Displaying publications 41 - 60 of 95 in total

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  1. Fulltext Ex Utero Intrapartum Treatment (EXIT) Into the World: A Multidisciplinary Approach and Outcomes in a Malaysia Tertiary Centre
    Oon A, Zulkifli S, Foong YK, Azhar AS, Abdul Ghafar MH, Soo MY
    Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):190-195.
    PMID: 35813785 DOI: 10.1007/s12070-021-02851-y
    Fetal airway obstruction that present during birth are challenging to manage. Cervical and thoracic mass may cause significant airway compression that leads to irreversible fetal morbidity and mortality. With the current advancement in prenatal diagnosis and assessment for surgical planning, EXIT has become an accepted, recognized and preferred option for safe delivery in complex head and neck masses. Ex utero intrapartum treatment (EXIT) is a life-saving procedure that provides time to establish an airway while maintaining uteroplacental circulation. It requires flawless coordination amongst multidisciplinary team to ensure immediate and safe baby deliveries. Retrospective review of EXIT procedures performed from the initial establishment of pediatric otolaryngology service in this centre starting from January 2019 to December 2020. Based on the prenatal diagnosis, five EXIT cases were performed in this centre within 2 years. 4 cases were diagnosed as lymphatic malformation and 1 immature teratoma with cervical and thoracic compression. 4 babies successfully delivered to airway without any complications with 1 death resulting from disseminated intravascular coagulopathy after EXIT. This review of five EXIT procedures aims to bring forth the different outcomes, preoperative planning and sharing our experience as a tertiary and newly established centre. Early prenatal diagnosis, good collaboration and experience among multidisciplinary team ensures good long term outcomes.
  2. Fulltext Challenges in Managing Intractable Epistaxis in a Post-nasal Surgery and Radiated Cancer Patient: A Case Report and Literature Review
    Goh SP, Wilfred R, Husain S, Tang IP
    Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):1096-1100.
    PMID: 37206815 DOI: 10.1007/s12070-023-03625-4
    Recurrent epistaxis represents an alarming sign that may suggest a sinister aetiology, especially in patients with previous head and neck malignancy. The recognition of certain potentially life-threatening conditions, namely pseudoaneurysm or tumour recurrence, remains prudence to avoid disastrous repercussion. Nasal endoscopy has become an essential tool in otolaryngology. It can aid identify the underlying cause of epistasis and facilitate therapeutic management. On the other hand, radio imaging is highly sensitive in detecting vascular lesions, besides providing a pre-operative mapping if surgical intervention is planned. This paper reported a patient with sphenoidal sinus squamous cell carcinoma in remission presented with torrential epistaxis not relieved with nasal packing. Despite a repeated angiogram and magnetic resonance image, the identification of the source of bleeding remained futile, culminating in an examination under general anaesthesia. The diagnosis of carotid blowout syndrome was made intraoperatively, and the bleeding was temporarily secured with a muscular patch, preceded by the insertion of a vascular stent. The authors wish to highlight the importance of examination under general anaesthesia if radio imaging does not correlate to the clinical findings. Management options for carotid blowout should be tailored to the patients' medical conditions.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-023-03625-4.

  3. Fulltext Bone Changes in Chronic Rhinosinusitis: Pathological or Physiological?
    Pokharel M, Khadilkar MN, Sreedharan S, Pai R, Shenoy V, Bhojwani K, et al.
    Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):178-184.
    PMID: 35813780 DOI: 10.1007/s12070-020-02076-5
    Bone remodelling is a normal physiological process which occurs in all bones. Hence bone changes should also be detected in undiseased or minimally diseased ethmoids as well as in chronic rhinosinusitis (CRS) patients. To test this hypothesis, we compared ethmoid bone histology between two groups of patients; a study group of CRS patients and a group of patients whose radiological, endoscopic and symptom scores were significantly less when compared to the CRS group. The study group had 75 patients who underwent functional endoscopic sinus surgery for CRS. The control group included 16 patients who had significantly different endoscopic and radiological scores from the study group. On histopathology, the bone harvested from the ethmoid sinuses were grouped as no remodelling activity (Score 1), mild activity (Score 2) and marked activity (Score 3). Thirty-six percent of patients in the study group and 37.5% of patients in the control group had Score 2 and 3 bone changes and the difference was not statistically significant (χ2 = 1.824, p = 0.402). Correlation of bone changes in CRS done with parameters like Lund-Mackay radiological, surgical and symptom scores and Lund-Kennedy endoscopic scores showed no statistical significance. Similar bone changes were detected in CRS patients and the control group. The bone changes seen in histopathology in CRS patients could partly be due to the normal physiological remodelling occurring in all bones.
  4. Fulltext A Rare Case of Cerebrospinal Fluid Rhinorrhea from Canal of Stenberg
    Ngu CYV, Lee TH, Ramachandran K, Liew DNS, Tang IP
    Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):764-767.
    PMID: 37206705 DOI: 10.1007/s12070-022-03347-z
    Background: A spontaneous cerebrospinal leak from Sternberg's canal with meningoencephalocele is a very rare clinical entity. Endoscopic repair of the defect is challenging and crucial in identifying the defect. The aim of this case report is to highlight the presence and management with endoscopic surgery in repairing Sternberg canal. Case: 40-year-old woman presents with spontaneous CSF rhinorrhea with no predisposing factors. CT imaging and MRI showed osteodural defect in the lateral recess of sphenoid with meningoencephalocoele lateral to the foramen rotundum. Endoscopic transethmoidal - transphenoidal - transpterygoid approach was used to repair the defect, and patient is well post-operative with least complication from the intervention surgery. Conclusion: Endoscopic approach proved to be the best and safest method in localizing the defect and closure of the leak. Angled scopes and image guided system were used to identify the precise location of the leak.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-022-03347-z.

  5. Fulltext Effectiveness of Direct Transcricothyroid Electromyographic Monitoring in Thyroidectomy Surgery
    Ling AOL, Toong LY, Omar TASBTD, Ghauth S
    Indian J Otolaryngol Head Neck Surg, 2023 Mar;75(1):193-199.
    PMID: 37007880 DOI: 10.1007/s12070-022-03336-2
    Thyroid surgeries are associated with complications of vocal cord palsy and hypocalcemia which can be debilitating. The usage of intraoperative nerve monitoring is a useful adjunct to direct nerve visualization in thyroidectomies. We advocate the usage of direct transcricothyroid electromyographic monitoring in identifying recurrent laryngeal nerve. We retrospectively collected data of all patients who underwent thyroidectomies (total thyroidectomy, hemithyroidectomy, isthmusdectomy) using direct transcricothyroid electromyographic monitoring from April 2020 to August 2021. Data was analysed based on patient's demographics, comorbidities, complications post thyroidectomy such as vocal cord palsy, transient and permanent hypocalcemia. 50 thyroidectomies were performed, 10 developed unilateral vocal cord palsy. Out of 22 total thyroidectomies, 7 developed transient hypocalcemia and 4 permanently. 1 patient developed vocal cord hematoma secondary to direct insertion of intraoperative nerve monitor's electrode. Direct transcricothyroid electromyographic monitoring is a feasible and effective method in intraoperative monitoring of recurrent laryngeal nerve during thyroid surgeries.
  6. Fulltext Huge Long Standing Staghorn Rhinolith in a Young Adult
    Kumareysh VV, Kumarasamy G, Letchumanan P, Rajan P, Md Shukri N
    Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):1053-1055.
    PMID: 37206833 DOI: 10.1007/s12070-023-03611-w
    Rhinolith is an uncommon condition that usually happens due to mineralisation of calcium and magnesium salts over a retained foreign body inside the nasal cavity for long period of time. Here we report one such case of a 33-year-old lady who presented to us with long standing intermittent epistaxis and on examination rhinolith was discovered.
  7. Fulltext Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center
    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.
  8. Fulltext A Single Institution Cadaveric Study on Anatomical Variation of the Sublingual Gland Duct
    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.
  9. Fulltext A Timely Burst: Tuberculous Retropharyngeal Abscess
    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.
  10. Fulltext A Rare Case Report of Unilateral Maxillary Mass from Adrenal Neuroblastoma
    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.
  11. Fulltext Total Laryngectomy Following Severe Laryngeal Trauma: A Case of Surgical Dilemma
    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. Fulltext The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia
    Chew CC, Lim XJ, Narayanan MS, Letchumanan P, Rajan P, Chong CP
    Indian J Otolaryngol Head Neck Surg, 2023 May 30.
    PMID: 37362103 DOI: 10.1007/s12070-023-03896-x
    AIMS: This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic.

    METHODS: This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022.

    RESULTS: 3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p 

  13. A Low-cost 3D Printed Telescopic Sleeve: A Technical Note
    Hafeza S, Firdaus S, Goh LC, Jeyanthi K
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):1259-1262.
    PMID: 37275017 DOI: 10.1007/s12070-022-03281-0
    Background: Endoscopic nasal surgery is often a tedious process due to repeated removal of the Hopkins rod telescope from the nasal cavity for manual defogging of the tip due to the presence of blood, smoke, and secretions. Objective: To design and print a 3-dimensional (3D) low-cost telescopic sleeve to allow the defogging solution to clean the rigid telescope tip without removing it from the nasal cavity. In addition, the sleeve must also act as a conduit for suction and irrigation to provide a clear surgical field view intraoperatively. Results and conclusion: A 3D printed low-cost telescopic sleeve, when used in conjunction with other add-ons, can be a helpful and cost-effective adjunct during endoscopic nasal surgery.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-022-03281-0.

  14. Floor of Mouth Squamous Cell Carcinoma Presenting as an Abscess
    Mohd Afandi MF, Liew YT
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):902-904.
    PMID: 37274978 DOI: 10.1007/s12070-022-03128-8
    Oral squamous cell carcinoma (OSCC) is the most common malignancy encountered in oral cavity. Etiology is often multifactorial but strongly associated with chronic tobacco smoking, excessive alcohol consumption and tobacco chewing. Factors such as poor oral hygiene, ill-fitting dentures causing chronic mucosal irritation can also contribute to the cancer development. In recent years, studies shown association of HPV infections, especially subtypes 16 and 18 in malignant transformation of head and neck squamous cell carcinoma, as it present may change prognosis, outcomes and management strategies from HPV-negative OSCC. OSCC have variable presentation, and most of the patients tend to seek treatment at later stage of disease. The lesion may present as leukoplakia or erythroplakia and may be ulcerated with indurated base and rolled out edges. We describe an uncommon presentation of floor of mouth squamous cell carcinoma which presented as localized abscess.
  15. Suspension Microesophagoscopy: A Simple Diagnostic And Therapeutic Technique For Foreign Body In Esophagus
    Subramaniam D, Saniasiaya J, Kulasegarah J
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):1271-1273.
    PMID: 37275052 DOI: 10.1007/s12070-022-03383-9
    BACKGROUND: Foreign body ingestion involving the paediatric age group is a common emergency referral encountered by Otorhinolaryngologists. The cervical oesophagus has been noted as the most prevalent site of impaction. Traditionally, a rigid oesophagoscopy would be required for examination under anaesthesia and removal of the foreign body is found, but this method may miss foreign bodies that are embedded into the mucosa, and faulty technique may result in perforation of the esophagus. Method and results: We present a suspension microesophagoscopy technique using a Lindholm laryngoscope and suspension to retract and suspend the opening of the oesophagus. Conclusion: This technique not only gives the surgeon an advantage to perform a two-handed procedure but also allows for a magnified examination of the oesophageal mucosa with the help of a rigid telescope for a thorough examination.

    BULLET POINT SUMMARY: The best diagnostic and therapeutic method for the management of foreign body in the oesophagus is examination under anaesthesia.Suspension microesophagoscopy can be done in the operation theatre with pre-existing instrument.This technique allows freedom for a two-handed technique.This technique gives a magnified visualisation of the mucosa revealing any embedded foreign body.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-022-03383-9.

  16. Laryngeal Suction tube: A Novel Technique for Tracheal Ventilation in an Obstructed Airway in a Child with Respiratory Papillomatosis
    Saniasiaya J, Lim SM, Kulasegarah J
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):1274-1276.
    PMID: 37276073 DOI: 10.1007/s12070-022-03411-8
    BACKGROUND: Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress.

    OBJECTIVE: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine.

    RESULT AND CONCLUSION: Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

  17. A Novel Methylene Blue Guided Neopharynx Closure and a Review of Essential Applications in Otolaryngology
    Lim CC, Liew YT, Ghauth S, Bakar MZBA, Narayanan P
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):1255-1258.
    PMID: 37274994 DOI: 10.1007/s12070-022-03192-0
    Methylene blue has many usages in the field of otolaryngology. We describe a preliminary finding of methylene blue guided neopharynx closure after total laryngectomy. This technique can potentially reduce the risk of pharyngocutaneous fistula and has not been described in the literature. It is also handy in assisting junior surgeons to perform modified Connell suture during neopharynx reconstruction. Concurrently, we reviewed other essential applications of methylene blue in otolaryngology.
  18. A Rare Case and Literature Review of Endoscopic Endonasal
    Rajoo TS, Ng BHK, Abdullah B, Tang IP
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):996-999.
    PMID: 37275000 DOI: 10.1007/s12070-022-03212-z
    We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach.
  19. Inverted Follicular Keratosis: A Rare Presentation in External Ear Canal
    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.
  20. Successful Management of Retropharyngeal Lymphangioma with Stridor Using Sirolimus: A Case Report
    Razali SSCM, Mohd NKN, Ibrahim FM, Hamid SSA
    Indian J Otolaryngol Head Neck Surg, 2024 Feb;76(1):1298-1301.
    PMID: 38440478 DOI: 10.1007/s12070-023-04273-4
    Lymphatic malformations (LMs) are one of the congenital malformations of the lymphatic system in the body. The patient usually presents with head and neck swelling, airway compression, and/or airway obstruction. The diagnosis of retropharyngeal LMs can be challenging due to their rare occurrence. We report a case of a five-month-old boy diagnosed with retropharyngeal LMs. He presented with a three-day history of fever, cough, and stridor and was initially treated for acute bronchiolitis. A lateral neck radiograph revealed prevertebral widening, suggesting retropharyngeal collection. The patient's condition worsened, requiring intubation in the operating room and proceeding with aspirations and drainage. However, the symptoms recurred after a few days, necessitating re-intubation, repeated aspirations and drainage procedures. The patient was intubated, and the neck's magnetic resonance imaging (MRI) confirmed retropharyngeal LMs. An elective tracheostomy was performed and was treated with sirolimus. The patient had a successful tracheostomy decannulation and showed no recurrence during follow-up.
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