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  1. Aziah Ab Rani, Nadarajah, Sanjeevan
    MyJurnal
    Tongue pain attributed to lingual neuralgia has been reported following dental and oral surgical procedures. Lingual nerve insult through traction and compression during laryngoscopic examination has been proposed as possible etiology for lingual nerve neuralgia. We report a case of tongue ischemia during laryngoscopic procedure which resulted in lingual neuralgia. We recommend that intermittent release of pressure by relaxing the instrument or gag and monitoring the perfusion state of the tongue will reduce the risk of this lingual neuralgia.
  2. Lim EH, Nadarajah S, Mohamad I
    Oman Med J, 2017 Sep;32(5):432-435.
    PMID: 29026477 DOI: 10.5001/omj.2017.81
    Sialolithiasis is the formation of calculi or sialoliths in the salivary gland. It is the most common benign condition of the salivary gland. Sialolithiasis can occur in all salivary glands. The submandibular gland is most commonly affected followed by the parotid gland. Calculi commonly measure less than 10 mm. Calculi of more than 15 mm are termed giant salivary gland calculi and are infrequently reported in the literature. Here, we report a case of unusually large submandibular gland calculus of 5 cm in greatest dimension which caused erosion of the oral cavity.
  3. Maruthamuthu T, Saniasiaya J, Mohamad I, Nadarajah S, Lazim NM, Wan Abdul Rahman WF
    Oman Med J, 2018 Jul;33(4):342-345.
    PMID: 30038735 DOI: 10.5001/omj.2018.62
    Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.
  4. Chai-Lee T, Nadarajah S, Abdullah B, Mohamad I, Maruthamuthu T, Nadarajan C, et al.
    Int J Surg Case Rep, 2017;33:119-123.
    PMID: 28314224 DOI: 10.1016/j.ijscr.2017.02.051
    INTRODUCTION: The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery.

    PRESENTATION OF CASE: A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage.

    DISCUSSION: Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique.

    CONCLUSION: Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.

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