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Fulltext Transtubular Transoral Surgery for Excision of a Dystrophic Os Odontoideum: A Case Report

Ariffin MH, Ashfaq MM, Kang E

Malays Orthop J, 2016 Mar;10(1):50-52.
PMID: 28435547 MyJurnal DOI: 10.5704/MOJ.1603.009

Transoral approach to the cervico-medullary junction is a well-established procedure. However oropharyngeal complications in the form of soft tissue morbidity postoperatively do occur. We report a case of a teenage boy with traumatic quadriparesis secondary to compression of the cervico-medullary junction by an os odontoideum. Decompression was done via transoral approach through a tubular retractor system, hence obviating the need for the splitting or separate retraction of the soft palate and minimised the damage and violation of surrounding soft tissues. His neurological status improved and he was able to ambulate with support on fourth post-operative day with no soft tissue morbidity in the oral cavity. To our knowledge this is the first case reported using this technique. We conclude that adoption of this method would improve the traditional transoral approach and reduce the oropharyngeal complications.

Matched MeSH terms: Palate, Soft
Fulltext Bilateral peritonsillar abscess: A rare emergency

Boon C, Wan Mohamad WE, Mohamad I

Malays Fam Physician, 2018;13(1):41-44.
PMID: 29796210 MyJurnal

Peritonsillar abscess, or quinsy, is a rare complication of acute tonsillitis. It usually presents with odynophagia, trismus, and muffled voice, reflecting the space-occupying lesion in the oral cavity. Examination reveals a unilateral swelling on either side of the soft palate, which drains thick pus after an incision is made. It is regarded as an emergency as an upper airway obstruction can develop. Bilateral peritonsillar abscess is a rare presentation and results in catastrophic sequelae. We present a case of bilateral peritonsillar abscess that was initially referred by a primary care centre facing a dilemma in diagnosis. Prompt diagnosis and fast drainage are warranted to avoid unwanted morbidity, and, also, mortality.

Matched MeSH terms: Palate, Soft
Management of velopharyngeal insufficiency by modified Furlow palatoplasty with pharyngeal flap: a retrospective outcome review

Wong LS, Lim E, Lu TC, Chen PKT

Int J Oral Maxillofac Surg, 2019 Jun;48(6):703-707.
PMID: 30755357 DOI: 10.1016/j.ijom.2019.01.010

The surgical approach for the correction of residual velopharyngeal insufficiency requiring secondary surgery at Chang Gung Memorial Hospital is the modified Furlow palatoplasty with pharyngeal flap (mFP-PF). The aim of this study was to describe the mFP-PF technique and to determine the results obtained with regard to improvements in velopharyngeal function in patients undergoing this surgery. This retrospective analysis included 58 non-syndromic patients treated during the period 1992-2015 who complained of hypernasal speech after primary cleft palate repair and failed postoperative speech therapy. All of them underwent mFP-PF surgery. Preoperative and postoperative perceptual speech assessment results were obtained. The male to female ratio in the study group was 1.2:1, and the mean patient age at the time of surgery was 8.27 years. The patients underwent nasoendoscopic examination and the velar closing ratio was categorized as 0.1-0.4 in 53.4% and 0.5-0.7 in 46.6%. The assessment of speech after mFP-PF showed statistically significant changes for all perceptual speech outcomes. The incidence of repeat surgery was 3.4%. This study revealed that 96.6% of patients did not require second surgery for velopharyngeal insufficiency. Further studies on obstructive sleep apnoea in post-mFP-PF patients and improvements to the surgical technique should be considered.

Matched MeSH terms: Palate, Soft
Fulltext Primary tuberculosis of palate

Chen I, Jamal S, Pua KC

Malays Fam Physician, 2015;10(3):32-4.
PMID: 27570606 MyJurnal

Primary tuberculosis (TB) of the hard palate is very rare. A 74-year-old man was presented with 6-month history of dysphagia along with an irregular mass in the hard and soft palate. Magnetic resonance imaging (MRI) revealed thickened and increased signal intensity within hard and soft palate. Tissue biopsy showed focal caseating granulomatous-like lesion and the histochemical staining using Ziehl-Neelsen stain for acid-fast bacilli was positive. Positive histochemical studies provided evidences that the hard palate mass was most likely due to TB. Thus, the patient was started on antituberculous therapy.

Matched MeSH terms: Palate, Soft
Fulltext Hole on the palate, saliva in the nose: what is your diagnosis?

Irfan Mohamad, Shamina Sara Moses, Rose linda Abdul Rahman

Archives of Orofacial Sciences, 2013;8(1):44-45.
MyJurnal

A 69-year-old lady was diagnosed to have mucoepidermoid carcinoma of hard palate 3 years ago. She completed 20 cycles of external beam radiotherapy and 5 cycles of mould brachytherapy and remained asymptomatic until she again presented to us with the recurrence of a painless mass at the hard palate. The hard mass appeared as an ulcerated dimple measuring 2 x 1 cm located at the junction of the hard and soft palate, more towards the right. Excision biopsy of the mass was done with a 1cm circumferential margin deep to the periosteum, with the resulting exposed bony defect covered with a rotational flap from the soft palate. During follow-up, the patient complained that the saliva came up into the nose whenever she swallowed. Oral examination (Figure 1) and flexible nasopharyngolaryngoscopy (FNPLS) (Figure 2) were performed. What is your diagnosis?

Matched MeSH terms: Palate, Soft
Bulbar signs in normal population

Lim KS, Hew YC, Lau HK, Lim TS, Tan CT

Can J Neurol Sci, 2009 Jan;36(1):60-4.
PMID: 19294890

BACKGROUND AND OBJECTIVES: There is lack of published data on bulbar signs among the healthy population. This study aims to determine the range of normality of bulbar signs particularly among the elderly.
METHODS: Systemic examination of bulbar signs was carried out according to a predetermined protocol on a cohort of young and elderly healthy subjects.
RESULTS: A total of 206 subjects were recruited in the study, 104 young adults with mean age of 20 years, and 102 elderly with mean age of 73 years. Uvula deviation was seen in 28 (26.9%) young subjects and 22 (21.6%) elderly. Irregular tongue border was seen in 17 subjects, unilateral in 4 subjects. Fourteen (6.8%) subjects had deviation on tongue protrusion. Occasional tremor of tongue on protrusion is common in both young and old. Persistent (severe) tongue tremor on protrusion was seen in 18.6% of the elderly, and 4.8% of the young. None of the subjects had tremor of tongue at rest. In gag reflex, absence of gagging response was common in elderly, seen in two thirds of the subjects on stimulation of the posterior pharyngeal wall. However, all the subjects had uvular movement. Habituation or suppression of gagging response was seen in close to 90% of young males.
CONCLUSION: There is wide range of normality in bulbar signs in normal population, particularly among the elderly.

Matched MeSH terms: Palate, Soft/physiology
Fulltext Outcome of laser-assisted uvulopalatoplasty (LAUP) in the management of snoring in Hospital Universiti Sains Malaysia (USM)

Abdullah B, Othman NA, Daud MK

Malays J Med Sci, 2008 Apr;15(2):29-32.
PMID: 22589622

To determine the outcome of laser-assisted uvulopalatoplasty for the management of patients with snoring in Universiti Sains Malaysia Hospital (HUSM). A retrospective review of patients who underwent LAUP with or without tonsillectomy or adenoidectomy under general anaesthesia between December 2003 to December 2006. Data was obtained from admission and follow-up records in the otorhinolaryngology clinic of USM Hospital (HUSM). A total of nineteen patients underwent procedure for the treatment of snoring. Majority of these patients presented with symptoms of loud snoring and daytime somnolence. The main operations performed were LAUP with or without tonsillectomy or adenoidectomy. The justification for LAUP were overhanging and excessive uvula or soft palate, whereas for adenotonsillectomy were the hypertrophied adenoids and tonsils. On follow-up, most of the patients claimed improvement of snoring within the first 2 months post-operation. However, majority of them defaulted follow-up after that. One patient (AHI preoperatively was mild) was reviewed up to 8 months with no snoring. One patient (AHI was severe preoperatively and normal post operatively) remained in our follow-up was satisfied with the operation. Two patients continued to experience snoring post LAUP despite trial of non-surgical methods. The outcome of LAUP in our patients showed variable results. This showed that patient selection is very important to achieve good result in LAUP. Long-term follow-up is also essential to document the success for LAUP.

Study site: otorhinolaryngology clinic of USM Hospital (HUSM)

Matched MeSH terms: Palate, Soft