A 24 year old Somalian woman was referred to the ear, nose, and throat department by an emergency nurse practitioner, who said that the patient's “uvula has fallen off and stuck onto the back of her tongue.” The woman also had a three day history of worsening pain on swallowing with resulting anorexia. On examination, she had no uvula but a visible prominent oedematous epiglottis, and we diagnosed supraglottitis. This resolved within three days with intravenous antibiotics and steroids. It is common practice in Somalian communities to cut off the uvula within the first week of life in the belief that it promotes future good health and prevents weakness.

Scott C Maskell (scottmaskell@hotmail.co.uk), senior house officer, Murali Sivanandan, senior house officer, Robert L Harris, specialist registrar, ear, nose, and throat department, St George's Hospital, London SW17 0QT