Martin Wai Pak

A prospective study of foreign-body ingestion in 311 children

OBJECTIVE: To determine the preferable management protocol of foreign body ingestion in pediatric patients. METHODS: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. RESULTS: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. CONCLUSIONS: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.

Congenital laryngeal cysts: current approach to management

Congenital laryngeal cysts are a rare cause of neonatal upper airway obstruction which may lead to serious morbidity and mortality if diagnosis and treatment are delayed. We reviewed our experience with nine patients over a six-year period. The annual incidence of this condition was 1.82 per 100,000 live births. The diagnosis can be confirmed safely by flexible laryngoscopy before definitive surgery is contemplated. Contrary to other studies, we found that endoscopic removal of cysts can achieve an effective cure without recurrence. Endoscopic deroofing is as effective as endoscopic excision but is technically simpler and thus is recommended as the treatment of choice.

Late complications of nasal augmentation using silicone implants.

Alloplastic nasal augmentation with silicone elastomer (Silastic) is popular in areas of Asia. Although the silicones are bio-inert, they have been implicated in a number of adverse reactions after implantation. We report our experience of three patients who presented with late complications after nasal augmentation using Silastic implants. The mechanisms of implant failure are proposed. It is advised that this material should only be used on an individual basis in carefully selected cases.

Nasopharyngeal carcinoma in situ (NPCIS)--pathologic and clinical perspectives.

Dysplasia or carcinoma in situ lesions (NPCIS) of the nasopharynx have rarely been reported. The prevalence, biologic behavior, and the transformation period of the pure preinvasive lesions have not been fully explained.

In vivo diagnosis of persistent and recurrent nasopharyngeal carcinoma by contact endoscopy.

Objective To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.

In vivo diagnosis of nasopharyngeal carcinoma using contact rhinoscopy

Objectives To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC).

Nasal manifestation of extranodal Rosai-Dorfman disease – diagnosis and management

Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.

Retropharyngeal abscess. A rare presentation of nasopharyngeal carcinoma.

Early symptoms of nasopharyngeal carcinoma (NPC) can often be deceptive and confusing. Most patients with nasopharyngeal carcinoma present at an advanced stage with metastatic cervical nodes present at the time of diagnosis. A deep neck abscess as the presenting feature has not been reported. We report two cases of nasopharyngeal carcinoma which presented with retropharyngeal abscesses and persistent lymphadenopathy. These two patients illustrate that refractory lymphadenopathy, despite adequate treatment of the associated infection, should prompt a search for underlying disease. The relationship between nasopharyngeal carcinoma and retropharyngeal abscess is discussed.

T-cell non-Hodgkin’s lymphoma of the larynx and hypopharynx☆☆☆★★★♢

Before a diagnosis of geniculate neuralgia is made, an extensive differential diagnosis should be entertained. The following must be ruled out: otitis; temporomandibular joint disease; Eagle’s syndrome; carcinoma of the nasopharynx, temporal bone, external auditory canal, or pinna; vascular lesions; and referred pain from the cerebellopontine angle and laryngeal and pharyngeal sites. A complete neurologic, otologic, and dental evaluation is paramount. Attempts have centered on section of the nervus intermedius, with or without section of other cranial nerves; section of the greater superficial petrosal nerve; and resection of the geniculate ganglion. 2 Others have found vascular loops in relation to these cranial nerves and advocate decompression or nervus intermedius section combined with microvascular decompression of other cranial nerves. 3 Major series report a 72% to 90% success rate with sectioning of the nervus intermedius. 2,3

In vivo real-time diagnosis of nasopharyngeal carcinoma in situ by contact rhinoscopy.

Nasopharyngeal dysplasia or nasopharyngeal carcinoma in situ (NPCIS) lesions have rarely been reported. Timely diagnosis of the preinvasive lesion may improve prognosis. Contact endoscopy has been documented to accurately differentiate normal cells of the nasopharynx from malignant cells and allows a real‐time diagnosis of primary and recurrent nasopharyngeal carcinoma (NPC) in a clinical setting. However, the role of contact endoscopy in the diagnosis of NPCIS is unknown.