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Fulltext A Five-Year Review on Pediatric Foreign Body Aspiration

Nasir ZM, Subha ST

Int Arch Otorhinolaryngol, 2021 Apr;25(2):e193-e199.
PMID: 33968219 DOI: 10.1055/s-0040-1709739

Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.
Fulltext Lingual thyroid--a lesson to learn

Ramzisham ARM, Somasundaram S, Nasir ZM

Med J Malaysia, 2004 Oct;59(4):533-4.
PMID: 15779588

We present a case of a middle-aged woman with a mass in the posterior third of the tongue which was diagnosed as a tongue haemangioma. The tumour was successfully excised via a midline mandibular osteotomy and tongue splitting approach. The histopathology examination, however, revealed the 5x4 cms mass to be a lingual thyroid. The salient features of this unusual presentation of a thyroid enlargement will be discussed.
Comment in: Ng CS, Mohd MS. Lingual thyroid--a lesson to learn. Med J Malaysia. 2005
Mar;60(1):115
Successful free omental flap and skin graft reconstruction of scalp avulsion injury

Ramzisham AR, Somasundaram S, Nasir ZM, Ali F, Das S

Clin Ter, 2010;161(5):453-5.
PMID: 20949243

For the management of a full-thickness scalp avulsion injury, thorough wound debridement and immediate primary revascularization or a split-thickness skin graft may be necessary. Graft failure may be common situation thereby predisposing the individuals to unnecessary multiple operations. In the recent times, the use of omental graft has gained much popularity. In the present study, we describe an interesting case of chronic non healing scalp ulcer in a young woman who eventually underwent a free omental flap reconstruction with split-thickness skin graft and had satisfactory outcome.
A proposal for needle projections in transcutaneous injection laryngoplasty using three-dimensionally reconstructed CT scans

Nasir ZM, Azman M, Baki MM, Mohamed AS, Kew TY, Zaki FM

Surg Radiol Anat, 2021 Aug;43(8):1225-1233.
PMID: 33388863 DOI: 10.1007/s00276-020-02639-9

PURPOSE: This study aims to determine laryngeal dimension in relation to all three transcutaneous injection laryngoplasty (TIL) approaches (thyrohyoid, transthyroid and cricothyroid) using three-dimensionally reconstructed Computed Tomography (CT) scan and compare the measurements between sex, age group and ethnicity.
METHODS: CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured.
RESULTS: There were statistically significant differences between males and females for all measurements except for CTa (p 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability.
CONCLUSION: This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure.