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Fulltext Letter in Reply: When the Air is the Complication

Arepen SAM, Hassan NE

Oman Med J, 2020 May;35(3):e142.
PMID: 32704390 DOI: 10.5001/omj.2020.61
Fulltext Non-syndromic Bilateral Branchial Cyst: A Case Report

Salahuddin NA, Sanmugam SS, Abu Bakar AZ, Md Arepen SA, Mohd Bakhit NHD, Bin Muhammad Saifullah AA, et al.

Oman Med J, 2023 May;38(3):e515.
PMID: 37313249 DOI: 10.5001/omj.2023.25

Branchial cleft cysts generally occur unilaterally at the lateral aspect of the neck. Bilateral branchial cysts are rare and may have familial associations. We report a rare case of non-syndromic bilateral branchial cyst in a 23-year-old woman who presented with chronic bilateral, progressively enlarging painless neck swellings. Complete surgical excision of the bilateral cyst was done. A histopathological examination confirmed the diagnosis. Precise diagnosis with early and complete surgical excision of branchial cysts may help prevent recurrence and other complications.
A Case Report on Cervicofacial Subcutaneous Emphysema and Its Management: A Unique Presentation of Congenital Defect of the Foramen of Huschke

Sharudin SN, Salahuddin NA, Md Arepen SA, Md Anuar NA, Hassan NE, Hitam S, et al.

Cureus, 2023 Oct;15(10):e47078.
PMID: 38021523 DOI: 10.7759/cureus.47078

Congenital defect to the foramen of Huschke with a manifestation as temporomandibular joint (TMJ) soft tissue herniation in a radiological study is rare. The patient may present with nonspecific symptoms such as otalgia, mandibular joint pain, tinnitus and conductive hearing loss, and scarcely cervicofacial subcutaneous emphysema. Here, we report a patient presented with cervicofacial subcutaneous emphysema secondary to a congenital defect of the foramen of Huschke. A 45-year-old gentleman presented with right-sided neck swelling and right otalgia with a crackling sound over the right ear upon chewing. Examination shows right-sided fullness with subcutaneous emphysema from the zygoma to the upper neck. Otherwise, it is non-tender with no skin changes, and the facial nerve is intact. Otoendoscopy shows erythematous soft tissue bulging of the anterior wall of the right external auditory canal (EAC) upon closing the mouth and prolapsing upon mouth opening. The right tympanic membrane was intact. Contrast-enhanced computer tomography (CECT) of the neck and temporal region revealed extensive cervicofacial subcutaneous emphysema with a bony defect at the anterior wall of the right EAC, indicating fistulous communication between the right EAC and TMJ. The subcutaneous emphysema resolved on the treatment of the right otitis externa. The patient is subjected to a combined approach of open and endoscopic-assisted repair of the anterior EAC wall defect. TMJ herniation into the anterior EAC is rare; however, the patient presentation may vary. CECT is the gold standard for diagnosing and facilitating treatment options. Treatment choice is based on the patient's condition, including conservative or surgical intervention.
Fulltext A Case Report of Kissing Carotid Arteries in the Retropharynx

Md Arepen SA, Abu Bakar AZ, Mohd Bakhit NHD, Muhammad Saifullah AAB, Salahuddin NA, Hassan NE

Iran J Otorhinolaryngol, 2022 May;34(122):181-185.
PMID: 35655544 DOI: 10.22038/IJORL.2022.58891.3033

INTRODUCTION: An aberrant carotid artery has distinct terms and may exhibit a submucosal mass in the posterior pharyngeal wall. While it is primarily asymptomatic, an extreme aberrancy doubles the risk of dissection, a cerebrovascular accident (CVA) and an injury intraoperatively.
CASE REPORT: We report a case of 'kissing carotid artery' in a 65-year-old lady who presented with a foreign body sensation felt in the throat for one week. A finding of flexible nasopharyngolaryngoscopy (FNPLS) showed a bilateral paramedian retropharyngeal pulsating mass. Radiological examinations, including Computed Tomography (CT) of the neck and an angiogram, revealed an aberrant course of bilateral carotid arteries. In view of no malignancy and vascular malformations, there was no further intervention done, and the patient was subjected to yearly surveillance.
CONCLUSION: Retropharyngeal carotid arteries are clinically significant anatomic variants. Such anomalies are potentially life-threatening and a risk factor for a severe hemorrhage during the simplest and commonly performed transoral surgeries. Thus, thorough perioperative assessment with accurate imaging techniques and studies are required to evaluate these anomalies and may avoid any disastrous complications.