Comedonal lupus is a rare variant of chronic cutaneous lupus erythematosus. Its misleading clinical appearance may delay diagnosis, which relies on histopathology and direct immunofluorescence. Early treatment is essential to prevent scarring.

Oral amyloidosis is rare. The presence of amorphous, acellular, eosinophilic deposits on haematoxylin and eosin staining of an oral biopsy should trigger staining with Congo red. Positive Congo red staining is seen in this image, which in polarised light shows apple green-birefringence typical of amyloid. Characteristation of the protein in amyloid is an essential step in management, as is further investigation to determine if the amyloid deposit is localised or a manifestation of a systemic process.

This case report details a modified tracheostomy technique used in an adult patient with Klippel-Feil syndrome, a condition characterized by congenital fusion of cervical vertebrae. The unique challenges posed by the patient's anatomy were addressed using a combination of open and percutaneous approaches, successfully avoiding the need for more invasive procedures.