We report a rare case of bilateral maxillary mucoceles. This was the primary presentation in a child with an underlying diagnosis of cystic fibrosis.

A five-month-old infant presented with isolated symptoms of nasal congestion. Initial examination and investigation with computed tomography identified the cause to be bilateral maxillary mucoceles. The child was investigated for cystic fibrosis and found to be positive. Given the young age and anatomy, a modified surgical approach was used to treat the mucoceles, comprising endoscopic and bilateral uncapping of the maxillary mucocele, uncinectomy, and middle meatal antrostomy. The child was then followed up with appropriate treatment for cystic fibrosis. At six-week follow up, there was no recurrence of symptoms.

Maxillary mucoceles are extremely rare but can present in patients with chronic sinusitis or cystic fibrosis. To our knowledge, there are no prior reports of this condition being the primary indicator of underlying cystic fibrosis in the absence of upper respiratory tract symptoms. Doctors should be aware that mucoceles can present in very young individuals and may indicate an underlying diagnosis of cystic fibrosis. A high index of clinical suspicion will avoid delays in diagnosis and long-term management.

We present the first report of methicillin-resistant Staphylococcus aureus and Propionibacterium acnes parotid abscesses complicated by facial nerve palsy. Facial nerve palsy secondary to parotid gland abscess is rare, with only eight previously reported cases.

Case reports and literature review concerning parotid abscess and facial nerve palsy presentation and management.

Within two months, two female patients presented with parotid gland abscess complicated by unilateral facial paralysis. Both were treated with intravenous antibiotics and surgery. In the first case, methicillin-resistant Staphylococcus aureus was cultivated, in the other, Propionibacterium acnes was found. In the first case, facial nerve function did not recover.

Parotid gland abscess can lead to facial paralysis. Both methicillin-resistant Staphylococcus aureus and Propionibacterium acnes may be involved. Ultrasonography or computed tomography is recommended to exclude a parotid abscess in patients presenting with suppurative parotitis.

A 33-year-old woman presented with a three-day history of an abscess in the left alar region, four weeks after drainage of a breast abscess. The later infection was confirmed to be due to Panton–Valentine leukocidin positive, methicillin-resistant Staphylococcus aureus. This report aims to raise awareness of such infections, and to advise when Panton–Valentine leukocidin toxin testing is appropriate.

Case report and discussion.

Although superficial Panton–Valentine leukocidin positive Staphylococcus aureus infections are relatively benign, more serious infections can be potentially life-threatening. Clinicians should be able to identify the features of potential Panton–Valentine leukocidin positive Staphylococcus aureus infection, in order to implement appropriate therapy.

Clinicians need to be aware of Panton–Valentine leukocidin positive Staphylococcus aureus infections, and should ask specific questions when investigating the clinical history of patients with recurrent abscesses, as this bacterial strain is not routinely assessed by microbiology departments. If such an infection is suspected, clinicians should be aware of local protocols regarding toxin testing, antibiotic choice and decolonisation agents.

We report a novel bilateral suture lateralisation technique that allowed permanent tracheostomy decannulation in a patient with severe paradoxical vocal fold movement.

A 45-year-old woman presented to the accident and emergency department with worsening shortness of breath. Flexible nasoendoscopy revealed limited vocal fold abduction and an emergency tracheostomy was sited; this was subsequently changed to a long-term Silver Negus tube. Her tracheostomy care was complicated by discomfort and dislodgement. The diagnosis of paradoxical vocal fold movement was only made when the patient presented to our department. Cognitive behaviour therapy and botulinum toxin injection were tried without success. A right vocal fold lateralisation procedure was performed, which enabled temporary tracheostomy decannulation. A left vocal fold lateralisation procedure was subsequently performed and the patient was successfully decannulated, with significant improvement in quality of life.

Paradoxical vocal fold movement is a rare condition that is most commonly managed by biofeedback sessions, relaxation manoeuvres or botulinum toxin injection. However, in cases similar to ours in which these treatments are unsuccessful, we suggest a ‘last resort’ technique to manage this rare condition.