A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.

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This paper focuses on the process of haemostasis and methods of aiding haemostasis following minor oral surgery; these include both local and systemic measures. Consideration is given to patients with bleeding disorders, on anticoagulant medication or antiplatelet medication. The importance of recognising the increased risk of haemorrhage following minor oral surgery in such patients is explored with current recommendations for good practice in such patients. The dilemma as to whether antiplatelet and anticoagulant medication should be continued or discontinued prior to or immediately following minor oral surgery procedures is also discussed. Clinical RelevanceHaemorrhage following minor oral surgery is to be expected; if left uninterrupted and persistent, can prove fatal. It is therefore essential to understand the process of haemostasis and methods one can use to aid haemostasis in such instances. Similarly, with a shift in population demographics and an increase in life expectancies, comes a surge in co-morbidities and new medication to tackle them; among them anticoagulant and antiplatelet medication. It is important to be aware of how these medications can affect our patients, and how to manage such patients to avoid unnecessary prolonged haemorrhage following minor oral surgery. ObjectiveTo explain the process of haemostasis and the different methods of aiding haemostasis following minor oral surgery procedures. To understand the importance of aiding haemostasis in patients with a bleeding disorder or on anticoagulant or antiplatelet medication and the role of secondary care.

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