We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
Ameloblastoma is a slow growing benign tumour of the jaw and patients usually present late after the tumour achieved considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and characteristic findings on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumour are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.
Introduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most
circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma
is complicated, because there is no established management approach for this potentially life-altering, high
morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention
may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the
above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We
reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from
June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative
findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of
phonation except for one patient who had reduced speech function. After one year, one patient was still
dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used
to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion:
Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma.
Subcutaneous emphysema is an important hallmark that should alert the attending physician to the
possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce
favorable patient outcomes.
To investigate the case incidence, causes, clinical profile and outcome of temporal bone fracture complicating head trauma. A 1-year (2005) retrospective study of head injured patients presented to the Emergency Department, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. Gender distribution, cause of injury, radiological findings and otorhinolaryngological clinical presentations were analyzed. Of 1309 patients, 61 patients were diagnosed to have temporal bone fracture (4.7%). Majority of cases were caused by motor vehicle accident (85.9%) and were predominantly male (88.5%). The right temporal bone was more frequently fractured (62.3%). Most (88.5%) were petro-mastoid fractures. Sixty-seven percent of the petrous fractures were longitudinal type. Clinical presentations mostly reported were blood rhinorrhea (36%) and blood otorrhea (32.7%). Other clinical presentations were hearing loss (9.8%), cranial nerve palsy (8.2%), cerebrospinal fluid oto-rhinorrhea (8.2%) and labyrinth concussion (6.5%). Four out of five cranial nerve palsies were facial nerve. Out of the 61 cases, 16 (26.2%) had no clinical presentation at the time of Emergency Department consultation. Thirteen (21.3%) died due to severe head injury. The case incidence of temporal bone fracture in head injured patients in our centre is 4.7%. The petro-mastoid type fracture predominates. Proper early diagnosis and management minimize complications.
The occurrence of pharyngocutaneous fistula (PCF) after total salvage laryngectomy following radiotherapy
as primary treatment is quite common. In most cases, pharyngocutaneous fistula can heal spontaneously
with conservative measures. Here, we are reporting a 69-year-old male with a residual carcinoma of the
larynx following failed radiotherapy as primary treatment whose later underwent a salvage total
laryngectomy. Post-operatively, it was complicated by the formation of pharyngocutaneous fistula which
was failed to heal with conservative measures and few attempts of surgical repair. The fistula later healed
with the application of Montgomery Salivarybypass tube after 3 weeks. The application of the salivary
bypass tube should be considered and used to promote healing in persistent pharyngocutaneous fistula
especially in a post radiotherapy patient.
We report a case of an inflammatory pseudotumour (IP) involving the floor of the skull base, which demonstrated aggressive behavior both clinically and radiologically. In this case, the diagnosis was established by clinical presentation, magnetic resonance imaging (MRI), histopathological examination (HPE) and the dramatic response towards high dose steroid therapy. The clinical features improved with oral cyclophosphamide in combination with oral steroid, which were given for a period of three months.
We report a 56-year-old Malay woman with a tumour that involved the skin and caused hyoid bone erosion. There was no clinical or radiological evidence of regional lymph node involvement. A modified radical neck dissection with preservation of the accessory nerve and internal jugular vein was performed, followed by an "extended" Sistrunk operation. The surgical defect was reconstructed with a pectoralis major myocutaneous flap. Our literature review showed that this is the first reported thyroglossal duct carcinoma which involved the skin and required a pedicle flap reconstruction.
The standard management for the majority of benign jaw cysts is enucleation, marsupialisation, curettage and decompression. Enucleation has the advantage that the whole specimen is sent for microscopic evaluation so that more sinister pathological processes (i.e. squamous cell carcinoma) may not be missed. In a large cystic lesion, enucleation is still possible, but technical difficulties might be encountered. In such instances, inevitable damage can occur to the surrounding structures. We report a case of a large radicular cyst of the maxilla that was enucleated via endoscopic assistance through the Caldwell Luc approach.
Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.