian retropharyngeal pulsating mass. Radiological examinations, including Computed Tomography (CT) of the neck and an angiogram, revealed an aberrant course of bilateral carotid arteries. In view of no malignancy and vascular malformations, there was no further intervention done, and the patient was subjected to yearly surveillance. Conclusion: Retropharyngeal carotid arteries are clinically significant anatomic variants. Such anomalies are potentially life-threatening and a risk factor for a severe hemorrhage during the simplest and commonly performed transoral surgeries. Thus, thorough perioperative assessment with accurate imaging techniques and studies are required to evaluate these anomalies and may avoid any disastrous complications.

Retropharyngeal abscess is life-threatening with potential airway emergency. A 53-year-old lady with diabetes mellitus presented with diffuse painful neck swelling for a week and difficulty in breathing with stridor. Video laryngoscopy done in operating theatre showed edematous laryngeal inlets with bulging posterior pharyngeal wall. Patient was tested positive for COVID-19 infection. The management was taken with high precautions, careful planning with unconventional and multidisciplinary approach. Management included airway protection, antibiotic, surgical drainage and correction of hyperglycaemia besides the compliance to COVID-19 SOP. Prognosis is good if identified early, managed aggressively and complications are avoided albeit the comorbidity and COVID-19 infective status

Branchial cleft cysts generally occur unilaterally at the lateral aspect of the neck. Bilateral branchial cysts are rare and may have familial associations. We report a rare case of non-syndromic bilateral branchial cyst in a 23-year-old woman who presented with chronic bilateral, progressively enlarging painless neck swellings. Complete surgical excision of the bilateral cyst was done. A histopathological examination confirmed the diagnosis. Precise diagnosis with early and complete surgical excision of branchial cysts may help prevent recurrence and other complications.

Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide. It is the fifth most common cancer among the Malaysian male. NPC is complex and unique in terms of its initial presentation. The patient usually presents late when the NPC is already in its advanced stage due to unusual and confusing nature of its manifestation which often misleads the clinician. Initial presentation of vision loss or impairment is rare in NPC. Up to date, there are only 9 reports of NPC cases presenting initially with impaired vision. We report a case of NPC with an uncommon initial presentation of bilateral visual impairment.