Summary Cutaneous serratia marcescens (S. marcescens) infection is very rare and most cases had history of skin trauma or cutaneous procedure done before. It presents in various forms like non-healing ulcers, abscess formation, nodules with an intermittent course or as granulomatous lesions, thus mimicking non-infective lesions. Antibiotic choice is challenging due to multiple antibiotic resistant strains. We are reporting a case of cutaneous S. marcescens in a 70-year old lady with diabetes mellitus presented with non-healing ulcers over the dorsum of left hand for 6 months.
Serratia marcescens ; Dermatomycoses

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication. KEY WORDS: Microtia; canal atresia; cochleovestibular nerve aplasia; inner ear anomaly
Congenital Microtia

Laryngospasm is a serious event that can result in partial or complete upper airway obstruction. It is a common complication during recovery phase of anaesthesia, resulting from acute irritation of the vocal folds. We report a rare case of laryngospasm secondary to a multinodular goitre that settled after treatment. We postulate that the enlarged thyroid gland can lead to direct irritation of the laryngeal nerve as possible cause of repeated episodes of laryngospasm in this patient. To our knowledge, this is the first reported case of a multinodular goitre as the underlying cause of laryngospasm.
Airway Obstruction ; Laryngismus ; Goitre, Nodular

Objective: To describe our experience in managing two cases of primary malignant parotid lymphoma. Methods: Design: Case Report Setting: Tertiary University Referral Center Patients: Two Results: Both patients underwent superficial parotidectomy. Despite recurrence in one, the disease was controlled with conservative management. However, the disease was more aggressive in the other, requiring additional chemo-radiotherapy. Conclusion Malignant parotid lymphoma may present with varying stages, grades and clinical courses, requiring different management approaches. The treatment options are based on grading and staging at diagnosis and should be implemented depending on individual case.
Parotid Neoplasms ; Lymphoma

Synovial sarcoma is a rare soft tissue sarcoma of the head and neck region involving the parapharyngeal space. The diagnosis of synovial sarcoma can be very challenging to the pathologists. We present a rare case of parapharyngeal synovial sarcoma in a young female patient who had a two-month history of left cervical intumescent mass at level II. The fine needle aspiration cytology of the mass was proved inconclusive. Transcervical excision of the mass was performed and the first case of parapharyngeal sarcoma was identified in our center by fluorescence in situ hybridization (FISH) technique. Repeat imaging revealed residual tumor. The patient successfully underwent a second excision of the residual tumor and received adjuvant radiotherapy.
Adult ; Biopsy, Fine-Needle ; Combined Modality Therapy ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Neoplasm, Residual ; Pharyngeal Neoplasms ; diagnosis ; pathology ; radiotherapy ; surgery ; Radiotherapy, Adjuvant ; Sarcoma, Synovial ; diagnosis ; pathology ; radiotherapy ; surgery ; Tomography, X-Ray Computed

There are three types of papilloma which arises from the Schneiderian membrane namely inverted, fungiform and oncocytic. Oncocytic papilloma is the rarest type and occurs predominantly in the older age group. Clinically, its behaviour is similar to inverted papilloma in having both local recurrence and associated malignancy. We report a rare case of oncocytic papilloma arising from the maxillary sinus, extending into the nasal cavity and nasopharynx, in a 78-year-old lady. Despite the longstanding history there was no evidence of associated malignancy in this lesion. An endoscopic medial maxillectomy was successfully utilized for approach and complete tumour excision. In conclusion, oncocytic papilloma should be considered as a differential diagnosis in patients presenting with unilateral polypoid nasal lesions especially in the elderly. In addition, endoscopic medial maxillectomy can provide an adequate approach for complete tumour removal.

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

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.

p style=text-align: justify;strongOBJECTIVE:/strong To describe our experience in performing the lower cheek flap for access to the infratemporal fossa combined with the neurosurgical approach. br /br /strongMETHODS:/strongbr /strongDesign:/strong Case report br /strongSetting:/strong Tertiary Referral Center br /strongPatients:/strong Two br /br /strongRESULTS:/strong Two unusual tumours involving the infratemporal and middle cranial fossa were excised using this combined appoach. The infratemporal fossa tumour was accessed via the lower cheek flap while the intracranial portion was resected from above via craniotomy.br /br /strongCONCLUSION:/strong The lower cheek flap in combination with the neurosurgical approach allows optimal exposure to tumours involving the infratemporal and middle cranial fossae. It has less complications and better aesthetic outcome compared to other approaches./p
Human ; Male ; Female ; Surgical Flaps ; Surgically-Created Structures ; Cheek ; Neoplasms ; Neurosurgical Procedures ; Cranial Fossa, Middle ; Infratentorial Neoplasms

This was a retrospective study of operative records between 2000 – 2007 from two ear, nose and throat (ENT) referral centers in Malaysia to review demographic patterns, clinical presentations and management of retropharyngeal abscess (RPA). Our case series comprised of eight patients with five females and three males with a median age at presentation of 47 years. Comorbid factor in this series was diabetes mellitus, with four patients having diabetes. There were three cases of fish bone ingestion. The commonest presentation was dysphagia or odynophagia. None of them had fever. All patients were treated with broad spectrum intravenous antibiotics (IV) and drainage was performed for the abscess. Four patients underwent transoral drainage with three having the cervical approach and one having spontaneous rupture. All patients recovered well from the infection and only one patient passed away due to septicaemia. In conclusion, patients with retropharyngeal abscess may present with vague symptoms of sore throat, odynophagia without fever due to partial antibiotics treatment. A correct diagnosis should be made so that adequate treatment can be given to prevent mortality.