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  1. Teoh JW, Hassan F, Mohamad Yunus MR
    Singapore Med J, 2013 Oct;54(10):e208-10.
    PMID: 24154590
    Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior one-third of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatumon periodic acidSchiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.
  2. Fader F, Mohamad Yunus MR, Mat Baki M
    BMJ Case Rep, 2021 Oct 27;14(10).
    PMID: 34706913 DOI: 10.1136/bcr-2021-245193
    A 33-year-old woman was diagnosed with right recurrent laryngeal nerve (RLN) schwannoma. She presented with a long history of hoarseness, and only recently developed dysphagia. On physical examination, a mass was observed over the right cervical level IV. Endoscopic examination of the larynx showed that she had right unilateral vocal cord palsy. She successfully underwent transcervical resection of the tumour followed by injection laryngoplasty. This study discusses the presentation of the tumour, radiological findings, our working diagnosis and treatment options of RLN schwannoma.
  3. Razali MN, Mat Baki M, Kew TY, Mohamad Yunus MR
    Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):93-95.
    PMID: 31741939 DOI: 10.1007/s12070-017-1116-3
    Basal cell adenocarcinoma (BCAC) is a rare tumour entity. Despite its tendency to be infiltrative and destructive tumour with propensity to recur, it rarely metastasizes and long-term outcome following surgery is favourable. This paper presents a 42-year-old male with residual BCAC of parotid gland that had extended into infratemporal fossa and intracranial. The important aspect of this case is the rarity occurrence of BCAC of parotid with intracranial extension and its surgical approaches to achieve tumour clearance.
  4. Fuad M, Goh BS, Lokman FL, Mohamad Yunus MR
    Cureus, 2023 Oct;15(10):e46415.
    PMID: 37927667 DOI: 10.7759/cureus.46415
    Parotid lymphangioma is a benign lymphatic malformation commonly observed in infancy or early childhood. It often grows insidiously and presents as a painless, soft fluctuant mass. We report a case of an eight-year-old boy who was diagnosed from another center with right parotid lymphangioma of one-year duration. He presented with right painful preauricular swelling and trismus for nine days after a recent history of blunt trauma to the preauricular caused an acute expansion of the swelling and subsequently, the patient developed ipsilateral facial nerve palsy. Examination showed right preauricular swelling measuring about 6 x 6 cm that extended posteriorly until the mastoid region, superiorly until the zygoma, and inferiorly until the angle of the mandible, pushing the ear lobule anteromedially. There was bluish discoloration of the overlying skin. The swelling was warm and tender on palpation. Multiple shotty lymph nodes were palpable at the posterior triangle. Aspiration of the swelling revealed blood content, but it reaccumulated after a few hours. A magnetic resonance imaging (MRI) of the neck showed a lesion confined within the parotid gland. There was a presence of air-fluid level with dependent layers of hyperintense on the T1-weighted image (T1WI) and T2-weighted image (T2WI) with clumps of isointensity on T1WI, which are hypointense on T2WI, which is suggestive of acute-late subacute blood product. A diagnosis of lymphatic malformation complicated with hemorrhage was made. Hence, the patient underwent surgery for the evacuation of blood clot and right superficial parotidectomy. Histopathological examination of the intraoperative tissue biopsy revealed evidence of venolymphatic malformation of the parotid gland. Postoperatively, he was discharged home after three days. The facial nerve function recovered from House and Brackmann grade II to grade I three weeks after the surgery.
  5. Dayangku Norsuhazenah PS, Baki MM, Mohamad Yunus MR, Sabir Husin Athar PP, Abdullah S
    Ann Acad Med Singap, 2010 Jul;39(7):565-4.
    PMID: 20697675
    INTRODUCTION: In laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period.

    MATERIALS AND METHODS: A retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted.

    RESULTS: Eighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain.

    CONCLUSIONS: TEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

  6. Ab Rani A, Azman M, Ubaidah MA, Mohamad Yunus MR, Sani A, Mat Baki M
    J Voice, 2021 May;35(3):487-492.
    PMID: 31732294 DOI: 10.1016/j.jvoice.2019.09.017
    OBJECTIVE: This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments.

    PARTICIPANTS: The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria.

    MAIN OUTCOME MEASURES: The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups.

    RESULTS: Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups.

    CONCLUSION: This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.

  7. Sai-Guan L, Min-Han K, Kah-Wai N, Mohamad-Yunus MR
    Iran J Otorhinolaryngol, 2017 Mar;29(91):117-120.
    PMID: 28393061
    INTRODUCTION: Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer's ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed.

    CASE REPORT: A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma.

    CONCLUSION: Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass.

  8. Nabil S, Nazimi AJ, Nordin R, Hariri F, Mohamad Yunus MR, Zulkiflee AB
    Int J Oral Maxillofac Surg, 2018 Dec;47(12):1511-1518.
    PMID: 30837061 DOI: 10.1016/j.ijom.2018.05.020
    The mandibulotomy is a procedure that was developed to improve access in tumour resection. This study aimed to investigate the complications associated with mandibulotomy and analyze factors that could affect the risks of developing these complications. The hospital records of all patients who underwent a mandibulotomy as part of their tumour ablative surgery at two major centres in Malaysia were reviewed retrospectively. Demographic, clinical, and complications data were recorded and analyzed. Early postoperative complications occurred in 46.5% of the patients and post-radiation therapy complications in 16.1%. Wound dehiscence (27.9%) and inferior alveolar nerve injury (25.6%) were the common early postoperative complications. Dental injuries (9.7%) and plate exposure/infection (9.7%) were the common post-radiation therapy complications. Furthermore, inferior alveolar nerve injury and early abscess formation were significantly associated with the site of the mandibulotomy. The T-stage of a tumour but not the site of mandibulotomy was significantly associated with tumour margin clearance. Mandibulotomy does pose an added risk of complications for a patient undergoing tumour surgery. The benefits of mandibulotomy in terms of gaining margin clearance could not be proven in this study. The site of mandibulotomy appears to increase the risk of developing an inferior alveolar nerve injury.
  9. Jumaat AF, Mohamad Yunus MR, Yong DJ, Md Zin RR, Mat Baki M
    Iran J Otorhinolaryngol, 2023 Mar;35(127):101-108.
    PMID: 37223400 DOI: 10.22038/IJORL.2023.57806.2995
    INTRODUCTION: An abnormal mass in the head and neck involving the supraglottic and cervical region offers a wide range of differential diagnoses. The pathology is either benign or malignant in nature. Castleman disease (CD) is an uncommon lymphoproliferative disorder characterised by hypervascular lymphoid hyperplasia and is classified into unicentric or multicentric disease. Histopathologically it is divided into hyaline vascular (HV), plasma cell (PC), and mixed cellularity variants. The multicentric disease is linked with PC and has the propensity to progress to lymphoma or Kaposi Sarcoma.

    CASE REPORT: We report a case of a 45-year-old gentleman who presented with a painless anterior neck swelling and left supraglottic mass for six months. Computed tomography (CT) contrast imaging demonstrated a homogenous enhancing lesion at the left supraglottic and the midline of the anterior neck with erosive changes of the thyroid cartilage. A surgical resection of the anterior neck mass was performed. The diagnosis of Castleman disease plasma cell variant was made by histopathologic evaluation. The patient remained well post-resection.

    CONCLUSION: Supraglottic multicentric Castleman disease is the least expected diagnosis in this case. Unicentric disease is treated with surgery. However, limited studies are available in determining the effectiveness of surgery in multicentric diseases. The plasma cell variant requires a multidisciplinary and multimodal approach due to an inclination towards malignancy. Research is needed to determine the role of surgery in multicentric disease and to develop optimum guidelines for managing cases. To date, there is unsubstantial literature describing supraglottic multicentric disease.

  10. Leong Abdullah MF, Nik Jaafar NR, Zakaria H, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.
    Psychooncology, 2015 Aug;24(8):894-900.
    PMID: 25612065 DOI: 10.1002/pon.3740
    Positive and negative psychological reactions have been described in head and neck cancer patients. Nevertheless, the relationships between these responses across time need to be studied to understand the patients' strengths and vulnerabilities.
  11. Nik Jaafar NR, Abd Hamid N, Hamdan NA, Rajandram RK, Mahadevan R, Mohamad Yunus MR, et al.
    Front Psychol, 2021;12:716674.
    PMID: 34764904 DOI: 10.3389/fpsyg.2021.716674
    Despite an enormous number of studies addressing the importance of posttraumatic growth (PTG) among cancer patients, the literature lacks data regarding how different coping strategies affect PTG among head and neck cancer (HNC) patients over time. This longitudinal study investigated the PTG trend and coping over 5-7months among a cohort of HNC patients within the first year after their diagnosis. It determined an association between coping strategies and PTG over time. The study's HNC respondents were administered a socio-demographic and clinical characteristics questionnaire during their baseline assessments. Additionally, the Malay versions of the "PTG Inventory-Short Form" (PTGI-SF) and the "Brief Coping Orientation to Problems Experienced Inventory" (Brief COPE) were administered during respondents' baseline assessments and follow-up assessments (5-7months after the baseline assessments). In total, 200 respondents reported an increasing PTG trend and approach coping (active coping, planning, positive reframing, acceptance, emotional support, and instrumental support) and a decreasing trend of avoidant coping (self-distraction and denial) over time. Two approach coping strategies (acceptance and planning) significantly increased PTG while denial was the only avoidant coping strategy that significantly lowered PTG, after controlling for socio-demographic and clinical characteristics, over time. Our study's findings identified the need to incorporate psychosocial interventions that enhance approach coping and reduce avoidant coping into HNC patients' treatment regimes.
  12. Zhang Z, Azman N, Eyu HT, Nik Jaafar NR, Mohd Salleh Sahimi H, Mohamad Yunus MR, et al.
    Int J Environ Res Public Health, 2022 Nov 01;19(21).
    PMID: 36361144 DOI: 10.3390/ijerph192114266
    The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876, p < 0.001). The EFA and CFA confirmed that the SSS-M consisted of 16 items in 3 domains. Its convergent and discriminant validity were achieved. Hence, the SSS-M demonstrated good psychometric properties and is available for use to assess stigma among cancer patients in Malaysia.
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