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

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

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.

Introduction: Obesity has been demonstrated to induce oxidative stress and inflammation processes that lead to senescence. Obesity-induced cellular senescence in the brain is still widely investigated. This study aimed to investigate the expression of senescence markers in the frontal lobes of obese rats. Methods: Three groups of rats: control, Obese-2 (Ob-2), and Obese-4 (Ob-4) were observed. Control rats were fed with a standard diet for one month. In contrast, Ob-2 and Ob-4 rats were fed with a high-fat diet daily for two and four months, respectively. After being sacrificed, the rats’ brains were dissected out then the frontal lobes were used for RNA extraction. Reverse transcriptase PCR of p-16, p-21, and beta-actin was performed to investigate the relative expression of the senescence markers. Results: Ob-2 and Ob-4 groups had significantly increased body weight after being fed with a high-fat diet for two and four months, respectively. The mRNA expressions of p-16 and p-21 in the frontal lobes of three groups showed similar patterns. The ob-4 group had the highest mRNA expressions of both p-16 and p-21. In comparison to control and Ob-2 groups, the mRNA expressions of p-16 and p-21 were markedly increased. Furthermore, the mRNA expressions of p-16 and p-21 between control and Ob-2 groups were comparable. Conclusion: Increased senescence markers in the rats’ frontal lobes were observed as the chronic effect of obesity.

Introduction: Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods: This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p>0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the combination total intravenous anaesthesia and apneic pause technique with or without steroid injection. Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and after dilatation, number of dilatation were observed and compared. The outcome measures are decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for the narrowed airway.

We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.
Orbital Cellulitis

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.
Tracheostomy

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.

The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods: Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord palsy at our institution and medical records were retrospectively reviewed. Results: There were 18 males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration which would otherwise be disabling for the patients.