Coronavirus disease 2019 critical care patients endure prolonged periods of intubation. Late tracheostomy insertion, large endotracheal tubes and high cuff pressures increase their risk of subglottic and tracheal stenosis. This patient cohort also often appears to have co-morbidities associated with laryngotracheal stenosis, including high body mass index and laryngopharyngeal reflux.

This paper presents three coronavirus disease 2019 patients who were intubated for a mean of 28 days before tracheostomy, leading to complex multi-level stenoses.

All patients underwent multiple endoscopic tracheoplasty procedures and two required tracheal resections. There was a mean of 33.9 days between interventions. Coronavirus disease 2019 patients do not appear to respond as well to steroid, laser and balloon dilatation as other adult stenosis patients.

Intubated coronavirus disease 2019 patients have an increased risk of laryngotracheal stenosis, as a result of multiple factors. Otolaryngology teams should be vigilant in investigating for this complication. International guidelines on time to tracheostomy should be followed, despite a diagnosis of coronavirus disease 2019.

Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure.

Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure.

The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced.

This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.