Benign Calcified Thyroglossal Duct Cyst, – Defying The Hallmark of Papillary Carcinoma, 4th Case Reported In Literature

Thyroglossal duct cyst is the most common upper neck midline lesion in children. Approximately 1% of thyroglossal duct cyst undergoes malignant transformation. Calcification which is a marker of malignancy almost always points out to papillary thyroid carcinoma. Benign case of calcified thyroglossal cyst maybe undiagnosed or under reported. We report a case of a 5 year old girl with a benign calcified thyroglossal duct cyst, a fourth case in world literature. Here the differences between a benign and malignant thyroglossal duct cyst are discussed.

Prolong Placement of Tracheostomy Tube Causing Unusual Complication

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.

Gore-Tex Medialisation Thyroplasty for Unilateral Vocal Cord Palsy: A Tertiary Centre 7 Years Experience

The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods: Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord palsy at our institution and medical records were retrospectively reviewed. Results: There were 18 males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration which would otherwise be disabling for the patients.

Tracheal resection and anastomosis: an 11 year management outcome

To evaluate the etiology, perioperative management and outcome of surgery in cases of tracheal stenosis. This was a retrospective analysis of patients with tracheal stenosis who underwent resection with anastomosis from January 2000 until December 2010. Ten patients, aged between 15 to 53 years old [mean of 34.4 years] were included. Post intubation injury was the major cause of tracheal stenosis [n=8], followed by external laryngeal trauma [n=2]. Using the Cotton-Myer classification, 60% of patients had Grade III stenosis whilst 40% had Grade IV stenosis. Intravenous corticosteroids were given 24 hours before extubation. Four patients were well post- operatively without complications. The most common complication in the other patients was granulation tissue in the anastomosis region [n=3], vocal cord paresis [n=2] and one restenosis [n=1]. Four of these patients underwent examination under anesthesia with removal of granulation tissue and/or laser dilatation. However, 2 cases needed Shian Lee operation and required T-tube until present. The success rate for tracheal resection and anastomosis is taken as the number of patients successfully decannulated, which was 80%. Tracheal resection with end-to-end anatomosis was a successful procedure for cervical tracheal stenosis, with low mortality and few complications related to it

Oncocytic Schneiderian Papilloma: A Rare Sinonasal Papilloma Removed via Endoscopic Medial Maxillectomy

There are three types of papilloma which arises from the Schneiderian membrane namely inverted, fungiform and oncocytic. Oncocytic papilloma is the rarest type and occurs predominantly in the older age group. Clinically, its behaviour is similar to inverted papilloma in having both local recurrence and associated malignancy. We report a rare case of oncocytic papilloma arising from the maxillary sinus, extending into the nasal cavity and nasopharynx, in a 78-year-old lady. Despite the longstanding history there was no evidence of associated malignancy in this lesion. An endoscopic medial maxillectomy was successfully utilized for approach and complete tumour excision. In conclusion, oncocytic papilloma should be considered as a differential diagnosis in patients presenting with unilateral polypoid nasal lesions especially in the elderly. In addition, endoscopic medial maxillectomy can provide an adequate approach for complete tumour removal.

Retropharyngeal Abscess: A Seven-Year Review - Clinical Presentation, Diagnosis and Management

This was a retrospective study of operative records between 2000 – 2007 from two ear, nose and throat (ENT) referral centers in Malaysia to review demographic patterns, clinical presentations and management of retropharyngeal abscess (RPA). Our case series comprised of eight patients with five females and three males with a median age at presentation of 47 years. Comorbid factor in this series was diabetes mellitus, with four patients having diabetes. There were three cases of fish bone ingestion. The commonest presentation was dysphagia or odynophagia. None of them had fever. All patients were treated with broad spectrum intravenous antibiotics (IV) and drainage was performed for the abscess. Four patients underwent transoral drainage with three having the cervical approach and one having spontaneous rupture. All patients recovered well from the infection and only one patient passed away due to septicaemia. In conclusion, patients with retropharyngeal abscess may present with vague symptoms of sore throat, odynophagia without fever due to partial antibiotics treatment. A correct diagnosis should be made so that adequate treatment can be given to prevent mortality.