An interesting case is described here in which partial airway obstruction resulted in sleep apnoea and which was relieved by adeno-tonsillectomy. Enlarged tonsils and adenoids causing upper airway obstruction represent one facet of a continuum of hypoventilation - sleep disorders and clinical examination with x-rays will help in determining patients at risk of developing these syndromes.
Safety and feasibility of transoral robotic surgery (TORS) in adults for otolaryngology surgery,
mainly in the treatment of oropharyngeal carcinoma and obstructive sleep apnoea has already
been established several years ago. However, less is known with respect to the role and safety
of TORS for otolaryngology surgery in the paediatric age group and its description in the
literature is currently insufficient. As paediatric patients are unique in their anatomy, physiology
and pharmacological kinetic, special attention and consideration has to be applied when using
TORS, hence this increases the perioperative challenges. Herewith we present our experience
in anaesthetising a paediatric patient for TORS adenotonsillectomy which is the first not only
in our centre but in Malaysia. Our major obstacle was the limited airway access as the area of
concern was shared by the anaesthesiologist, surgeon and also the robotic system.
Haemodynamic stabilisation was a challenge compared to the conventional method as the
operative time increased due to robot docking time and the new surgical learning process. In
our opinion, the key point for the success of TORS adenotonsillectomy in paediatric patients is
good communication and teamwork between all personnel involved in the surgery.
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 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)
Tracheal intubation in children can be achieved by deep inhalational anaesthesia or an intravenous anaesthetic and a muscle relaxant, suxamethonium being widely used despite several side-effects. Studies have shown that oral intubation can be facilitated safely and effectively in children after induction of anaesthesia with propofol and alfentanil without a muscle relaxant. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist that is 20-30 times more potent than alfentanil. This clinical study was designed to assess whether combination of propofol and remifentanil could be used without a muscle relaxant to facilitate tracheal intubation in children.