Although nasopharyngeal carcinoma (NPC) is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology (FNAC) of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.
A 38-year-old female presented with foreign body sensation in the throat for one year. It was
increasing in severity. There was no other associated symptom. Examination of the oral cavity showed an abnormal looking uvula(Fig. 1). The rest part of the oral cavity, oropharynx and larynx were unremarkable. What is your diagnosis?(Copied from article).
Leech infestation in otolaryngology is sporadically seen in
remote area of tropical countries, but the cases are usually not
scientifically reported. We are reporting an unusual case of a
land leech removal from external auditory canal (EAC).
Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Foreign bodies or objects in the ear are one of the most common problems encountered by otorhinolaryngologist (ORL) with attendant complications, removal of which requires expertise. Patients with this problem who sought treatment in the otorhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM) were studied for duration of one year from January 2010 to December 2010. Specifically, the clinical presentation, type of foreign body and management outcome were analysed. 72 patients were reviewed - 44 (61.1%) males and 28 (38.9%) females. The age range was one year to 75 years with 59.8% being children below 10 years old. Ear pain (56.9%) was recorded as the most common and persistent symptom and insects (54%) were the commonest foreign body encountered. 95% (69) of the foreign bodies were removed under clinic setting with only three (4.2%) cases requiring general anaesthesia. Post-removal complications were noted in only one patient (1.4%). Repeated attempts by untrained personnel should be avoided and timely referral is vital to avoid undesirable complications.
Study site: torhinolaryngology clinic of Hospital Universiti Sains Malaysia (HUSM)
Assault injury can occur to any parts of the body. Usually the target area is the head, neck, chest and abdomen as they contain many major structures that are vital for life. However, movement of the victim few seconds before the instrument reach the body can redirect the impact to the less fatal part of the body. The outcome may be less fatal but can lead to cosmetically unacceptable condition. (Copied form article).
Azadirachta indica (neem) has been used for a long time in agricultural and alternative medicine. Neem
had been proved effective against certain fungi that could infect human body. This pilot study aims to
demonstrate the antifungal effect of Malaysian neem leaf extracts on the pathogenic fungi in otomycosis,
Aspergillus niger and Candida albicans. This is a laboratory-controlled prospective study conducted at
Universiti Sains Malaysia. The powder form of Malaysian neem leaf was prepared. Ethanol and aqueous
extracts of the neem leaf was diluted with sterile water to establish five different concentrations of 50 g/
ml, 25 g/ml, 12.5 g/ml, 6.25 g/ml and 3.125g/ml. The extract was tested on Sabouraud Dextrose Agar
suspended with Candida albicans and Aspergillus niger respectively. Well diffusion method was used
and zone of inhibition was measured. Growth of the fungi was inhibited in both alcohol and aqueous
extract concentrations. The minimum inhibitory concentration (MIC) of Malaysian neem aqueous extract
against Candida albicans was 11.91 g/ml, neem ethanol extract against Candida albicans was 5.16 g/
ml, neem aqueous extract against Aspergillus niger was 7.73 g/ml and neem ethanol extract against
Aspergillus niger was 9.25 g/ml. Statistical analysis showed that the antifungal activity of Candida
albicans is better in alcohol neem than aqueous extract (p
Fungal ball is an extramucosal mycosis. The patient may present with facial pain, nasal blockage, purulent nasal discharge and cacosmia, the fungal ball being present unnoticed for years. Some patients do present as having other nasal problems and later on are found out to have a fungal ball incidentally. We present a case of 38 yearold man who was clinically diagnosed as having left antrochoanal polyp. Intraoperatively, a fungal ball was discovered in the left maxillary antrum.
Ludwig angina is a submandibular space cellulitis secondary to oral cavity infection. It is strongly associated with difficult intubation due to limitation in the mouth opening. The presentation of Ludwig angina varies according to the severity of the infection. The extreme presentations include upper airway obstruction and respiratory failure. We present a female teenager with right submandibular abscess as the consequence of Ludwig angina, who was planned for incision and drainage. Successful awake fibre optic intubation was performed as a method of induction due to trismus, deferring the need for tracheostomy.
Radicular cyst is the most common cyst in the mandible. It usually presents in the later age of life because the formation of the cyst is the last step in a progression of inflammatory events following a periapical inflammatory lesion. The cyst usually goes unnoticed because of the size that is rarely palpable, and it is often painless. In this paper, we present a 12 year-old girl who developed a relatively large cyst for the age. The outline of management is discussed.
Squamous cell carcinoma is the most common malignant neoplasm of the upper aerodigestive
tract, and presentation is usually at the late stages when the diagnosis is made. Recurrence
after 1st therapy is common especially in the locoregional area of the tumour. For cancers
affecting the oral cavity, oropharynx, and mandible, “COMMANDO” (Combined
Mandibulectomy and Neck Dissection Operation) is one of the surgical approaches which
constitutes of primary tumour resection, mandibulectomy and neck dissection. We describe a
case of rapid locoregional recurrence following 1st surgical procedure of bilateral tonsillectomy
and extended neck dissection of oropharyngeal squamous cell carcinoma in a young healthy
individual without history of alcohol and tobacco abuse involving the right buccal region which
after positron emission tomography was done, showed involvement of right pterygoid muscles,
right-sided tongue muscle, and right mandible. The patient underwent redo salvage surgery
and reconstruction with anterolateral thigh flap.
To describe and determine the possibility of surgical trauma to the external branch of the superior laryngeal nerve and to assess the role of intraoperative neuromonitoring in thyroid surgery.
Managing a patient with a huge intraoral mass is always challenging. Manipulation or even a simple biopsy of the mass may lead to hemorrhage and further compromise the airway. An examination under anesthesia is not without risk. The method of securing the airway itself may become an issue if the mass is fully occupying the airway before intubation. Usually a tracheostomy is indicated. We share a gentleman presented with a huge intraoral mass occupying the oropharynx, which initially necessitates tracheostomy. We utilized the ultrasonic scalpel-assisted instrument to biopsy by debulking the tumour, thus avoiding the tracheostomy while waiting for the definitive treatment.
Osteomas occur in all parts of the temporal bone, including the mastoid, squamous, middle
ear, styloid process, internal auditory canal and external auditory canal (EAC). The EAC has
been reported to be the most common site, followed by the mastoid and squamous parts.
Diagnosis is made based on history, clinical examination and radiological findings. Computed
tomography reveals a pedunculated hyperdense mass that usually arises from the
tympanosquamous suture. Surgical removal of EAC osteomas can be achieved using the
endaural or postauricular approaches. It can be performed with a drill or osteotome, either
endoscopically or by using microscopy. This report presents two patients with EAC osteomas
who underwent excision under microscopy using the endaural approach. Surgery is the gold
standard treatment, while close observation may be considered in asymptomatic patients.
Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.
Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery
aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done
showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with
severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.