1.Isolated Blunt Lingual Artery Injury Secondary to a Road Traffic Accident: Diagnostic and Therapeutic Approach
Azman Mawaddah ; Bee See Goh ; Thean Yean Kew ; Zakaria Rozman
Malaysian Journal of Medical Sciences 2012;19(2):77-81
Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.
2.Paediatric cholesteatoma: Experience of Universiti Kebangsaan Malaysia Medical Centre
Bee See GOH ; Jian Woei TEOH ; Rahim FAIZAH ; Saim LOKMAN ; Abdullah ASMA
Brunei International Medical Journal 2012;8(2):71-77
Introduction: Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions. Materials and Methods: A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. Results: A total of 46 patients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female patients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid sinus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post-operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. Conclusion: Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may represent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence.
Cholesteatoma
;
Hearing Loss
;
Recurrence
3.The Prevalence of Sensorineural Hearing Loss in β-thalassaemia patient treated with Desferrioxamine
Kong Min Han ; Goh Bee See ; Hamidah Alias ; Zarina Abdul Latiff
The Medical Journal of Malaysia 2014;69(1):9-12
Objective: This study aimed to evaluate the prevalence of
sensorineural hearing loss (SNHL) in β-thalassaemia
patients treated with Desferrioxamine (DFO) and determine
the correlation of SNHL with average daily DFO dosage,
serum ferritin level and Therapeutic index (T.I).
Methods: This is a cross sectional descriptive study carried
out for a period of 14 months and 54 patients were recruited.
The recruited patients are transfusion dependant β-
thalassaemia patient aged 3 years and above treated with
DFO. An interview, clinical examination and hearing
assessment, which included tympanogram, and Pure Tone
Audiometry (PTA) or behaviour alaudiometry were performed.
The data on age started on DFO, average daily DFO, duration
of DFO intake, serum ferritin past 1 year and Therapeutic
Index (T.I) were obtained from patients’ case notes.
Results: The prevalence of SNHL was 57.4% and majority
has mild hearing loss (93.6%). Fourteen patients (25.9%)
have bilateral ear involvement and as many as 17 patients
(31.5%) have SNHL in either ear. A total of 23 patients (42.6%)
have normal hearing level. Although the prevalence of SNHL
was 57.4%, only a small percentage of the patient noticed
and complained of hearing loss (11.1%). There is no
association between age started on DFO, average daily DFO
and duration of DFO intake with normal hearing group and
those patients with SNHL. Positive correlation was seen
between average daily DFO with 2000 and 4000Hz on PTA in
the left ear and between serum ferritin level past 1 year with
4000 and 8000Hz in the right ear and 8000Hz in the left ear.
No significant correlation was seen between T.I on PTA.
Conclusion: The prevalence of SNHL from hearing
assessment is high in β-thalassaemia patients in this study.
However, it is manifested clinically in a smaller percentage.
We suggest a baseline hearing assessment should be
carried on all β-thalassaemia patients prior to DFO chelation
therapy.
4.Partial Cricotracheal Resection (PCTR), a RewardingOutcome for Paediatric Subglottic Stenosis : An Early Experience
Goh Bee See ; Roopesh Sankaran ; Marina Mat Baki, Abdullah Sani Mohamed
The Medical Journal of Malaysia 2014;69(1):13-15
This is a retrospective study examining the outcome of
paediatric patients with subglottic stenosis who underwent
partial cricotracheal resection (PCTR) as a primary open
procedure from 2004 to 2012. There were 5 patients
identified aged from 3 to 18 years old. All the subglottic
stenosis were acquired type. All of them were secondary to
prolonged intubation. Three patients were classified as
Myer-Cotton grade III and the other two were Myer-Cotton
grade IV. Two of the patients had concomitant bilateral vocal
cord immobility. All patients underwent two staged PCTR .
All patients underwent two staged PCTR, and one patient
underwent posterior cordectomy apart from partial CTR at
different setting. All patients were successfully
decannulated at various durations postoperatively.
Although this is an early experience in our institution, PCTR
has shown to be effective and safe procedure in patients
with subglottic stenosis especially those with Myer-Cotton
grade III and IV.
5.Mastoid Abscess in Acute and Chronic Otitis Media
Mazita Ami ; Zahirrudin Zakaria ; Goh Bee See ; Asma Abdullah ; Lokman Saim
Malaysian Journal of Medical Sciences 2010;17(4):44-50
Background: Mastoid abscess remains a recognised complication of otitis media despite
the advent of antibiotics. The objectives of this study were to describe the risk factors in patients
with mastoid abscess following acute and chronic otitis media and discuss the management of this
infection.
Method: A retrospective analysis was done on all patients who underwent mastoidectomy
for mastoid abscess from January 2002 to December 2007. Data on the patients’ presentation,
associated complications, management, and follow-up were analysed.
Results: A total of 12 patients were enrolled in this study population. Group A consisted of
patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients
with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid
immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group
B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial
complications, and 1 patient had intracranial complications. Most patients recovered well after
mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia.
Conclusion: Mastoid abscess is still a recognised complication of acute otitis media, especially
in patients who are immunocompromised. Immunocompetent patients may also develop mastoid
abscess following chronic otitis media associated with cholesteatoma. Thus, early treatment of otitis
media and close vigilant follow-up are advocated to ensure prompt detection of mastoid abscess
complications.
6.Multiple Metastatic Deposits in the Head and Neck Region from a Renal Cell Carcinoma
Azlan Iskandar Ishak ; Suria Hayati Md Pauzi ; Noraidah Masir ; Goh Bee See
Malaysian Journal of Medical Sciences 2010;17(4):71-74
Metastatic renal cell carcinoma (RCC) presenting with multiple deposits in the head and
neck region is unusual. It is not uncommon for a RCC to metastasise to a distant site after years of
a tumour-free period, but most of it would be expected to have a single site of deposit. We report a
rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours
in the frontal sinus and posterior pharyngeal wall. Radiological imaging and histology confirmed
metastatic RCC at both sites.
7.Inverted papilloma of nasal septum.
Philippine Journal of Otolaryngology Head and Neck Surgery 2012;27(2):39-40
Dear Editor,
Papillomas are primary benign epithelial neoplasms producing finger–like projections that typically cover fibrous stalks.1 The term Inverted Papilloma (IP) describes the endophytic projection of epithelium into the stroma. Also known as Schneiderian papillomas, IPs predominantly affect males in the 6th decade.2 They usually arise from the lateral nasal wall and seldom involve the frontal or sphenoid sinuses.2 The frequency of IP on the nasal septum is even less.3 We report a case of IP of the nasal septum and the role of endoscopic resection of the IP without any sign of recurrence.
Human
;
Male
;
Middle Aged
;
Nasal Septum
;
Papilloma, Inverted-surgery, treatment
;
nose
;
neoplasms
8.Middle ear carcinoma masquerading as an aural polyp.
Doh Jeing Yong ; Abd Majid Md Nasir ; Bee See Goh
Philippine Journal of Otolaryngology Head and Neck Surgery 2012;27(2):17-19
OBJECTIVE/strong: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology. br /br /strongMETHODS/strong:br /strongDesign/strong: Case Reportbr /strongSetting/strong: Tertiary Public Hospital br /strongPatient/strong: Onebr /br /strongRESULTS/strong: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.br /br /strongCONCLUSION/strong: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible./p
Human
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Female
;
Middle Aged
;
Ear, Middle
;
Carcinoma-diagnosis,radiotherapy
;
Treatment Outcome
;
polyps-diagnosis
;
Ear
;
Temporal Bone
;
earache
;
ear diseases
;
Tomography Scanners, X-Ray Computed
;
Biopsy
;
General Surgery
;
Radiotherapy
;
Otitis Media
9.A Toddler with Rhabdomyosarcoma Presenting as Acute Otitis Media with Mastoid Abscess.
Chinese Medical Journal 2016;129(10):1249-1250
Abscess
;
pathology
;
Acute Disease
;
Female
;
Humans
;
Infant
;
Mastoid
;
pathology
;
Otitis Media
;
diagnosis
;
Rhabdomyosarcoma
;
diagnosis