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  1. Kamalden TMIT, Misron K
    PMID: 34226993 DOI: 10.1007/s00405-021-06980-6
    OBJECTIVES: This study aims to assess the clinical trends of malignant otitis externa (MOE) and classify MOE based on the findings related to high-resolution computed tomography (HRCT) of the temporal bone and 99-Tech3-Phase Bone Scintigraphy (TPBS). We also reconstruct a treatment algorithm for MOE in our institution.

    METHODOLOGY: A 10-year retrospective review was carried out on MOE in a single otology institution from January 2011 to December 2020. The MOE was classified based on proposed Tengku's radiological stratification according to HRCT and TBPS findings. Phase I is defined as inflammation limited to the soft tissue in the external auditory canal, without involvement of the bone. Phase II is the inflammation beyond the soft tissue, involving bone, but limited to the mastoid. Phase III is when the inflammation extends medially, involving the petrous temporal bone or temporomandibular joint, with or without parapharyngeal soft tissue involvement. Phase IV refers to inflammation extending medially to involve the nasopharynx, with or without abscess formation. Finally, Phase V is inflammation that further extends to the contralateral base of the skull.

    RESULTS: A sample of 49 patients was involved in this study. Majority of the patients were having Phase III (36.7%) of the disease, followed by Phase V (24.5%), Phase II (18.4%), Phase IV (16.3%), and Phase I (4.1%). A comprehensive treatment algorithm was drafted based on our institution's experience in managing MOE. The mortality rate was low (8.2%), mainly involving patients in advanced phase of the disease (Phases IV and V).

    CONCLUSION: This study has revealed the evidence of progression of MOE based on the proposed radiological stratification. This stratification is simple and practically applicable in clinical settings. We suggest the use of our proposed treatment algorithm as a standard diagnostic and treatment protocol for MOE.

  2. Kamalden TMIT, Yusof ANM, Misron K
    J Int Adv Otol, 2021 Nov;17(6):570-573.
    PMID: 35177397 DOI: 10.5152/iao.2021.21189
    The aim of this study is to evaluate the incidence of delayed facial nerve paresis after total endoscopic ear surgery. This review also aims to describe the possible contributing factors and its management. This is a retrospective review of all patients who had undergone total endoscopic ear surgery for all otologic cases that required endoscopic intervention in a single otologic center from 2014 up to 2020. The delayed facial nerve paresis is defined as deterioration of facial nerve function 72 hours after total endoscopic ear surgery. A total of 56 patients were included in the study. Delayed facial nerve paresis following total endoscopic ear surgery was observed in 2 patients (3.4%). Facial weakness sets in on day 6 post operation and another one developed at day 16 after the surgery. Both patients were investigated and only one of them showed a higher titer of Varicella zoster virus antibody while another patient showed no raise of titer. Thus, explanation of postoperative edema or mechanical compression is discussed. The incidence of delayed facial nerve paresis following total endoscopic ear surgery is rare. It can occur probably several days after surgery up to 3 weeks. Our 2 cases revealed that virus reactivation may not be the only factor for delayed facial nerve palsy after surgery. The overall prognosis for incomplete delayed facial nerve paresis is very good as both patients recovered well few days after treatment with steroids.
  3. Yusof ANM, Thong HK, Kamalden TMIT
    Med Arch, 2020 Aug;74(4):312-314.
    PMID: 33041452 DOI: 10.5455/medarh.2020.74.312-314
    INTRODUCTION: Chondroblastoma is an uncommon benign, locally destructive tumor that usually arises from epiphyses of the long bones. Temporal bone chondroblastoma is an extremely rare occurrence. Chondroblastoma arise from immature cartilage cells and it may display certain malignant features by invading surrounding structures and metastasizing to adjacent sites.

    AIM: To present a case of extradural temporal bone chondroblastoma and discuss the clinical presentation, radiographic findings, histology and particularly the surgical management of the case.

    CASE REPORT: We report a case of a 31-year-old man who presented with a painless left temporal swelling and left sided hearing loss for four months. Computed tomography (CT) scan revealed an aggressive mass involving the left preauricular region with temporal mastoid bone erosion. Magnetic resonance imaging (MRI) showed an extra-axial left temporal mastoid mass pushing the left temporal lobe superiorly. The patient underwent complete excision of the temporal bone tumor. The final histopathological diagnosis was in keeping with chondroblastoma.

    CONCLUSION: Temporal bone chondroblastoma is rare but an aggressive condition. Complete tumor resection via an appropriate approach that enables adequate exposure will lead to a favorable outcome.

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