Assessment of soft tissue facial profile, nasal airway morphology and dental arch features in adult malay obstructive sleep apnea patients using geometric morphometric analysis

a serious public health problem. The objectives of this study were to localize and quantify the differences in facial soft tissue profile, nasal airway morphology and dental arch features in adults Malay with and without OSA using geometric morphometric analysis. One hundred and twenty adult Malays aged 18-65 years (mean± SD, 33.2 ± 13.31) were divided into two groups of 60. Both OSA and control groups undergone clinical examination and limited channel polysomnography. Only 108 subjects (54 in each group) were able to complete facial soft tissue imaging, acoustic rhinometry (AR) measurements, and upper and lower dental impression. Nine facial soft tissue and 25 upper and lower study models homologous landmarks were digitized using MorphoStudio software to obtain the x, y, z coordinates. The minimal cross section l(MCAl) and minimal cross sectional2 (MCA2) were also obtained from AR. The mean OSA and control were computed, and subjected to t-test and geometric morphometric analysis. The mean body mass index was found to be significantly greater for the OSA group (33.2kg/m2 ± 6.5) when compared to the control group (22.7 kg/m2 ± 3.5 p < 0.001). The mean neck size was also greater for the OSA group (43.6cm ± 6.02) compared to the control group (22.7cm ± 3.52, p < 0.001). Using geometric morphometric analysis, significant differences were found in facial soft tissue profile between the two groups. These differences were localized in the bucco-submandibular regions of the face predominantly, with inter-landmark distances indicating an increase in size of7-22% in OSA groups (p < 0.05). For nasal airway morphology, the mean MCA1 and MCA2 on the AR graph were found to be significantly smaller in the OSA group than control group (p < 0.001). Using geometric morphometric analysis on AR data, significant differences were found in nasal airway morphology between the two groups . Specifically, the mean nasal airway were significantly narrower in OSA groups with decreased in size ("'10-22%) appears in nasal valve I head of inferior turbinate area predominantly. For dental arch features, the mean upper and lower OSA dental arch morphologies were significantly narrower in widths with an increase in upper and lower dental arch length when compared with control subjects (p < 0.05). Specifically, the mean OSA configuration of the upper arch was 7-11% narrower in the transverse plane in the incisor and canine regions compared to the control configuration, and inter-landmark analysis confi1med this finding. For the lower arch, the mean OSA configuration was lOll% narrower in the premolar and molar regions. In conclusion, there were clearly definable differences in the facial soft tissues profile, nasal airway morphology and dental arch features when comparing patients with OSA to controls, with obesity acting as an additional risk factor in this particular group of Malay patients. These differences need to be recognized since they can improve our understanding of etiological basis of OSA disorder, facilitate the limited availability of diagnostic setup, and provide valuable screening information in the identification of patients with undiagnosed OS A

XIII Asean ORLand Head & Neck Congress Siem Reap, Komboja 18-20 November 2009

Subglottic stenosrs maybe congenital or acquired. Both have typical characteristics and presentations. Despite great advances have been made in the surgrcal techniques, the management of paedratnc subglottic stenosis remains challenging for the otolaryngologist Often the operation is very much tarlored to the needs of the individual patrents. In addition, the surgeon managing the problem must be fully trained in paediatric airway endoscopy and laryngotracheal surgery as inappropriate inrtral management may lead to permanent rntractable sequelae The management rnclude the hrstory of stridor, medrcal history, assessment of seventy of stridor, assessment of the arrway, appropriate treatment and posl-operatrve management The presentation will hrghlrght some of the lessons learned dunng the learnrng curve in the management of paediatnc subglottic stenosis rn Universiti Sains Malaysi

Paediatric laryngotracheal Cases: Universiti Sains Malaysia Experience

There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and differ widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anaesthetist and paediatrician. During the past five years great advances have been made in managing paediatric airway cases in the Department of Otorhinolaryngology-Head & Neck Surgery at Universiti Sains Malaysia. The paediatric laryngotracheal cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 are presented. More than 80 cases have been reviewed. The most commonly presenting symptom was stridor. Other reasons for referral were laryngotracheal stenosis, foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Interventions were varied and tailored to each problem. The management include observation, medical treatment, closed (encdoscopic) techniques and open surgery

Genotoxicity study of sea coral used as bone replacement material

Most of the methods available today to detect carcinogens and mutagens are based upon the principle that genotoxicity/mutagenicity may serve as an indicator of carcinogenic potential.This in vitro study was made to evaluate the genotoxicity characteristic of coral of Porites sp. produced by the National Tissue Bank, Universiti Sains Malaysia (USM), by using the Bacterial Reverse Mutation Assay test or Ames test.The Bacterial Reverse Mutation Assay of the coral material was performed on Salmonella typhimurium strains TA98, TAIOO, TA1535, TA1537 and Escherichia coli strain WP2 uvr A using the preincubation method in the presence and absence of an exogenous metabolic activation system. The results showed the numbers of revertant colonies of all strains which -were treated with the test substance were less than twice that of each negative control with and without S9 Mix.In conclusion the results of the tests showed that the coral material was considered to have no reverse mutagenic potential under the present test condition

Imaging Profile of the Ear in Hearing Loss Patients in Hospital Universiti Sains Malaysia: 5 year Cross Sectional Analysis at a Tertiary Otologic Centre

BACKGROUND: Hearing impairment is a major disability. The otologic assessment together with high-resolution CT images is an important step to obtain precise diagnostic profile of ear malformations. This study was conducted to obtain the detailed anatomy and objective assessment of the ear in patients presenting with hearing loss in a tertiary care otologic center using high-resolution CT scan. METHODS: A cross-sectional study of 55 patients with hearing loss who had undergone high-resolution CT scans at Hospital Universiti Sains Malaysia from 1st January 2008 until 31st May 2014. Patients with temporal bone fractures, malignancy, post-operative ear and cholesteatoma were excluded. RESULTS: Nine patients noted to have external ear anomaly on right ear and 7 patients on left ear. Middle ear abnormality in both ears was seen in 2 patients. Patients noted to have cochlear anomaly on the right ear (R) were 8 and left ear (L) were 4. Measurements of vestibular aqueduct diameter were 0.08 ± 0.09 cm (R) and 0.06 ± 0.04 cm (L), lateral semicircular canal diameter 0.10 ± 0.03 cm (R) and 0.10 ± 0.02 cm (L), vestibule diameter 0.30 ± 0.06 cm (R) and 0.31 ± 0.05 cm (L), bone width between the lateral vestibular wall and the inner wall of the lateral semicircular canal diameter 0.35 ± 0.07 cm (R) and (L) and internal acoustic meatus diameter 0.40 ± 0.08 cm (R) and 0.41 ± 0.08 cm (L). One patient had cochlear aplasia and common cavity deformity, 2 patients had lateral semicircular dehiscence and internal acoustic meatus stenosis, 4 patients had cochlear ossification and 5 patients were noted to have enlarged vestibular aqueduct. CONCLUSION: High-resolution CT scan image is a good single imaging modality to obtain an objective measurement of the ear as well as to detect subtle or underestimated ear anomalie

A Study of Single Nucleotide Polymorphisms of Tumour Necrosis Factor α-1031 And Tumour Necrosis Factor β+ 252 in Chronic Rhinosinusitis

Objectives This case-controlled study aimed to identify the association of tumor necrosis factor (TNF)α-1031 and TNFβ+ 252 gene polymorphisms between chronic rhinosinusitis (CRS) and healthy controls. Another purpose of this study was to investigate the associations of these gene polymorphisms with factors related to CRS. Methods All deoxyribonucleic acid (DNA) samples were genotyped for TNFα-1031 and TNFβ+252 genes by mean of polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP). The statistical analysis were carried out using chi-square test or Fisher exact test to determine the associations of these gene polymorphisms in CRS. Multiple logistic regression was performed to evaluate the associations of these gene polymorphisms in CRS and its related risk factors. Results The genotype and allele frequencies of TNFα-1031 and TNFβ+252 gene did not show any significant associations between CRS and healthy controls. However, a significantly statistical difference of TNFα-1031 was observed in CRS participants with atopy (P-value, 0.045; odds ratio, 3.66) but not in CRS with asthma or aspirin intolerance. Conclusion Although the presence of TNFα-1031 and TNFβ+252 gene polymorphisms did not render any significant associations between CRS and healthy control, this study suggests that TNFα-1031 gene polymorphisms in CRS patients with atopy may be associated with increase susceptibility towards CRS

A Rare Manifestation of Cervical Yolk Sac Tumor in an Unfortunate Infant

Paediatric germ cell tumor is composed of various neoplasms which exhibit capricious clinical presentation and histological features depending on the age and the area of presentation. Yolk sac tumor is an extremely rare malignant tumor of embryonic origin which usually arises from the gonads. Its manifestation in the head and neck region is extremely rare. Here, we report a rare case of the malignant transformation of mature teratoma into yolk sac tumor of the neck in an infant. Diagnosis was confirmed following histopathological examination of the neck mass along with marked increase of the serum alpha-fetoprotein. The child unfortunately succumbed prior to chemotherapy. We highlight the challenge we faced in diagnosing and managing this rare entity. We would also like to recommend serial monitoring of serum alpha-fetoprotein in all patients with mature teratoma to detect malignant transformation early

Amniotic membrane enhance the effect of vascular endothelial growth factor on the angiogenic marker expression of stem cells from human exfoliated deciduous teeth

Previously, it was reported that human amniotic membrane (AM) induced stem cells from human deciduous exfoliated teeth (SHED) endothelial-like-cell differentiation. This interesting effect of AM matrix on SHED demands further elucidation. Objective of this in vitro work was to study the effect of 24-h VEGF induced on SHED endothelial differentiation when seeded on acellular stromal side (SS) of AM matrix. Stemness of SHED was identified by flow cytometry. Cell attachment and morphological changes towards the matrix was observed by scanning electron microscopy. Protein expression of endothelial marker was examined by Western blot. The expression of stem cells and endothelial-specific gene markers of VEGF-induced SHED cultured on human AM was inspected via reverse transcriptase-polymerase chain reaction. Results showed SHED at both passages retain stemness property. Ang-1 protein was expressed in SHED. Cells treated with VEGF and cultured on AM transformed attached well to AM. VEGF induced SHED expressed both stem cell and endothelial-specific markers throughout the treatments and timeline. Interestingly, prolonged VEGF treatment increased the expression of Cox-2 and VE-Cadherin genes in all treated groups when compared to SHED. It was concluded that the VEGF-induced SHED showed better expression of endothelial-specific markers when cultured on SS of AM, with prolonged VEGF treatment

Paediatric airway reconstruction: a preliminary study

To set the foundation for developing a centre for airway reconstruction, we performed a retrospective database review of patients operated at a tertiary-care university hospital. Over the past 3-year period from 2004 onwards, five paediatric cases of airway reconstruction procedures were performed. All cases had a two stages laryngotracheal reconstruction (TSLTR) for laryngotracheal stenosis (LTS). All patients were children below 15 years and the mean age was 9 years. Only one patient had a Grade IV Myer-Cotton1 stenosis, the rest all had Grade III stenosis. Three out of four of the Grade III stenosis patients were successfully decannulated within one year, the other one died of causes unrelated to LTS. The grade IV patient was still under follow up and surgery was done only recently. This paper highlights the complexity of managing LTS in the paediatric age group and recommends the use of LTR with rib graft as a choice for the management of LTS