Norhafiza Mat Lazim

The effect of Tualang honey in enhancing post tonsillectomy healing process. An open labelled prospective clinical trial.

INTRODUCTION Tonsillectomy is a common operative procedure performed for tonsillar hypertrophy complicates with recurrent tonsillitis. Among the post tonsillectomy morbidities, post operative wound healing is of utmost importance to be effectively managed as it will interfere with patient recuperation from surgery. Tualang honey has been shown to accelerate wound healing in postoperative patients. OBJECTIVE The aim of this study was to investigate the effect of Tualang honey in enhancing healing process in post tonsillectomy patients. METHODOLOGY In this open labelled prospective study, the selected paediatric patients were randomized into two groups. The 35 subjects in the Tualang honey-antibiotic group received 3 mls of Tualang honey intraoperatively followed by 4 mls of oral Tualang honey three times daily for seven days. Concurrently, 25mg/kg of intravenous Sultamicillin was given three times daily for two days followed by oral Sultamicillin twice daily for five days. The 28 subjects in the antibiotic only group received intravenous at 25mg/kg Sultamicillin kg for two days followed by oral Sultamicillin twice daily for five days. The healing process was assessed at day 1, day 3, day 7 and day 14 postoperatively by semiquantitative endoscopic photograph examination of both tonsillar fossae. RESULTS The average ages for the treatment group and the control groups were 9 and 11 years old respectively. Wound healing was significantly faster in the treatment group in both tonsillar fossae compared to the control group (left: p-value = <0.001; right: p-value = <0.001). CONCLUSION Tualang honey has positive effect in enhancing healing process in post tonsillectomy patient. It is easy to use topically, safe to consume orally and available at low cost locally. Overall it can be used as an excellent adjunct therapy for post operative patients.

Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

A concealed giant peritonsillolith masquerading as oropharyngeal tumor

Tonsillolith is defined as concretion of calcified materials in the crypt of palatine tonsil. Small tonsillolith is relatively common and can occur up to 10% of the population but due to the asymptomatic nature of this condition, most cases go unreported. Symptomatic patients can present with foreign body sensation, halitosis, sore throat, odynophagia and in certain cases even dysphagia or referred ear pain. Large or giant tonsillolith are fairly uncommon. Calculi found in the peritonsillar space or also known as peritonsillolith are even rarer. Peritonsillolith was first described in 1975 and since then there are only few literatures describing this entity. A giant peritonsillolith that is properly concealed by tonsil substance or mucosa may present as oropharyngeal mass that mimics tumor. We report an extremely rare case of giant peritonsillolith that underwent diagnostic tonsillectomy and surgical excision.

Dilemmas in Managing OralCavity Carcinoma: A SingleInstitution Experience withIllustration of Four Cases

Dilemmas in Managing Oral Cavity Carcinoma – A Single Institution Experience with Illustration of Four Cases Introduction: Oral cavity carcinoma is a common tumor of head and neck with tongue carcinoma is the main site of involvement in South East Asia region. Majority of patients present late and prognosis is dismal despite optimal treatment. Methodology: A retrospective study of oral cavity malignancy at Hospital Universiti Sains Malaysia located in East Coast of Peninsular Malaysia was carried out from January 2011 to October 2013. Only four cases of oral cavity carcinoma were identified. Details of clinical presentation, imaging finding, histopathological diagnosis and treatment outcomes were reviewed. Clinical presentation and Result: The age of patients ranges from 35 to 43 years old with a Chinese and three Malays. Two patients were male and two were female. All cases are oral tongue carcinoma subsites. Three patients had glossectomy and neck dissections with adjuvant chemoradiation. The other male patient adamantly refused any form of surge and went for complementary and alternative medicines. All patients had minimal response to chemoradiation and two patients succumbed to diseases. Discussion: The survival of oral cavity carcinoma patient is reducing in South East Asia in contrast to an increasing survival trend seen in Western World. Multiple factors contribute to this phenomenon and numerous local issues are taken into consideration in highlighting the true spectrum of this diseases and its progression locally. Most patients deteriorate despite multimodality treatment. Conclusion: OCSCC is an important entity in the armamentarium of head and neck cancer management. Despite multimodality treatment, the outcome remains poor. Thus it is imperative to refine treatment strategies and expertise locally in order to ensure a finesse cancer patients care in near future.

A Rare Presentation ofCarcinosarcoma in a LongStanding Parotid Mass

A Rare Presentation of Carcinosarcoma in a Long Standing Parotid Mass Introduction: Parotid tumours represent one of common tumours seen in the field of Otorrhinolaryngology. Common benign tumours include pleomorphic adenoma and warthins tumour while most common malignant parotid gland tumour is mucoepidermoid carcinoma. This case, however, highlights a rare parotid tumour in a long standing parotid mass. Objective: To present a rare case of parotid carcinosarcoma ex pleomorphic adenoma. Clinical Report: A 35 year old Malay gentleman with no prior medical illness first presented on 22nd October 2013 with history of left parotid swelling for more than 10 years in which he had not seeked treatment before. He was compelled to seek treatment after a drastic increase in size within 2 weeks prior to swelling. Patient has been an active smoker past 20 years. Examination revealed a large, lobulated left parotid mass measuring 10 cm x 9 cm x 8 cm which was hard, not tender and fixed to overlying skin. There were no palpable neck nodes and facial nerve was intact. Fine needle aspiration cytology revealed mucoepidermoid carcinoma ex pleomorphic adenoma. He underwent tracheostomy, left extended total parotidectomy, left supraomohyoid neck dissection with soft tissue reconstruction with free fasciocutaneous anterolateral thigh (ALT) flap on 11th March 2014. Histopathological examination of the parotid mass revealed carcinosarcoma ex pleomorphic adenoma. Conclusion: This case report highlights a rare malignant transformation of a long standing parotid mass to form carcinosarcoma of the parotid gland.