Tang Ip

Migrating foreign body into the common carotid artery and internal jugular vein - A rare case

Ingested foreign bodies are a fairly common otorhinolaryngological emergencies encountered in Malaysia. The vast majority of these foreign bodies are fish bones which most commonly are impacted at the level of the cricopharynx. Rarely, however, a foreign body may migrate extraluminally and may even extrude subcutaneously. We report a rare occurrence where a fish bone not only migrated extraluminally, it was found to have migrated into the common carotid artery and the internal jugular vein and required surgical removal.

Surgical outcomes in cystic vestibular schwannoma versus solid vestibular schwannoma.

Objective To review the postoperative surgical outcomes of cystic vestibular schwannomas (CVSs), especially facial nerve outcomes, and compare these results with those from matched solid vestibular schwannomas (SVS) resected during the same period at a tertiary referral center. Study Design Retrospective case series. Methods One hundred thirty-one surgically managed patients with cystic vestibular schwannomas (CVSs) were age, sex, and tumor size matched to 131 surgically managed patients with solid vestibular schwannomas (SVSs). Demographics, tumor morphology, surgical approach, extent of resection, facial and nonfacial complications, and recurrence rates were compared between the 2 groups. Subtotal removal was defined as removal of at least 95% of the tumor. Results The mean maximal tumor diameter was 2.8 cm for both groups. For CVS, gross total tumor resection (GTR) was achieved in 92 patients (70.2%), and subtotal tumor resection (STR) was achieved in 39 patients (29.8%). Postoperative facial nerve outcomes at 1-year follow-up were good (HB Grade I–III) in 116 (88.5%) of 131 CVS patients. Twenty-three patients developed nonfacial nerve-related complications (17.6%). For SVS, GTR was achieved in 102 patients (77.9%), and STR was achieved in 29 patients (22.1%). Postoperative facial nerve outcomes at 1-year follow-up were good (HB Grade I–III) in 118 (90.1%) of 131 SVS patients. Nonfacial nerve related complications occurred in 14 patients (10.7%). None of the differences in outcome between the 2 groups were statistically significant. Conclusion The difference in surgical outcomes is minimal between patients with CVS and those with SVS, not reaching statistical significance. We think, with judicious surgical management, similar outcomes can be achieved in cystic tumors and solid tumors.

Multiple symmetrical lipomatosis: case report and literature review.

OBJECTIVE To discuss the pathophysiology and various treatment methods of multiple symmetrical lipomatosis. CASE REPORT We report a case of multiple symmetrical lipomatosis in a middle-aged man. He presented to us with an extensive, disfiguring neck mass. Clinical examination and computed tomography suggested a lipomatous mass without compression of vital neck structures. The proximity of the lipomatous mass to the carotid sheaths attracted our interest. We performed surgical excision in this case, because of the deep infiltrative behaviour of the lipoma. The benefits and drawbacks of liposuction and surgical excision of extensive neck lipomatosis are discussed. CONCLUSION Surgical excision and liposuction are complementary treatments in the management of multiple symmetrical lipomatosis. Patients should be aware of the limitations of both surgical options, and the risk of lipoma recurrence, before surgery. The decision on the mode of surgery relies upon the disease extent, the patients expectations and the surgeons experience.

Grisel's syndrome: a rare complication of tonsillectomy

OBJECTIVES To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning. CASE REPORT We report a case of post-tonsillectomy atlanto-axial subluxation, also known as Grisels syndrome, in a child. On the third day after surgery, the boy presented with torticollis with no neurological deficit. Rotatory atlanto-axial subluxation was clearly shown in computed tomography scans of the neck. Cervical traction for one week successfully reduced the subluxation, with no long-term sequelae. CONCLUSION Pre-existing cervical ligamentous laxity and post-operative infection are believed to be the main causes of Grisels syndrome. Although it is rare, patients are advised to seek treatment early if any neck pain or fever persists. Early diagnosis is important for better treatment outcome. Initial conservative measures are advised before more invasive cervical traction is adopted.

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses: a rare case.

OBJECTIVE We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour. RESULTS Small cell neuroendocrine carcinoma involving the nasal cavity and paranasal sinuses with intracranial extension may be treated successfully with surgery alone, without development of local recurrence. CONCLUSION Small cell neuroendocrine carcinoma is a locally aggressive tumour with a high rate of recurrence. Early and aggressive surgical excision with or without radiotherapy or chemotherapy can improve a patients outcome and prognosis. Regular follow up is needed to detect any local or distant recurrence.

Velopharyngeal stenosis, a late complication of radiotherapy.

Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons.

Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

BACKGROUND Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency. AIM We report two patients presenting with spinal stenosis and cord compression secondary to cranio-vertebral tuberculosis, who were successfully decompressed via an endoscopic, endonasal approach. STUDY DESIGN Two case reports. METHODS AND RESULTS Both patients were successfully decompressed via an endoscopic, endonasal approach which provided access to the cranio-vertebral junction and upper cervical spine. CONCLUSION An endoscopic, endonasal approach is feasible for the surgical management of cranio-vertebral junction stenosis; such an approach minimises surgical trauma to critical structures, reducing post-operative morbidity and the duration of hospital stay.

Diagnostic challenges in tuberculous otitis media.

OBJECTIVES To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases. CASE REPORT We report four cases of tuberculous otitis media with different clinical presentations, encountered between 1998 and 2002. None of the cases showed improvement with local or systemic antibiotics. The diagnosis, complications and management of these cases are discussed. CONCLUSIONS A high index of clinical suspicion of tuberculous otitis media is required in patients who do not respond to standard antibiotic therapy for (nontuberculous) chronic middle-ear infection. Early diagnosis and treatment of tuberculous otitis media is important to avoid irreversible complications, surgical intervention and propagation of the disease.

A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications

Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.

Nasolacrimal relapse of nasopharyngeal carcinoma

OBJECTIVES To describe three rare cases of nasolacrimal relapse of nasopharyngeal carcinoma, and to discuss the route of tumour spread from nasopharynx to lacrimal system as well as the relevant computed tomography findings. CASE REPORT We report three cases of nasolacrimal relapse in patients with previously treated nasopharyngeal carcinoma. The common initial presentations in these cases were epiphora and medial canthal swelling. The tumour spread from the nasopharynx to the lacrimal sac along the lateral nasal wall and nasolacrimal canal. Computed tomography demonstrated nasolacrimal canal invasion and osteomeatal complex obliteration by the tumour. Distant metastasis was detected in two cases. CONCLUSION More targeted radiotherapy should be delivered to prevent under-treatment of nasopharyngeal carcinoma. Nasolacrimal relapse of nasopharyngeal carcinoma is an advanced disease with a poor prognosis.