There are many important concerns and issues raised in managing acute airway obstruction cases with regards to the current COVID-19 pandemic. As a further matter, a patient with a huge thyroid mass in anaplastic thyroid carcinoma (ATC) presenting with impending airway obstruction poses treatment challenges, as immediate active intervention is necessary despite the risk of spreading of COVID-19 viruses. The unknown status of COVID-19 of the patient will add additional concerns during active assessment and treatment as patients with this undifferentiated thyroid carcinoma commonly deteriorate fast. This carcinoma may also invade the trachea and result in upper airway obstruction leading to a fatal outcome. Therefore, an appropriate treatment strategy is essential. This report highlights a case of an ATC patient who presented with diffuse cemented-hard anterior neck, whereby the whole management of ATC with acute airway obstruction during this COVID-19 pandemic is purely contentious and challenging. The issue of providing artificial ventilation either via intubation or tracheostomy is made more complicated as the patient presents with an acute upper airway obstruction whilst the COVID-19 status is unknown. While endotracheal intubation approach was not easy, the trachea was also difficult to be identified externally due to the huge ‘cemented-hard’ mass plastered over the compressed trachea. Due to the advanced disease, surgical intervention was not an option.

Post-tonsillectomy pain is an undesirable complication that can affect a patient’s emotion and daily activity. There have been many studies on different surgical techniques and medications to find the best treatment to alleviate pain in post-tonsillectomy patients. This study aims to compare the effectiveness of oral gargle and throat spray as different modes of delivery of benzydamine hydrochloride in post-tonsillectomy pain control. We focused on local analgesia using different methods of delivery. A total of 92 patients aged between 13 and 40 who underwent tonsillectomy with or without adenotonsillectomy, were included. They were randomly divided into two groups: gargle group and spray group, with 46 patients in each group. Pain score using Visual Analogue Score (VAS) was assessed for both groups at least six hours post operation as the baseline pain score, followed by assessments at days 1, 4 and 7. There was a significant difference in the VAS pain scores between the two modes of benzydamine hydrochloride delivery. The gargle group reported higher pain scores compared to the throat spray group (p < 0.001). In conclusion, using throat spray as a method to deliver local analgesia provides greater benefit in pain control for post-tonsillectomy patients, to the use of oral gargle. So, we can consider prescribing throat spray for treating the post-tonsillectomy pain perhaps it can prevent further complications such as dehydration, infection and bleeding.

Papillary thyroid carcinoma (PTC) comprises almost eighty percent of differentiated thyroid malignancy. It affects female more than male in the age range between 40–50 years old. It usually metastasizes to ipsilateral regional lymph nodes of neck and rarely have distant metastasis. Common route of dissemination of tumour is through lymphatic system. We reported a rare case of bilateral mandibular metastasis from incomplete resection of follicular variant of PTC.