Extrasinusal mucoceles are exceptionally rare cystic lesions that arise outside the paranasal sinuses and may pose diagnostic challenges, particularly when incidentally detected in atypical locations. Their imaging appearance can overlap with other cystic skull-base and intracranial lesions. We report the case of a 45-year-old woman with an asymptomatic extrasinusal mucocele incidentally discovered on CT performed during follow-up of a peritonsillar abscess. Imaging revealed a well-defined expansile cystic lesion in the spheno-temporo-orbital region, causing cortical thinning without surrounding intracranial edema or diffusion restriction. MRI demonstrated homogeneous fluid signal intensity, thin peripheral enhancement, and absence of solid components. Based on these radiological findings, an imaging-based diagnosis of a probable extrasinusal mucocele was favored. As the patient declined surgical intervention, a conservative approach with regular clinical follow-up every 3 months and annual MRI surveillance was adopted. At the most recent follow-up, the lesion remained radiologically stable without interval growth or new symptoms. This case underscores the importance of considering extrasinusal mucocele in the differential diagnosis of skull-base cystic lesions.

Spontaneous tonsillar hemorrhage (STH) is a rare but potentially life-threatening complication most commonly associated with tonsillitis and, less frequently, peritonsillar abscess. Prompt recognition and management are critical due to the risk of airway compromise and vascular injury. We report the case of a 30-year-old female who developed massive oropharyngeal hemorrhage following spontaneous drainage of a peritonsillar abscess, requiring emergent airway protection and surgical intervention. The patient underwent Quinsy tonsillectomy, which revealed an extensive defect created by the hematoma communicating with the parapharyngeal and submandibular spaces, placing major cervical vessels at risk. Given the size and depth of the defect, reconstruction was performed using a pedicled buccal fat pad flap to provide vascularized coverage of exposed deep neck spaces. Computed tomography angiography demonstrated close proximity of the peritonsillar space to the facial artery without evidence of pseudoaneurysm or active extravasation. The patient had an uneventful recovery with complete mucosalization of the reconstructed oropharyngeal defect. This case highlights that spontaneous tonsillar hemorrhage following peritonsillar abscess drainage may result in extensive deep neck space involvement requiring not only definitive tonsillectomy but also reconstructive intervention. The successful use of a buccal fat pad flap in this non-oncologic infectious setting expands reconstructive options for complex oropharyngeal defects and underscores its utility in preventing secondary hemorrhage and vascular complications.

Group A streptococci (GAS) are one of the most common bacteria encountered daily, and they result in acute infections with a wide array of manifestations in both adults and children and is responsible for an estimated 9,000-12,000 deaths per year in the United States.[1] Group A streptococci (GAS) are classified as gram-positive cocci that cause a range of diseases. GAS can be divided into greater than 100 different subtypes based on their surface ‘M-protein’. Infections due to GAS result in acute pharyngitis, impetigo, erysipelas, and cellulitis. GAS also tends to produce manifestations of more invasive diseases, including streptococcal toxic shock syndrome and necrotizing fasciitis. In addition to acute infection, infections due to GAS result in several nonsuppurative complications, including acute rheumatic fever and post-streptococcal glomerular nephritis.[2]

Background: Peritonsillar abscess (PTA) is a common deep neck infection associated with significant healthcare resource utilization. Needle aspiration (NA) and/or incision & drainage (ID) are the most frequently used treatment modalities; however, their comparative clinical outcomes remain controversial. Methods: This retrospective cohort study included 185 adult patients hospitalized with a diagnosis of PTA between January 2018 and January 2026 at a tertiary care center. Patients aged ≥18 years who underwent NA or ID were included. Demographic characteristics, clinical findings, laboratory parameters at admission, treatment-related variables (type and number of interventions, drainage volume, adjunctive corticosteroid use), microbiological results, and length of hospital stay were recorded. Patients were categorized according to the drainage method performed (NA vs. ID). Results: A total of 185 patients were included, of whom 87 (47%) underwent NA and 98 (53%) underwent ID. There were no significant differences between groups in age, sex, or length of hospital stay (p > 0.05). CRP levels and lymphocyte counts were significantly higher in the NA group (p = 0.028 and p = 0.009, respectively), whereas drainage volume and number of interventions were significantly higher in the ID group (p < 0.001 and p = 0.005, respectively). Successful resolution on the first attempt was more frequent in the ID group (89.8% vs. 75.9%, p = 0.011), while steroid use was more common in the NA group (16.1% vs. 2.0%, p = 0.001). In multivariate analysis, drainage volume, first-attempt success, and corticosteroid use were independently associated with the choice of drainage method (p < 0.05). Conclusions: Both NA and ID are effective treatment options for PTA; however, ID was associated with higher first-attempt success and greater drainage volume. Indeed, NA was more frequently accompanied by steroid therapy. These findings suggest that treatment modality selection may influence short-term clinical outcomes in patients with PTA.

Croup is a common childhood respiratory illness with peak incidence in October and November. Inflammation of the subglottic structures results in obstruction of the upper airway, causing the characteristic barking cough, hoarseness, and inspiratory stridor. Fever may also be present. Patients with suspected croup should be assessed for more severe causes of upper airway obstruction, such as bacterial tracheitis, retropharyngeal abscess, peritonsillar abscess, foreign body obstruction, and epiglottitis. Radiography or laboratory testing is typically unnecessary for diagnosis but should be considered if the diagnosis is unclear. Corticosteroids are recommended as first-line treatment to reduce symptom burden and the need for advanced medical care. Dexamethasone is the most-studied corticosteroid, but prednisolone may also be used. A single oral dose of dexamethasone (0.6 mg/kg, maximum 12 mg) is standard. Moderate to severe croup should be treated with nebulized epinephrine and corticosteroids. Recurrent episodes of croup should prompt evaluation for an underlying anatomic abnormality or medical condition.

Tonsil stones or tonsilloliths are mineralised concretions in the crypts of palatine tonsils. They are usually small and asymptomatic. Sometimes, they can be recurrent, large in size and produce symptoms like a sense of foreign body in throat, mild pain and heaviness in throat and halitosis. In such cases, a surgical intervention may be required for permanent cure. We came across one such patient with massive tonsillolith which mimicked a peritonsillar abscess initially. Eventually, the large tonsillolith was surgically removed in toto. It measured 5.2 × 2.5 × 2.5 cm which makes it the largest tonsillar stone ever to be successfully removed till date.

Postoperative bleeding is a well-known complication of tonsillectomy. Although inadequate hemostasis and vascular injury are common causes, occult coagulation disorders may also contribute. Factor XIII deficiency is an extremely rare condition that is particularly difficult to detect preoperatively because PT and APTT typically remain normal. A 27-year-old man underwent bilateral tonsillectomy for a recurrent peritonsillar abscess. Despite normal coagulation screening, the patient developed repeated postoperative hemorrhages requiring surgical management. Further evaluation revealed reduced Factor XIII activity (36%). After Factor XIII concentrate administration, bleeding ceased, and the postoperative course stabilized. Factor XIII deficiency should be considered in patients with recurrent postoperative bleeding despite normal routine coagulation tests. Early recognition and timely replacement therapy may prevent severe complications.