Displaying publications 41 - 60 of 92 in total

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  1. Prabhakar P, Rao N, Kairanna NV, Shetty S, Singh VK
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):6112-6118.
    PMID: 36742835 DOI: 10.1007/s12070-021-02764-w
    Oncocytes are epithelial cells having abundant eosinophilic cytoplasm. The presence of oncocytes in salivary glands pose a diagnostic challenge since they can be present in lesions ranging from non-neoplastic, benign to malignant. FNAC is a simple procedure which can aid in the pre-operative diagnosis of these lesions. This study is an eight year retrospective study in which salivary gland aspiration cytology cases having oncocytic cells and with available corresponding histopathology were included. These slides were reviewed for features like cellularity, presence of oncocytic cells, glandular elements, squamoid cells, nuclear atypia, mitosis, lymphoid tissue, necrosis. Twenty cases were included in the study. The mean age of presentation was 60 years showing male preponderance with parotid gland being the most common site of involvement. Concordant diagnosis on cytology and histopathology was seen in 16 cases and discordance was seen in 4 cases. All the discordant cases were reported as benign on cytology but on histopathology they were labelled as acinic cell carcinoma, squamous cell carcinoma, mucoepidermoid carcinoma and an intraparotid lymph node respectively. Review of discordant cases showed subtle findings like ill-formed acini, cytoplasmic vacuolation, goblet cells and dysplastic foci raising suspicion of a different diagnosis. The potential areas of pitfall and cause of discrepancy have been discussed in this study. It is crucial to be aware of the spectrum of lesions in which oncocytes are seen, to enable an accurate diagnosis on cytology. Careful evaluation of smears for subtle clues can minimize errors.
  2. Che Ab Rahim NA, Saniasiaya J, Narayanan P
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5169-5171.
    PMID: 36742856 DOI: 10.1007/s12070-022-03083-4
    Inducible laryngeal obstruction (ILO) describes as inappropriate, episodic, reversible laryngeal closure during inspiration, occurring at the glottic and/or supraglottic level, in response to external triggers causing exertional breathing difficulties. We describe a case of a female patient with an underlying major depressive disorder who presented with sudden onset of stridor and tachypnoea, whereby the external trigger was psychogenic in origin. Bedside flexible nasopharyngolaryngoscopy (FNPLS) showed characteristic findings of paradoxical adduction of vocal cords during inspiration. Arterial blood gas analysis, routine blood tests, chest radiography, and computed tomography (CT) scan of brain, neck, and thorax excluded neurological or airway abnormality. Bedside distraction breathing exercise alleviated the stridor and tachypnoea. The patient was managed by supportive psychotherapy, speech therapy, and anti-reflux medication and was discharged well with resolution of her respiratory distress. We would like to highlight that meticulous history along with physical examinations are imperative especially amongst Otorhinolaryngologists as emergent airway management tracheostomy would have been unnecessary and cause more stress and burden to the patient as well as family members.
  3. Ng SW, Zakawi FA, Shanmuganathan J, Al-Yahya SN
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5905-5909.
    PMID: 36742809 DOI: 10.1007/s12070-021-02480-5
    Langerhans cell histiocytosis (LCH) is a rare neoplasm characterized by accumulation of histiocytes in various tissues. It has a wide clinical spectrum and its presentation may mimic clinical features of common diseases. High level of suspicion is required for early diagnosis. Here is a rare case of a rapidly aggressive LCH which first presented with right zygomatic swelling.
  4. Ngu CYV, Tang IP, Ng BHK, Wong ASIIH, Liew DNS
    Indian J Otolaryngol Head Neck Surg, 2021 Jun;73(2):226-232.
    PMID: 34150596 DOI: 10.1007/s12070-021-02455-6
    Chordomas are rare and slow-growing locally destructive bone tumors that can develop in the craniospinal axis. It is commonly found in the sacrococcygeal region whereas only 25-35% are found in the clival region. Headache with neurological deficits are the most common clinical presentations. Complete surgical resection either via open or endoscopic endonasal approaches are the main mode of treatment. Here, we report a series of 5 cases of clival chordomas which was managed via endoscopic endonasal approaches in our center. A retrospective analysis of patients who had undergone endoscopic endonasal resection of clival chordoma in Sarawak General Hospital from 2014 to 2018. A total of 5 cases were operated on endoscopically via a combine effort of both the otorhinolaryngology team and the neurosurgical team during the study period from year 2013 to 2018. From our patient, 2 were female and 3 were male patients. The main clinical presentation was headache, squinting of eye and nasopharyngeal fullness. All our patient had endoscopic endonasal debulking of clival tumor done, with average of hospital stay from 9 - 23 days. Pos-operatively, patients were discharged back well. Endoscopic endonasal resection of clival chordomas gives good surgical resection results with low morbidity rates and therefore can be considered as a surgical option in centers where the surgical specialties are available.
  5. Anne J, Sreedharan S, Dosemane D, Shenoy V, Kamath PM, Zubair SM
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):835-841.
    PMID: 36452725 DOI: 10.1007/s12070-020-01855-4
    Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p 
  6. Abdul Rahim F, Goh BS
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2666-2669.
    PMID: 36452671 DOI: 10.1007/s12070-020-02358-y
    Tracheal bronchus (TB) is a rare congenital anomaly described as a abnormal bronchus that originates directly from the trachea above the carina directed towards the upper lung lobe. We analysed all paediatric rigid endoscopies of the airway from January 2015 until August 2020 to determine the incidence and characteristic of TB. In total, 68 rigid endoscopic airway examination record from children aged 0 to 12 years were analyzed. Endoscopic examination was performed from supraglottic region to carina using a 0 degree Hopkins rod lens telescope. Patients with a TB were identified and the site of TB origin was noted. Data of the identified patients was reviewed for the presence of preoperative airway findings such as stridor, upper lobe pneumonia, other congenital anomalies, intraoperative findings and complications and postoperative general condition outcome. TB was detected in 8 (11.8%) of 68 airway endoscopic examinations. 6 children (75%) were syndromic. 5 patients (62.5%) has congenital malacic airway and 2 patients (25%) has congenital tracheal stenosis. All TB originated from the right lateral wall of the trachea. All children had stridor unrelated to TB as presentation and 4 (50%) of children had preoperative upper lobe pneumonia. Tracheal bronchus is not a rare finding and is highly associated with syndromes and other airway anomalies. Although children with TB can be asymptomatic, upper lobe pneumonia is a common presentation. TB should be included in the differential diagnosis in patients with recurrent right upper lobe pneumonia or collapse and patients with unexplained oxygenation problem during endotracheal intubation, particularly in children with syndromes or other congenital anomalies.
  7. Kamarudin NA, Yeoh XY, Ibrahim MZ, Ab Rahman WI, Azman M
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2652-2655.
    PMID: 36452537 DOI: 10.1007/s12070-020-02340-8
    Laryngo-tracheo-bronchial tuberculosis may be primary or secondary to pulmonary tuberculosis. It causes stenosis of the airway, leading to life threatening airway obstruction. We herein describe the challenges in managing a case of laryngo-tracheo-bronchial stenosis in a 22-year-old patient who presented with stridor post antituberculous therapy secondary to a malacic airway.
  8. Velayutham J, Narayanan D
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2620-2622.
    PMID: 36452706 DOI: 10.1007/s12070-020-02324-8
    Phlebectasia is the abnormal saccular fusiform dilatation (without tortuosity) of a vein, which may affect any vein. Its etiology remains unknown and it is seen usually in the pediatric age group as a unilateral lower neck swelling, mostly on the right side. The other differential diagnoses of the neck swellings which increase in size during a Valsalva manoeuver are tumors or cysts of the upper mediastinum, external laryngeal diverticulum or laryngoceles. Our case report has highlighted the importance of understanding the nature of this lesion by using non-invasive radiological diagnostic modalities (USG), in order to avoid invasive investigations which can lead to catastrophic results. Case report. We describe a case of five year old boy with history of inguinal hernia repair a year ago presented with intermittent right sided neck swelling since he was two years old. His examination at rest was normal. However, with the Valsalva manoeuver a soft, painless, compressible swelling which appeared in the right lower neck was seen, which was not attached to the deep structures. Flexible nasopharyngolaryngoscope revealed normal laryngeal finding. Initial ultrasound finding revealed normal looking cervical lymph nodes bilaterally with no suspicious cystic lesion or collection. Patient then arranged for MRI neck where there are multiple bilateral subcentimeter cervical lymph nodes. However, repeated ultrasound neck while performing Valsalva manoeuver by patient showed sonographic features in keeping with bilateral internal jugular veins phlebectasia. Patient then was referred to pediatric surgeon for further management. A clinical diagnosis can be achieved by having a strong suspicion about this intermittent neck mass. It should be evaluated with non-invasive radiological modalities to avoid the possible catastrophic results which result from invasive techniques.
  9. Oon A, Razuan NA, Kuppan G, Mahadzir M
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1612-1614.
    PMID: 36452685 DOI: 10.1007/s12070-021-02770-y
    Tuberculosis is a highly contagious granulomatous disease which is endemic in South East Asia. Most common presentation is pulmonary tuberculosis which is spread by droplets inhalation of mycobacterium tuberculosis bacterium. Nasopharyngeal tuberculosis is a rare entity which poses a diagnostic difficulty as its presentation is greatly similar to that of nasopharyngeal carcinoma. Herein, we describe two cases of nasopharyngeal tuberculosis which mimics nasopharyngeal malignancy leading to diagnostic difficulties.
  10. Lim RCA, Loh TL, Yahaya Z, Wan Hamizan AK
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1964-1966.
    PMID: 36452519 DOI: 10.1007/s12070-020-01941-7
    Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.
  11. Retinasekharan S, Dompok TM, Mansor M
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2649-2651.
    PMID: 36452743 DOI: 10.1007/s12070-021-02371-9
    External laryngeal trauma is a rather rare occurrence, and comprises a varying severity of injuries. Every laryngeal injury is unique and the management can be invariably complex. For the most severe forms of external laryngeal trauma, reparative procedures and laryngeal stenting (after control of the airway) are considered standard treatment. We present a case of a complex laryngeal trauma with extensive loss of tracheal cartilage and soft tissues which was treated with total laryngectomy.
  12. Lim RCA, Krishnan EK, Husain S
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1450-1452.
    PMID: 36452606 DOI: 10.1007/s12070-021-02597-7
    Pathology of sphenoid sinus is uncommon and may pose a diagnostic challenge in view of its vague symptoms together with its relatively inaccessible location at the skull base. Radiological imaging is of utmost importance in diagnosis. We present an insidious case of a sphenoid sinus cholesterol granuloma.
  13. Lokman FL, Goh BS
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1050-1055.
    PMID: 36452792 DOI: 10.1007/s12070-020-02099-y
    Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12 years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only  2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.
  14. Ab Rahim NAC, Liew YT, Ghauth S, Narayanan P, Abu Bakar Z
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):347-351.
    PMID: 36406798 DOI: 10.1007/s12070-022-03261-4
    The purpose of this study was to conduct a cadaveric dissection study on the anatomical variation of the sublingual (SLG) excretory ducts and dictate an improved understanding of the anatomical communication between the SLG duct and submandibular (SMG) ducts. This study is carried out by standardized dissection of anterior floor of mouth in 6 formalin-fixed adult cadavers in Silent Mentor Workshop University Malaya in August 2020. The cadavers had no trace of scars, adhesions, signs of trauma or operation. SMG duct opening was identified lateral to the lingual frenulum through a papilla in the floor of mouth behind the lower incisor tooth. A horizontal incision line was done over floor of mouth just lateral to the opening. SMG duct and SLG was traced and skeletonized. Any presence of major duct arising from the SLG and its communication with SMG duct were investigated. We found there are 3 patterns of SLG excretory duct variants; (1) One major (Bartholin's) duct which open independently at its own orifice adjacent to the orifice of the Wharton's duct of SMG. (2) One major (Bartholin's) duct which joined into the Wharton's duct of SMG. (3) Absent of a major duct arising from SLG. The overall mean diameter of SLG ducts were 1.3 ± 0.41 and the mean length of SLG ducts were 18.5 ± 6.55. The overall mean diameter of SMG ducts was 2.6 ± 0.74 and the mean length of SMG ducts were 46.5 ± 6.57. Excretory ductal system of SLG showed great variations, not only between the different cadavers but also within the different sides of the same cadaver. Awareness of potential anatomical variations can aid in the accurate diagnosis and treatment of patients with salivary gland pathology as well as help surgeons reveal potential risk factor and avoid complications during surgical procedures in the floor of mouth.
  15. Chong W, Loh ST, Kulasegarah J, Loh TL, Tengku Kamalden TMIB
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1800-1802.
    PMID: 36452768 DOI: 10.1007/s12070-020-01809-w
    Tuberculous retropharyngeal abscess is a rare form of extrapulmonary tuberculosis. We describe an immunocompetent teenager who has her tuberculous retropharyngeal abscess ruptured and then diagnosis confirmed by the presence of acid-fast bacilli from the gastric lavage.
  16. Mohamad Yusof AN, Saifudin N, Tengku Kamalden TMI
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1408-1411.
    PMID: 36452747 DOI: 10.1007/s12070-021-02560-6
    Neuroblastoma is the most common extracranial neoplasm among paediatric patients, which arises from ectodermal neural crest cells. The most frequent primary site of neuroblastoma arises from retroperitoneum, specifically in the adrenal medulla. We present a rare case of adrenal neuroblastoma metastasis to maxillary sinus in a 20 month-old boy presenting with right maxillary swelling for the past 2 months. Computed tomography (CT) scan of paranasal sinus demonstrated right maxillary mass. A biopsy performed via a sublabial approach, surprisingly revealed neuroblastoma. Subsequent further workup depicted a huge right adrenal tumour. He was diagnosed with adrenal neuroblastoma stage 4 and treated with chemotherapy and surgical resection.
  17. Tuang GJ, Mansor M, Abdullah A
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):3671-3674.
    PMID: 36742599 DOI: 10.1007/s12070-020-02316-8
    Microtia comprises a spectrum of congenital malformation characterized by partial deformities of the auricular components to complete absence of pinna. Surgical reconstructions of this anomaly are often complex and technically challenging. Infection, hematoma, and skin necrosis with resultant exposed cartilage graft tend to occur in the early phase of post-operative care. Herein, we report a case of a spontaneous auricular abscess with exposed cartilage framework 20 years following rib cartilage reconstruction. To our knowledge, this is the first case of such an occurrence. The treatment options are discussed, along with the review of the literature.
  18. Cheah PF, Punithamalar K, Kong LSS, Goh LC, Yeoh AG, Mohd Razif MY
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):6032-6038.
    PMID: 36742789 DOI: 10.1007/s12070-021-02680-z
    Preoperative radiological assessment of parotid tumours represents a crucial step in the planning of a parotidectomy in order to avoid post-operative facial nerve paralysis. The purpose of this study is to determine the reliability of the novel 'M-line' in predicting the facial nerve position and compare it to various radiological methods in the same context. 66 patients whom had underwent parotidectomy for parotid tumours from January 2012 to February 2021 were analyzed. Parotid tumour location were identified using the retromandibular vein, facial nerve line, Conn's arc, Utrecht line and the 'M'-line were compared to the intraoperative location of parotid tumours.The 'M'-line is a novel hypothetical line (drawn between the lateral surface of the mandible to the lateral border of the mastoid process) used to identify the location of the facial nerve radiologically. The 'M-Line' and other methods of radiological assessments were associated with statistical significance in predicting if the parotid tumours were superficial or deep to the facial nerve (p-value 
  19. Rashid KNA, Zainon IH, Othman NAN
    Indian J Otolaryngol Head Neck Surg, 2024 Feb;76(1):1244-1246.
    PMID: 38440449 DOI: 10.1007/s12070-023-04241-y
    Inverted follicular keratosis is a benign skin lesion that typically presents as an asymptomatic, solitary nodule that may mimic malignant lesions, especially squamous cell carcinoma, both clinically and pathologically. It is developed from the hair follicle infundibulum and can be considered a variant of seborrheic dermatitis. We present a case of a 26-year-old gentleman with a soft tissue mass at the external auditory canal which was later confirmed as inverted follicular keratosis and was treated by endoscopic transcanal excision of the mass with temporalis fascia graft reconstruction. He is currently under surveillance follow-up with no symptoms and signs of recurrence.
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