The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential
diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis.
Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute
symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when
the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made
for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for
allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms.
Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.
Pyogenic granuloma is a benign lesion which is commonly found in the oral cavity. It is a reactive inflammatory process of the injured mucosa to trauma. It can appear as a sessile or pedunculated mass with smooth or lobulated surface, which sometimes can mimic malignant lesion. Excision biopsy of the lesion is the confirmatory investigation which also a treatment tool. We report a case of middle-aged lady who had pyogenic granuloma of the tongue, which was safely excised using ultrasonic scissors. This case highlights the new technique of using ultrasonic instruments for excision of benign tongue lesion, with marked reduction of blood loss and operation time.
Lingual tonsil is a part of Waldeyer’s ring. It consists of lymphoid follicles and subject to proliferation and hypertrophy. Palatine tonsillitis, by far is the commonest cause of odynophagia originating from oropharyngeal region. Lingual tonsillitis is a rare occurrence. We reported a patient who presented with severe odynophagia after two months of palatine tonsillectomy. Examination revealed the lingual tonsils were inflamed and covered with exudates.
Fungal ball is an extramucosal mycosis. The patient may present with facial pain, nasal blockage, purulent nasal discharge and cacosmia, the fungal ball being present unnoticed for years. Some patients do present as having other nasal problems and later on are found out to have a fungal ball incidentally. We present a case of 38 yearold man who was clinically diagnosed as having left antrochoanal polyp. Intraoperatively, a fungal ball was discovered in the left maxillary antrum.
A 38-year-old female presented with foreign body sensation in the throat for one year. It was
increasing in severity. There was no other associated symptom. Examination of the oral cavity showed an abnormal looking uvula(Fig. 1). The rest part of the oral cavity, oropharynx and larynx were unremarkable. What is your diagnosis?(Copied from article).
Managing a patient with a huge intraoral mass is always challenging. Manipulation or even a simple biopsy of the mass may lead to hemorrhage and further compromise the airway. An examination under anesthesia is not without risk. The method of securing the airway itself may become an issue if the mass is fully occupying the airway before intubation. Usually a tracheostomy is indicated. We share a gentleman presented with a huge intraoral mass occupying the oropharynx, which initially necessitates tracheostomy. We utilized the ultrasonic scalpel-assisted instrument to biopsy by debulking the tumour, thus avoiding the tracheostomy while waiting for the definitive treatment.
Respiratory papillomatosis is a disease of viral origin which is characterized by warty exophytic lesions in the aerodigestive tract. It is the most common benign lesion of larynx and the second most common cause of hoarseness in children. It has the tendency to recur and to spread through out the entire length of the aerodigestive tract. Although a benign disease, it has the potential of morbid consequences in view of airway complications and the risk of malignant transformation. We report a case of juvenile onset of respiratory papillomatosis and its therapeutic challenges.
Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.
Azadirachta indica (neem) has been used for a long time in agricultural and alternative medicine. Neem
had been proved effective against certain fungi that could infect human body. This pilot study aims to
demonstrate the antifungal effect of Malaysian neem leaf extracts on the pathogenic fungi in otomycosis,
Aspergillus niger and Candida albicans. This is a laboratory-controlled prospective study conducted at
Universiti Sains Malaysia. The powder form of Malaysian neem leaf was prepared. Ethanol and aqueous
extracts of the neem leaf was diluted with sterile water to establish five different concentrations of 50 g/
ml, 25 g/ml, 12.5 g/ml, 6.25 g/ml and 3.125g/ml. The extract was tested on Sabouraud Dextrose Agar
suspended with Candida albicans and Aspergillus niger respectively. Well diffusion method was used
and zone of inhibition was measured. Growth of the fungi was inhibited in both alcohol and aqueous
extract concentrations. The minimum inhibitory concentration (MIC) of Malaysian neem aqueous extract
against Candida albicans was 11.91 g/ml, neem ethanol extract against Candida albicans was 5.16 g/
ml, neem aqueous extract against Aspergillus niger was 7.73 g/ml and neem ethanol extract against
Aspergillus niger was 9.25 g/ml. Statistical analysis showed that the antifungal activity of Candida
albicans is better in alcohol neem than aqueous extract (p
Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery
aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done
showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with
severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.
A 69-year-old lady was diagnosed to have mucoepidermoid carcinoma of hard palate 3 years ago. She completed 20 cycles of external beam radiotherapy and 5 cycles of mould brachytherapy and remained asymptomatic until she again presented to us with the recurrence of a painless mass at the hard palate. The hard mass appeared as an ulcerated dimple measuring 2 x 1 cm located at the junction of the hard and soft palate, more towards the right. Excision biopsy of the mass was done with a 1cm circumferential margin deep to the periosteum, with the resulting exposed bony defect covered with a rotational flap from the soft palate. During follow-up, the patient complained that the saliva came up into the nose whenever she swallowed. Oral examination (Figure 1) and flexible nasopharyngolaryngoscopy (FNPLS) (Figure 2) were performed. What is your diagnosis?
An 11-year-old Malay boy was allegedly involved in motor vehicle accident. He sustained left lung contusion and pneumothorax which necessitate chest tube insertion at a district hospital. On arrival at Accident & Emergency Unit, general physical examination was performed. Neck examination revealed multiple jagged lacerations wound on the left side of the neck (Panel 1). (Copied from article).
Assault injury can occur to any parts of the body. Usually the target area is the head, neck, chest and abdomen as they contain many major structures that are vital for life. However, movement of the victim few seconds before the instrument reach the body can redirect the impact to the less fatal part of the body. The outcome may be less fatal but can lead to cosmetically unacceptable condition. (Copied form article).
Radicular cyst is the most common cyst in the mandible. It usually presents in the later age of life because the formation of the cyst is the last step in a progression of inflammatory events following a periapical inflammatory lesion. The cyst usually goes unnoticed because of the size that is rarely palpable, and it is often painless. In this paper, we present a 12 year-old girl who developed a relatively large cyst for the age. The outline of management is discussed.
The effect of loud noise to the army personnel is often identified when hearing loss had already developed. Acoustic trauma during shooting training can also lead to acute changes in the ear which is shown on otoscopic examination. This study was undertaken to determine the effectiveness of hearing protective device (earplug) on the prevalence of external ear changes amongst military personnel during shooting. This is a prospective cross sectional study that was conducted among 76 military personnel, who were divided into two groups: those with and without earplugs during shooting. Each participant underwent 3 otoscopic examinations: (a) pre-shooting, (b) immediate post-shooting (within 48 hours) and (c) 2 weeks after shooting. A total of 78 army personnel who were scheduled to undergo shooting training were otoscopically examined. Eighty three percent of them did not wear earplugs before. The percentage of inflammation of external auditory canal and tympanic membrane dullness increased tremendously among subjects from non–earplug group less than 48 hours post-shooting. Assessment after 2 weeks showed improvement in around 30% of the subjects. Loud noise has become an occupational hazard not only to the inner ear but it also predisposes the external and middle ear structures to some form of injury. Although improvement is seen after some period, a protective device such as an earplug should be recommended and the usage should be reinforced among the army personnel involved in shooting.
Introduction: This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the
local community and its correlation to the clinical presentations.
Materials and Methods: The study was
done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in
Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal
polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years
old were selected and data relevant to the study were collected from the patient’s folders using a specially
created form prepared for the study. The NP histopathology report from each patient underwent FESS were
analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical
presentations from each patient were also gathered and analysed according to the NP group.
Results: In
HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which
is contrary to other study conducted on Asian populations. The clinical symptom correlations between either
eosinophilic or non-eosinophilic type of NP have not shown any significant associations.
Conclusion: The
study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that
found in other parts of the world (Europe and North America) which will reduce the possibility of racial or
geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are
not enough to differentiate the type of the nasal polyp without the histological study.
Leech infestation in otolaryngology is sporadically seen in
remote area of tropical countries, but the cases are usually not
scientifically reported. We are reporting an unusual case of a
land leech removal from external auditory canal (EAC).