1.Septal turbinates: An entity with physiological importance.
Mawaddah AZMAN ; Balwant Singh GENDEH
Brunei International Medical Journal 2011;7(3):168-172
Septal turbinate refers to a widened region of the septum located superior to the inferior turbinates and anterior to the middle turbinates. Although a common anatomical variant, its significance is not well reported. We report a 56-year-old Malay man who presented with a three year history of chronic nasal obstruction secondary to septal turbinate and type II deviated nasal septum. His nasal symptoms improved dramatically following commencement of intranasal steroids. He remained free of symptoms during seven years of follow up. The physiologic implication and management of septal turbinates is discussed.
2.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.
3.A Ten-Year Kuala Lumpur Review on Laser Posterior Cordectomy for Bilateral Vocal Fold Immobility
Azman Mawaddah ; Mat Baki Marina ; Sawali Halimuddin ; Mohd Yunus Mohd Razif ; Sani Abdullah
Malaysian Journal of Medical Sciences 2016;23(4):65-70
Bilateral vocal fold immobility (BVFI) is commonly caused by injury to the recurrent
laryngeal nerve (RLN) and leads to stridor and dyspnea of varying onsets. A retrospective study
was done at the Department of Otorhinolaryngology of Universiti Kebangsaan Malaysia Medical
Centre on laser microsurgical posterior cordectomy for BVFI. The objectives were to identify
the average duration of onset of stridor from the time of insult and to evaluate the outcome of
laser posterior cordectomy as a surgical option. From 1997 to 2007, a total of 31 patients with
BVFI were referred for surgery. Twelve patients had tracheostomy done prior to the procedure,
whereas 19 patients were without tracheostomy. Ten patients were successfully decannulated,
and only 4 patients had complications related to the procedure. The minimum onset of stridor
was 7 months, maximum onset of stridor was 28 years, and the mean onset of stridor was 8.7
years. The commonest complication observed was posterior glottic adhesion following bilateral
posterior cordectomy. Laser endolaryngeal posterior cordectomy is an excellent surgical option
as it enables successful decannulation or avoidance of tracheostomy in patients with BVFI. The
onset of stridor took years after the insult to the recurrent laryngeal nerves.
4.Upper respiratory tract sampling in COVID-19
The Malaysian Journal of Pathology 2020;42(1):23-35
Introduction: To review the present literature on upper respiratory tract sampling in COVID-19 and provide recommendations to improve healthcare practices and directions in future studies. Methods: Twelve relevant manuscripts were sourced from a total of 7288 search results obtained using PubMed, Medline and Google Scholar. The search keywords used were COVID-19, nasopharyngeal, oropharyngeal, swabs, SARS and CoV2. Original manuscripts were obtained and analysed by all authors. The review included manuscripts which have not undergone rigorous peer-review process in view of the magnitude of the topic discussed. Results: The viral load of SARS-CoV-2 RNA in the upper respiratory tract was significantly higher during the first week and peaked at 4-6 days after onset of symptoms, during which it can be potentially sampled. Nasopharyngeal swab has demonstrated higher viral load than oropharyngeal swab, where the difference in paired samples is best seen at 0-9 days after the onset of illness. Sensitivity of nasopharyngeal swab was higher than oropharyngeal swabs in COVID-19 patients. Patient self-collected throat washing has been shown to contain higher viral load than nasopharyngeal or oropharyngeal swab, with significantly higher sensitivity when compared with paired nasopharyngeal swab. Recommendations: Routine nasopharyngeal swab of suspected COVID-19 infection should take anatomy of the nasal cavity into consideration to increase patient comfort and diagnostic yield. Routine oropharyngeal swab should be replaced by throat washing which has demonstrated better diagnostic accuracy, and it is safe towards others.
5.Extramedullary plasmacytoma of the nasopharynx: A rare tumour with 7-year follow up
Mawaddah Azman ; Balwant Singh Gendeh ; Siti Aishah Mat Ali
Philippine Journal of Otolaryngology Head and Neck Surgery 2011;26(1):27-30
Objective:
To report a case of extramedullary plasmacytoma, a rare localized tumour involving the head and neck region in a 56-year -old gentleman.
Methods:
Design: Case Report
Setting: Tertiary University Referral Center
Patient: One
Result:
The patient presented with a 5-month history of right-sided nasal obstruction and intermittent epistaxis in 2003. Nasal endoscopy revealed a friable, dark red mass arising from the roof of the nasopharynx, occluding the right choana. No invasion of adjacent tissues or cervical lymphadenopathy was evident. A biopsy of the mass was diagnosed as plasmacytoma. Serum and urine electrophoresis failed to detect any monoclonal bands. All other screening tests to rule out multiple myeloma were negative. These findings confirmed the diagnosis of extramedullary plasmacytoma. He recieved radiotherapy to the nasopharynx of 50 Gy for a total of 23 fractions. No recurrence was noted at 7-year follow-up.
Conclusion
Extramedullary plasmacytoma of the nasopharynx represents a tumour with good prognosis but requires long term follow up in anticipation of local recurrence and progression to Multiple Myeloma.
Plasmacytoma
;
Nasopharynx
6.Salvage Mandibulectomy in an Octogenarian with Recurrent Oral Cavity Squamous Cell Carcinoma: A Case Report
Mawaddah Azman ; Mohd Razif Mohamad Yunus ; Mohd Shawal Firdaus Mohamad
Archives of Orofacial Sciences 2023;18(no.1):43-49
Oral squamous cell carcinoma (OSCC) is the commonest malignant tumour affecting the oral cavity with
a poor 5-year disease free survival. We present an octogenarian with a recurrent oral cavity squamous
cell carcinoma, treated with salvage mandibulectomy without bony reconstruction. No immediate or
intermediate perioperative complications were documented. Subsequent monthly surveillance clinical
examination, endoscopy and computed tomography at six months post-operative showed no evidence
of residual tumour. Geriatric syndrome, perioperative risk and oncologic stratification are three main
cornerstones in evaluating feasibility of oncologic surgery in an elderly patient. A multidisciplinary
approach allowed surgical extirpation of OSCC with a good outcome
7.Facial Palsy with Tongue Ulcer: A Rare Initial Presentation of Granulomatosis with Polyangiitis
Ain Nabila Za&rsquo ; im Nur ; Mohd Shawal Firdaus Mohamad ; Noor Afidah Abdullah ; Geok Chin Tan ; Azman Mawaddah
Archives of Orofacial Sciences 2022;17(1):151-156
ABSTRACT
Granulomatosis with polyangiitis (GPA) is a rare multisystem disease. Although GPA is rare, it
commonly presents in a localised stage where its manifestation involves the upper or lower respiratory
tract before progressing to a generalised stage. Therefore, most patients with GPA will visit an oral
surgeon or an otolaryngologist to seek treatment. However, the diagnosis of GPA is often delayed as
GPA is not frequently considered as a differential diagnosis in common oral and facial diseases. The lack
of gold standard investigation for the diagnosis of GPA makes management of this case, a diagnostic
conundrum. We herein report a patient who was diagnosed with bilateral acute otitis media and left
mastoiditis complicated with facial nerve palsy, and later developed tongue ulceration one month after
his initial presentation. The ear, facial and oral symptoms represent a diagnostic red herring to a full-blown generalised stage of GPA.
Facial Paralysis
;
Oral Ulcer
;
Granulomatosis with Polyangiitis