MyMedR

Five cases of iatrogenic cerebrospinal fluid (CSF) rhinorrhoea: Early management is crucial

Aidayanti MD, Salina H, Gendeh BS, Farah DZ, Faezah MZ

Med J Malaysia, 2018 08;73(4):249-252.

Endoscopic sinus surgery (ESS) is a standard treatment for rhinosinusitis, which failed optimum medical therapy. Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occur during ESS warrants early repair of the leakage. The common sites for CSF leakage are cribriform plate, fovea ethmoidalis, and anterior ethmoid sinuses. We present five cases of iatrogenic CSF rhinorrhoea due to ESS and its management.

Nasal type NK/T-cell lymphoma - diagnosis and treatment difficulties

Hamidah NH, Shahrom S, Siti Aishah MA, Das S, Gendeh BS, Fadilah SA

Clin Ter, 2014;165(3):139-42.

PMID: 24999566 DOI: 10.7417/CT.2014.1711

Primary nasal lymphomas are rare. One of the most common cellular subtypes in the Asian population is natural killer (NK)/T-cell lymphoma (NKTL) with a high association of EBV. We report a case of a 42-year-old female, who presented with a worsening sore throat, odynophagia, dysphagia to solid food due to oropharyngeal ulcers and bilateral nasal blockage and recurrent fever for the past two weeks prior to admission. Physical examination revealed ulcers over the soft palate with nasopharyngeal slough. Computerized Tomography (CT) scan of the neck showed nasopharyngeal abscess with bilateral maxillary ethnoidal sinusitis. The diagnostic and management challenge is discussed.

Fulltext Ophthalmic artery occlusion following neuro-embolization of the external carotid artery, a case report

Loon NW, Gendeh BS, Zakaria R, Hamzah JC, Din NM

BMC Ophthalmol, 2017 Jun 15;17(1):92.

PMID: 28619056 DOI: 10.1186/s12886-017-0490-7

BACKGROUND: Embozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery occlusion after Embozene® embolization of the external carotid artery (ECA).

CASE PRESENTATION: A 22-year-old African gentleman presented with left nasal obstruction and epistaxis for 2 years and was diagnosed with nasopharyngeal carcinoma. He subsequently underwent embolization of the maxillary branch of the left ECA using Embozene® Microspheres - 250 μm in size before endoscopic tumour excision to reduce intra-operative bleeding. He complained of sudden painless profound visual loss in the left eye (LE) two hours after embolization. Visual acuity in LE was no light perception. Fundus examination showed pale retina with no cherry red spot. Arterial narrowing and segmentation were seen in all quadrants. A diagnosis of left ophthalmic artery occlusion was made. Despite immediate management including ocular massage and lowering of intraocular pressure, the visual loss remained. Retrospective review of digital subtraction angiogram showed an anastomosis between the left ophthalmic artery and anterior deep temporal artery as a potential route for microspheres migration.

CONCLUSION: Pre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. The use of newer agents for embolotherapy may cause migration of embolic material from the external to the internal carotid system leading to ophthalmic artery occlusion and blindness.

An improved instrument mounting arm

Gendeh BS, Khalid BA, Alberti PW

J Laryngol Otol, 2001 Feb;115(2):126-7.

PMID: 11320829

Although some form of commercial instrument mounting arm is available, a paucity of information in the literature may cause problems in selecting the most appropriate model for an ENT department wishing to trial their invention for use in the clinic or operating theatre. The instrument mounting arm described here is based on existing designs used by hobbyists and model makers for many years but the main benefit of this innovation is its multi-purpose use in the operating theatre and cost effectiveness since it is made of aluminum alloy. It is compact, stable and easily adjustable and can incorporate an endoscope holder or an operating end piece to mount various ENT instruments that offers considerable advantages to the unassisted operator.

Fulltext Triple primary cancers of the larynx, lung and thyroid presenting in one patient

Iqbal FR, Sani A, Gendeh BS, Aireen I

Med J Malaysia, 2008 Dec;63(5):417-8.

PMID: 19803306 MyJurnal

Patients with multiple malignant primary tumours are often described, based on their chronology of presentation, as simultaneous, synchronous or metachronous tumours. Lung malignancies presenting in association with head and neck tumours are well documented while there have been small series of thyroid synchronous cancers presenting with laryngeal lesions in literature. No cases, to our knowledge, have been reported in literature of a single patient with all three laryngeal, lung and thyroid malignancies. We report one such case of a 71-year-old Chinese man who had undergone a total laryngectomy for a recurrent cancer of the larynx only to be found to have tumours of the lung and thyroid in the post-operative period and he eventually died of post-operative complications. We also discuss screening for lung and thyroid malignancies in patients with head and neck squamous cell carcinoma (SCC).

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