A Ten-Year Kuala Lumpur Review on Laser Posterior Cordectomy for Bilateral Vocal Fold Immobility

Bilateral vocal fold immobility (BVFI) is commonly caused by injury to the recurrent laryngeal nerve (RLN) and leads to stridor and dyspnea of varying onsets. A retrospective study was done at the Department of Otorhinolaryngology of Universiti Kebangsaan Malaysia Medical Centre on laser microsurgical posterior cordectomy for BVFI. The objectives were to identify the average duration of onset of stridor from the time of insult and to evaluate the outcome of laser posterior cordectomy as a surgical option. From 1997 to 2007, a total of 31 patients with BVFI were referred for surgery. Twelve patients had tracheostomy done prior to the procedure, whereas 19 patients were without tracheostomy. Ten patients were successfully decannulated, and only 4 patients had complications related to the procedure. The minimum onset of stridor was 7 months, maximum onset of stridor was 28 years, and the mean onset of stridor was 8.7 years. The commonest complication observed was posterior glottic adhesion following bilateral posterior cordectomy. Laser endolaryngeal posterior cordectomy is an excellent surgical option as it enables successful decannulation or avoidance of tracheostomy in patients with BVFI. The onset of stridor took years after the insult to the recurrent laryngeal nerves.

Tuberculous cervical lymphadenitis in a patient with suspected neck recurrence / 中华医学杂志(英文版)

The significance of metastastic disease in the cervical lymph nodes has long been appreciated. The rich lymphatics of the upper aerodigestive tract explained the high incidence of cervical metastasis, occasional bilaterally spread. Even with appropriate treatment, cervical recurrences do occur. Nonetheless, with the resurgence of tuberculosis, the differential of tuberculous cervical lymphadenitis should be excluded. Appropriate modalities should be employed in making the appropriate diagnosis possible.

Mandibular metastasis from nasopharyngeal carcinoma

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe a case of mandibular metastasis from nasopharyngeal carcinoma and review the literature.</p> <p style="text-align: justify;"><strong>METHODS</strong>: <br /><strong>Design</strong>: Case Report<br /><strong>Setting</strong>: Tertiary Public University Hospital<br /><strong>Patient</strong>: One<br /><br /><strong>RESULT</strong>: A 42-year-old Malay gentleman underwent concurrent chemoradiotherapy (CCRT) for T4N2M0 (Stage IVa) nasopharyngeal carcinoma (NPC) non-keratinizing type (WHO II). Upon completion of CCRT, he developed metastasis to the left body of the mandible that increased in size despite three cycles of adjuvant intravenous chemotherapy. Hemi-mandibulectomy was deferred due to recent irradiation and a further 15 fractions of boost radiotherapy reduced the mandibular metastasis in size but it has remained the same after six months follow up.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: Nasopharyngeal carcinoma (NPC) is a common malignancy in Oriental Asia and the South East Asian regions. It has the highest rates of nodal and distant metastases among all head and neck cancers. Distant metastasis to bone is common but we could find no previous report of mandibular bone involvement in the literature. Radiotherapy remains the main treatment modality and combination with chemotherapy has been shown to improve survival of patients. There are studies on nasopharyngeal carcinoma tumour markers for diagnosis and disease process follow up but these are still inconclusive.</p>

Necrotizing Fasciitis of the Head and Neck: Surgical Outcomes in Three Cases

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.