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  1. Wong EHC, Liew YT, Loong SP, Prepageran N
    Ann Otol Rhinol Laryngol, 2020 Mar;129(3):287-293.
    PMID: 31701754 DOI: 10.1177/0003489419887410
    AIM: Endoscopic endonasal nasopharyngectomy (EEN) for recurrent nasopharyngeal carcinoma (rNPC) is being increasingly used due to the added high magnification, reduced morbidities associated with open procedures and good survival outcomes. Most studies looked at usage of EEN in patients with lower recurrent staging (rT1 and rT2) although more and more surgeons are studying the outcome of EEN in advanced rNPC (rT3 and rT4). The aims of this study were to report the long-term 5-year survival outcome of EEN performed in patients with advanced rNPC, and to determine any prognostic factors for patients' survival.

    METHODS: All patients who underwent EEN for advanced rNPC between January 2003 and December 2015 inclusive were analyzed. All surgeries were performed in University Malaya Medical Centre in Kuala Lumpur and Queen Elizabeth Hospital in Sabah. We reported the 5-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) and any related complications and significant prognostic factors.

    RESULTS: Twelve patients with rNPC (2 rT3 and 10 rT4) were followed-up over a mean duration of 44.8 months (range, 40-440 weeks). The 5-year OS was 50.0% (mean 44.75 months), DFS was 25.0% (mean 35.25 months) and the DSS was 58.3% (mean 43.33 months). No severe operative complications were encountered and no independent prognostic factors for survival outcome were identified.

    CONCLUSION: This is the first report in English that exclusively described the long-term 5-year survival data in patients with both rT3 and rT4 recurrent NPC after EEN. The data suggest that EEN is a feasible treatment to improve survival with minimal morbidities in patients with rT3 and rT4 recurrent NPC. However, more studies with larger patient size is recommended.

  2. Loong SP, Afandi AN, Lum CL, Ong CA
    Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1692-1694.
    PMID: 31763226 DOI: 10.1007/s12070-015-0945-1
    Solitary extramedullary plasmacytomas are rare, discrete mass of neoplastic monoclonal plasma cells in the soft tissue with no evidence of multiple myeloma. They constitute 3 % of all plasma cell tumors and less than 1 % of head and neck malignancies. A 43 year old lady presented to our clinic with complains of diplopia and headache for 4 weeks. Computed Tomography scan showed a mass lesion in the sphenoid sinus eroding the sinus floor, right wall, basisphenoid and parasellar area. A biopsy of the mass reported as plasmacytoma. Systemic examination revealed no evidence of dissemination of the disease confirming the diagnosis of a solitary extramedullary plasmacytoma. The patient was subjected to 25 fractions of radiotherapy. Here, we report a rare case of solitary extramedullary plasmacytoma of the sphenoid sinus.
  3. Wong EHC, Tan HY, Dompok TM, Mohamad Ishak LA, Loong SP
    ORL J Otorhinolaryngol Relat Spec, 2021 06 18;83(4):258-262.
    PMID: 34148048 DOI: 10.1159/000516597
    BACKGROUND: Nasopharyngeal carcinoma (NPC) is the fourth common cancer in Malaysia. A few studies have looked into the incidence of NPC in Malaysia in general, but there has been no published data on its incidence in Sabah specifically, where NPC is very common among the population. The aim of this study is to present the first report on the incidence of NPC in the state of Sabah, Borneo.

    METHODS: Data of all patients diagnosed with NPC over a 5-year period from January 2015 to December 2019 inclusive were collected from the NPC registry of 3 main hospitals in Sabah. Age-standardized rates (ASRs) for different genders, ethnicities, and districts of origin were calculated.

    RESULTS: 215 NPC patients were identified with a mean age at diagnosis of 49 (range 9-82). The ASR of NPC was 7.9/100,000 where the average age-adjusted male-to-female ratio was 2.4. The highest ASR was found in Dusun ethnicity in both male (3.19/100,000) and female (1.69/100,000) individuals, followed by Chinese (both genders), and Kadazan (for male individuals) and Bajau (for female individuals). The highest ASR was found in patients originating from Sandakan, Kota Kinabalu, Keningau, and Tawau.

    CONCLUSION: This is the first report on the incidence of NPC in Sabah, Borneo. The data suggest high ASRs among the population, especially in male Dusun and Chinese ethnic groups. Further research looking into NPC in this state, especially on risk factors and ways to improve diagnosis and prevention among the population, is recommended.

  4. Ng CS, Foong SK, Loong SP, Ong CA, Hashim ND
    J Int Adv Otol, 2021 Jul;17(4):301-305.
    PMID: 34309549 DOI: 10.5152/iao.2021.0078
    BACKGROUND: Postoperative or post-traumatic canal restenosis in patients with external auditory canal (EAC) stenosis is a troublesome complication faced by many ear surgeons following canalplasty or meatoplasty. Many ear prostheses and surgical methods have been introduced to prevent the occurrence of such complication. Our aim in this study is to explore the feasibility of using modified non-fenestrated uncuffed tracheostomy tubes (TT) as postoperative stents after ear canal surgery.

    METHODS: Canalplasty or meatoplasty was performed under general anesthesia via the posterior auricular transcanal approach. The EAC diameter and length were measured and a non-fenestrated uncuffed TT of suitable size was fitted into the ear canal. The TT was then modified during fitting, to fit onto the concha. Patients were advised on the importance of compliance. The adequacy of the size of the EAC after the surgery was assessed during follow-ups.

    RESULTS: A total of 3 patients (4 ears) were included in our study. Various sizes of TTs were fitted into their EAC following canalplasty or meatoplasty. All of them showed excellent postoperative outcome on follow up 2 years after the surgery, with no evidence of postoperative EAC stenosis.

    CONCLUSION: Modified TT stent after canalplasty or meatoplasty is proposed as an excellent alternative in preventing restenosis of EAC in centers with limited resources.

  5. Lim CC, Misron K, Loong SP, Liew YT, Sawali H
    Iran J Otorhinolaryngol, 2019 Sep;31(106):319-322.
    PMID: 31598501
    Introduction: Primary tuberculosis (TB) of the oropharynx and nasopharynx is an extremely rare form of extra-pulmonary TB in children. Primary tuberculosis occurs more likely secondary to pulmonary TB and is more common in immunocompromised patients.

    Case Report: We reported the case of a young male presented with the symptoms of non-specific chronic adenotonsillitis, mild obstructive sleep apnoea, and cervical lymphadenopathy. Subsequently, he underwent adenotonsillectomy and excision of the cervical lymph node with the tissue specimens came back strongly positive for TB. Then, he started using antituberculous medication and recovered well.

    Conclusion: The authors would like to highlight this rare clinical entity in which accurate diagnosis is essential for complete treatment.

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