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Fulltext Pediatric laryngotracheal cases in Hospital Universiti Sains Malaysia

Irfan, M., Izani S.M., Adil, S.A.R., Suzina, S.A.H.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):55-59.
MyJurnal

There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.

Matched MeSH terms: Hoarseness
Fulltext Isolated unilateral vocal fold palsy following skull base fracture: a case report

Marina M.B., Hazleigh N.M., Thean, Y.K., Sani A.

International Medical Journal Malaysia, 2018;17(3):95-98.
MyJurnal

Isolated lower cranial nerve (CN) palsy affecting the CN X resulting from a skull base fracture is very rare. The clinical manifestation and natural history is related closely to the complex anatomy of this region and mechanism of injury. Here, we report a case of a 54 year-old man who presented with a delayed onset of dysphonia and dysphagia with aspiration following a closed head injury sustained from a motor vehicle accident. Injection laryngoplasty was implemented to alleviate symptoms of his CN X palsy, which eventually almost completely resolved. High index of suspicion should be maintained when investigating possible skull base fractures, especially with a suggestive clinical presentation of lower CN palsies affecting one or all the lower CNs. Delayed onset of these CN palsies are likely to have more favourable outcomes.

Matched MeSH terms: Hoarseness
Fulltext Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis

Seevaunnamtum SP, Mohd Ariff Ghazali NA, Nazaruddin WM, Besari AM, Fariza NHN, Omar SC, et al.

Respir Med Case Rep, 2017;22:292-294.
PMID: 29159029 DOI: 10.1016/j.rmcr.2017.10.011

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition.

Matched MeSH terms: Hoarseness
Primary Squamous Cell Carcinoma of the Thyroid Gland

Ibrahim MI, Jusoh YR, Adam NN, Mohamad I

Iran J Otorhinolaryngol, 2018 Jan;30(96):65-68.
PMID: 29387667

Introduction: Primary squamous cell carcinoma (SCC) of the thyroid gland is one of the rarest types of all reported thyroid malignancies worldwide. It is very aggressive in nature and carries a poor prognosis. The surgical resection with adjuvant radiotherapy and chemotherapy is the most recommended treatment despite its poor reported outcome.
Case Report: A 74-year-old woman presented with a rapidly progressive neck swelling, with hoarseness and compressive symptoms. Physical examination revealed a multilobulated firm thyroid mass with unilateral vocal cord palsy. Histopathological findings confirmed the diagnosis of SCC while radiological investigations and panendoscopy findings ruled out the possibility of other primary tumors. A surgical intervention was performed; however, the patient eventually succumbed to death prior to undergoing an oncological treatment.
Conclusion: With no standard consensus to guide the management plan, SCC of the thyroid gland presents a great challenge for the managing team to come up with the best treatment option, due to its unfavorable rate of survival.

Matched MeSH terms: Hoarseness
Fulltext Denture Induced Submandibular Hematoma in a Patient on Warfarin

Boon Tat Y, Muniandy RK, Ng Mooi Hang L

Case Rep Anesthesiol, 2018;2018:4245809.
PMID: 30647972 DOI: 10.1155/2018/4245809

A 79-year-old lady, who was taking warfarin, presented to the Emergency Department with a painless anterior neck swelling, which was associated with hoarseness of voice, odynophagia, and shortness of breath. She first noticed the swelling after she removed her dentures in the evening. On examination, she had an increased respiratory rate. There was a large submandibular swelling at the anterior side of her neck. Upon mouth opening, there was a hematoma at the base of her tongue, which extended to both sides of the tonsillar pillars. The patient was intubated with a video laryngoscope due to her worsening respiratory distress. Intravenous vitamin K and fresh frozen plasma were given immediately. The patient was admitted to the ICU for ventilation and observation. The hematoma subsided after 2 days and she was discharged well.

Matched MeSH terms: Hoarseness
Fulltext Gore-tex medialisation thyroplasty for unilateral vocal cord palsy: a tertiary centre 7 years experience

Dayangku, N.P.S., Marina, M.B., Mawaddah, A., Sharifa Ezat, W.P., Abdullah, S.

International Medical Journal Malaysia, 2016;15(2):13-17.
MyJurnal

Background: The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with
medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal
cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods:
Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord
palsy at our institution and medical records were retrospectively reviewed. Results: There were 18
males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was
thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice
outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex
medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone
cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two
cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex
medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration
which would otherwise be disabling for the patients.

Matched MeSH terms: Hoarseness
Fulltext Stridor Secondary to Acquired Subglottic Cyst: Rarity Makes it Missed

See GB, Mesran I

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):45-48.
PMID: 31741928 DOI: 10.1007/s12070-016-0992-2

Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.

Matched MeSH terms: Hoarseness