An Atypical Squamous Papilloma of the Uvula.

Squamous papilloma of the oral cavity is frequently seen in adult patients and is typically presented as painless exophytic granular or cauliflower-like lesions over the tongue, floor of the mouth, palate, uvula, lips, and faucial pillars. Most of the lesions are solitary and grow rapidly to about 0.5 cm. Oral squamous papilloma has no known malignant potential, with conservative surgical excision being the treatment of choice. Recurrence is rare. It occasionally causes symptoms, unless the presentation is atypical, as in our case. An elongated uvula can cause discomfort and reduce a patient's quality of life. This study aims to report an atypical presentation of a squamous papilloma over the soft palate.

Cultural Adaptation of Sniffin' Sticks Smell Identification Test: The Malaysian Version.

INTRODUCTION: Sniffin' Sticks smell identification test is a tool used for evaluation of olfactory function but the results are culture-dependent. It relies on the subject's familiarity to the odorant and descriptors. This study aims to develop the Malaysian version of Sniffin' Sticks smell identification test suitable for local population usage. MATERIALS AND METHODS: The odorant descriptors and distractors of the original version of Sniffin' Sticks were translated into Malay language. It was then tested for familiarity and identifiability in 30 normosmic subjects. The descriptors were replaced until the familiarity of all descriptors and identification rates of odorants achieved ≥ 70%. The validity of the new cultural-adapted version was tested in 60 hypo-anosmic subjects and 60 normosmic subjects with Student t-test. The test-retest reliability was evaluated after two weeks with interclass correlation. RESULTS: Two odorant descriptors and nine distractors achieved familiarity <70% (13.3% - 66.7%) and were replaced. Another three culturally inappropriate distractors were also replaced. The mean score among the healthy subjects was significantly higher than the subject with smell dysfunction [13.7 (1.12) and 7.3 (3.42); t = 7.24 (df = 34.23), P<0.001]. The coefficient of correlation (r) between test and retest scores was 0.93 (P<0.001). CONCLUSION: The cultural adapted Malaysian version of Sniffin' Sticks smell identification test is valid and has high test-retest reliability. This is the first smell identification test validated in Malaysia. It is effective for evaluation of olfactory function in local population.

A review of smell and taste dysfunction in COVID-19 patients

@#and taste loss were early subclinical symptoms of COVID-19patients. The objective of this review was to identify theincidence of smell and taste dysfunction in COVID-19,determine the onset of their symptoms and the risk factorsof anosmia, hyposmia, ageusia or dysgeusia for COVID-19infection.Methods: We searched the PubMed and Google Scholar on15th May 2020, with search terms including SARS-COV-2,coronavirus, COVID-19, hyposmia, anosmia, ageusia anddysgeusia. The articles included were cross sectionalstudies, observational studies and retrospective orprospective audits, letters to editor and shortcommunications that included a study of a cohort ofpatients. Case reports, case-series and interventionalstudies were excluded. Discussion: A total of 16 studies were selected. Incidence ofsmell and taste dysfunction was higher in Europe (34 to86%), North America (19 to 71%) and the Middle East (36 to98%) when compared to the Asian cohorts (11 to 15%) inCOVID-19 positive patients. Incidence of smell and tastedysfunction in COVID-19 negative patients was low incomparison (12 to 27%). Total incidence of smell and tastedysfunction from COVID-19 positive and negative patientsfrom seven studies was 20% and 10% respectively.Symptoms may appear just before, concomitantly, orimmediately after the onset of the usual symptoms. Occurspredominantly in females. When occurring immediately afterthe onset of the usual symptoms, the median time of onsetwas 3.3 to 4.4 days. Symptoms persist for a period of sevento 14 days. Patients with smell and taste dysfunction werereported to have a six to ten-fold odds of having COVID-19.Conclusion: Smell and taste dysfunction has a highincidence in Europe, North America, and the Middle East.The incidence was lower in the Asia region. It is a strong riskfactor for COVID-19. It may be the only symptom and shouldbe added to the list of symptoms when screening for COVID-19.KEYW

Nasopharyngeal Carcinoma with Cystic Cervical Metastasis Masquerading as Branchial Cleft Cyst: A Potential Pitfall in Diagnosis and Management.

INTRODUCTION: Most metastatic lymph nodes from head and neck malignancy are solid. Cystic nodes are found in 33% - 61% of carcinomas arise from Waldeyer's ring, of which only 1.8% - 8% originate are from the nasopharynx. Some cystic cervical metastases were initially presumed to be branchial cleft cyst. This case report aims to highlight the unusual presentation of cystic cervical metastasis secondary to nasopharyngeal carcinoma in a young adult. The histopathology, radiological features and management strategy were discussed. CASE REPORT: A 36-year-old man presented with a solitary cystic cervical swelling, initially diagnosed as branchial cleft cyst. Fine needle aspiration yielded 18 ml of straw-coloured fluid. During cytological examination no atypical cells were observed. Computed tomography of the neck showed a heterogeneous mass with multiseptation medial to the sternocleidomastoid muscle. Histopathological examination of the mass, post excision, revealed a metastatic lymph node. A suspicious mucosal lesion at the nasopharynx was detected after repeated thorough head and neck examinations and the biopsy result confirmed undifferentiated nasopharyngeal carcinoma. CONCLUSION: Cystic cervical metastasis may occur in young patients under 40 years. The primary tumour may not be obvious during initial presentation because it mimicks benign branchial cleft cyst clinically. Retrospective review of the computed tomography images revealed features that were not characteristic of simple branchial cleft cyst. The inadequacy of assessment and interpretation had lead to the error in diagnosis and subsequent management. Metastatic head and neck lesion must be considered in a young adult with a cystic neck mass.