Temporal Bone Squamous Cell Carcinoma the Outcome of Radical Surgery as an Initial Treatment.

Aims: The aim of this study is to analyse the clinical data and management of patients with temporal bone carcinoma and to discuss the management outcomes. Study Design: Retrospective study Place and Duration of Study: Universiti Kebangsaan Malaysia Medical Centre (academic tertiary centre) from January 2002 to December 2011. Methodology: Medical records of nine patients were retrieved for this study. There were seven male and two female patients. The mean age of presentation was 60 years old, with an age range between 49 to 75 years. The clinical presentations, investigations, staging, treatment modalities and outcomes are reviewed. Results: Four patients presented with primary tumour of the temporal bone, while the remaining five were referred from other centres with disease recurrence. Only one out of the five patients that were referred to us had underwent a lateral temporal bone resection (LTBR) at presentation which was however an incomplete LTBR. Three out of the five patients (60%) have died with disease recurrence. One patient remained disease free while another patient was lost to follow up. Two out of the four patients who presented with primary tumour remained well while two others had positive margins due to advanced disease at presentation. Conclusion: Recurrence of disease is likely to occur if aggressive treatment is not offered at presentation or if the diagnosis is delayed. We therefore strongly suggest for early referral to a tertiary centre as aggressive primary surgical treatment with adjuvant radiotherapy shows a better prognosis.

Partial Cricotracheal Resection (PCTR), a RewardingOutcome for Paediatric Subglottic Stenosis : An Early Experience

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.

The Prevalence of Sensorineural Hearing Loss in β-thalassaemia patient treated with Desferrioxamine

Objective: This study aimed to evaluate the prevalence of sensorineural hearing loss (SNHL) in β-thalassaemia patients treated with Desferrioxamine (DFO) and determine the correlation of SNHL with average daily DFO dosage, serum ferritin level and Therapeutic index (T.I). Methods: This is a cross sectional descriptive study carried out for a period of 14 months and 54 patients were recruited. The recruited patients are transfusion dependant β- thalassaemia patient aged 3 years and above treated with DFO. An interview, clinical examination and hearing assessment, which included tympanogram, and Pure Tone Audiometry (PTA) or behaviour alaudiometry were performed. The data on age started on DFO, average daily DFO, duration of DFO intake, serum ferritin past 1 year and Therapeutic Index (T.I) were obtained from patients’ case notes. Results: The prevalence of SNHL was 57.4% and majority has mild hearing loss (93.6%). Fourteen patients (25.9%) have bilateral ear involvement and as many as 17 patients (31.5%) have SNHL in either ear. A total of 23 patients (42.6%) have normal hearing level. Although the prevalence of SNHL was 57.4%, only a small percentage of the patient noticed and complained of hearing loss (11.1%). There is no association between age started on DFO, average daily DFO and duration of DFO intake with normal hearing group and those patients with SNHL. Positive correlation was seen between average daily DFO with 2000 and 4000Hz on PTA in the left ear and between serum ferritin level past 1 year with 4000 and 8000Hz in the right ear and 8000Hz in the left ear. No significant correlation was seen between T.I on PTA. Conclusion: The prevalence of SNHL from hearing assessment is high in β-thalassaemia patients in this study. However, it is manifested clinically in a smaller percentage. We suggest a baseline hearing assessment should be carried on all β-thalassaemia patients prior to DFO chelation therapy.

Foreign body in bronchus: a rare method of removal

We report a case of aspirated tooth in a patient with cervical bone fracture. The tooth was removed from the bronchus through the pre-existing tracheostomy stoma. Removal of bronchial foreign body using tracheostomy stoma is reported rarely in the literature. We propose tracheostomy as mode of such foreign body removal for patient with cervical fracture or patient who neck flexion is contraindicated

Middle ear carcinoma masquerading as an aural polyp

@#OBJECTIVE/strong: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology. br /br /strongMETHODS/strong:br /strongDesign/strong: Case Reportbr /strongSetting/strong: Tertiary Public Hospital br /strongPatient/strong: Onebr /br /strongRESULTS/strong: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.br /br /strongCONCLUSION/strong: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible./p

Multiple Metastatic Deposits in the Head and Neck Region from a Renal Cell Carcinoma

Metastatic renal cell carcinoma (RCC) presenting with multiple deposits in the head and neck region is unusual. It is not uncommon for a RCC to metastasise to a distant site after years of a tumour-free period, but most of it would be expected to have a single site of deposit. We report a rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours in the frontal sinus and posterior pharyngeal wall. Radiological imaging and histology confirmed metastatic RCC at both sites.

Mastoid Abscess in Acute and Chronic Otitis Media

Background: Mastoid abscess remains a recognised complication of otitis media despite the advent of antibiotics. The objectives of this study were to describe the risk factors in patients with mastoid abscess following acute and chronic otitis media and discuss the management of this infection. Method: A retrospective analysis was done on all patients who underwent mastoidectomy for mastoid abscess from January 2002 to December 2007. Data on the patients’ presentation, associated complications, management, and follow-up were analysed. Results: A total of 12 patients were enrolled in this study population. Group A consisted of patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial complications, and 1 patient had intracranial complications. Most patients recovered well after mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia. Conclusion: Mastoid abscess is still a recognised complication of acute otitis media, especially in patients who are immunocompromised. Immunocompetent patients may also develop mastoid abscess following chronic otitis media associated with cholesteatoma. Thus, early treatment of otitis media and close vigilant follow-up are advocated to ensure prompt detection of mastoid abscess complications.