Displaying publications 81 - 95 of 95 in total

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  1. Fulltext A Review of Tracheal Bronchus in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
    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.
  2. Fulltext Challenges in the Management of Laryngo-Tracheo-Bronchial Stenosis Secondary to Tuberculosis
    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.
  3. Oncocytic Salivary Gland Tumours: Cytological Features and Diagnostic Pitfalls
    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.
  4. Fulltext The Role of Non Invasive Diagnosis of Internal Jugular Vein Phlebectasia
    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.
  5. Fulltext Nasopharyngeal Tuberculosis mimicking Nasopharyngeal Carcinoma: A Case Series
    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.
  6. Distraction Breathing Exercise in Managing Inducible Laryngeal Obstruction in a Female Patient
    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.
  7. Fulltext Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly
    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.
  8. Fulltext Cholesterol Granuloma of the Sphenoid Sinus: An Insidious Entity
    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.
  9. Could Cultural and Background Resilience be the Main Culprit for Neglected Vestibular Dysfunction in Children?
    Saniasiaya J
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4114-4115.
    PMID: 37974752 DOI: 10.1007/s12070-023-03873-4
    Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging.Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-termresults in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptomsthat occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour 1. Whilst measuresto incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to beunfathomed in some parts of the world, notably the South-East Asian region.
  10. Acquired Hemophilia A: Rare Cause of Upper Airway Hematoma and a Literature Review
    Lim CC, Ling SW, Vijayan KV, Lee MJ, Devesayaham PR
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3886-3888.
    PMID: 37974717 DOI: 10.1007/s12070-023-03943-7
    BACKGROUND: Acquired hemophilia A (AHA) is a rare blood disorder with high morbidity and even mortality as severe bleeding can occur in up to 90% of affected patients. Unlike congenital hemophilia which presents with intra-articular bleeding, acquired hemophilia causes bleeding into the skin, muscle, mucous membranes and soft tissues.

    CASE PRESENTATION: We report an unusual case of upper airway hematoma in a 61-year-old man who presented with acute onset dysphagia and shortness of breath. There were bruises on his neck and blood clots on the floor of mouth when he was examined. Endoscopic examination revealed an extensive laryngeal hematoma. A prolonged activated partial thromboplastin time (APTT) prompted us to investigate for factor VIII deficiency leading to the diagnosis of AHA. He recovered completely after a treatment regime instituted by the hematology team without suffering any grave debilitating events.

    CONCLUSION: AHA with laryngeal hematoma is a rare condition with only a handful of cases reported. Although a life-threatening disease, it is easily reversed with early recognition and administration of medical therapy involving the hematology team.

  11. Rhinoplasty Surgical Technique for Nasal Dermoid Cyst Removal in Adult: Case Report
    Che Mohd Razali SS, Narayanan MS, Mohamad A, Ramli RR
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3815-3817.
    PMID: 37974762 DOI: 10.1007/s12070-023-03822-1
    Nasal dermoid cyst is a rare benign lesion. The mainstay of treatment for a nasal dermoid cyst is surgical excision, which aims to remove the cyst and associated structures to prevent recurrence. We report a case of a 30-year-old man with nasal dermoid cyst, without intranasal or intracranial extension. The patient underwent open rhinoplasty technique for dermoid cyst excision. He had an uneventful postoperative recovery and was discharged well. The cyst and associated structure were successfully removed. There was no evidence of recurrence and complications postoperatively after 2 years of follow-up.
  12. High-Riding Inominate Artery: Challenge During Tracheostomy
    Wannitta Wong ET, Saniasiaya J, Tharek A, Sallehuddin NS
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3878-3882.
    PMID: 37974895 DOI: 10.1007/s12070-023-03944-6
    An aberrant vessel presenting as a pulsatile neck mass poses a significant challenge intraoperatively if overlooked during the pre-operative period. We present a case of a high-riding innominate artery (HRIA) just above the suprasternal notch, with the right common carotid artery crossing the midline just inferior to the thyroid gland in a 72-year-old lady referred for tracheostomy. The surgeon operating on the anterior part of the neck must be aware of the HRIA and equipped with sufficient knowledge of interventions that may be adapted to prevent injury. We aim to highlight the importance of careful investigations of subtle signs which may lead to the diagnosis and treatment with a review of various interventions for this unusual condition.
  13. A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease
    Cheah Y, Jumastapha H, Tang IP
    Indian J Otolaryngol Head Neck Surg, 2023 Sep;75(3):2564-2567.
    PMID: 37636706 DOI: 10.1007/s12070-023-03792-4
    Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.
  14. An Unusual Presentation of Midline Lethal Granuloma
    Chin EW, Saniasiaya J, Hitam S, Hassan E, Kah Wai N
    Indian J Otolaryngol Head Neck Surg, 2024 Apr;76(2):2137-2140.
    PMID: 38566723 DOI: 10.1007/s12070-023-04466-x
    Extranodal natural killer T-cell lymphoma, nasal type (ENKTCL), is a rare form of non-Hodgkin lymphoma that is strongly related to Epstein-Barr Virus (EBV) infection and commonly presents as "midline lethal granuloma." Herein, we report a middle-aged lady who presented with a two-week history of fever, sore throat and constitutional symptoms. Intraoral examination revealed a lacerated soft palate with an ulcerated uvula. A diagnosis of ENKTCL was confirmed through deep biopsies under general anaesthesia supplemented with a positive serum EBV genome. Unfortunately, she succumbed due to disease progression with left frontal brain metastasis with concurrent pulmonary tuberculosis before treatment was completed. The recommended treatment is multimodality with L-asparaginase-containing regimes chemotherapy in an advanced stage, relapsed, or refractory ENKTCL for better outcomes. The quantification of circulating plasma EBV deoxyribonucleic acid (DNA) is helpful as the baseline of tumour load and a biomarker for monitoring treatment response and prognostication. We advocate repeated and deeper core tissue biopsies.
  15. Nasal Sebaceous Carcinoma - A Rare Presentation
    Sukumaran Y, Lynn JCS, Baba FB, Dam VSKE
    Indian J Otolaryngol Head Neck Surg, 2024 Apr;76(2):2151-2154.
    PMID: 38566732 DOI: 10.1007/s12070-023-04439-0
    Sebaceous carcinoma (SC) is a slow-growing but aggressive malignant skin tumour derived from sebaceous glands. SC most commonly occurs in the periocular region, whereas extraocular sites are rare. SC of the nasal dorsum is a rare pathology, and only a few cases are reported worldwide. Here, we report a case of an 80-year-old man who presented with a mass over the nasal dorsum, diagnosed morphologically and immunohistochemically as sebaceous carcinoma.
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