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Surgical approach of juvenile nasopharyngeal angiofibroma Marlinda Adham
Oto Rhino Laryngologica Indonesiana Vol 52, No 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.545

ABSTRACT Background: Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign tumor of blood vessels but clinically malignant, with distinctive growth patterns, and required various surgical approaches. The tumor arises from superior posterior sphenopalatine foramen with nasal obstruction and recurrent epistaxis symptoms. Purpose: To discuss the best surgical approach regarding the JNA stage. Case Report: A 13-year-old boy came complaining of recurrent unilateral epistaxis, unilateral nasal obstruction, and swelling of the right cheek. Tumor had expanded from nasopharynx to anterior maxillary region and intracranial. Clinical Question: Is open surgery with a lateral approach the best choice for clearing up the tumor mass and preventing recurrency in JNA which had expanded to anterior maxillary area and intracranial? Method: Literature search was conducted through PubMed, Clinical Key, Cochrane, and Google Scholar using keywords which were “juvenile nasopharyngeal angiofibroma”, “open surgery”, and “tumor recurrence”, obtained 71 papers which were screened using the inclusion and exclusion criteria. Result: The primary treatment for JNA is surgery, and the surgical approaches vary from anterior, lateral, and inferior. The literature search obtained one retrospective cohort study complied with this case, which reported 33 patients with JNA. Interventions on 25 patients with lateral surgical approaches and 8 patients with other approaches. There were 3 patients with lateral approach intervention and 2 patients with other approaches, had JNA tumor recurrence. Conclusion: The lateral approach is the best approach for clearing up the entire tumor mass and preventing recurrency in JNA cases with expansion to anterior maxillary region and intracranial. ABSTRAK Latar Belakang: Angiofibroma nasofaring belia (ANB) adalah tumor pembuluh darah yang secara histologis jinak tetapi klinis ganas, dengan pola pertumbuhan beragam dan membutuhkan teknik pendekatan pembedahan yang berbeda. Tumor berasal dari area superoposterior foramen sfenopalatina, mempunyai gejala klinik berupa sumbatan hidung dan epistaksis berulang. Tujuan: Menentukan tatalaksana pendekatan terbaik pembedahan ANB sesuai perluasan tumor. Laporan Kasus: Pasien laki-laki berusia 13 tahun dengan keluhan epistaksis berulang dari hidung kanan, hidung tersumbat, dan bengkak di daerah pipi kanan. Tumor sudah meluas ke nasofaring sampai ke intrakranial. Pertanyaan Klinis: Apakah pembedahan terbuka dengan pendekatan lateral merupakan pilihan terbaik untuk mengangkat seluruh massa tumor serta mencegah rekurensi, pada kasus ANB dengan perluasan ke area anterior maksila serta ke intrakranial? Metode: Pencarian literature menelusuri Pubmed, Clinical Key, Cochrane, dan Google Scholar menggunakan kata kunci “juvenile nasopharyngeal angiofibroma”, “open surgery”, dan “tumor recurrence” diperoleh 71 naskah yang selanjutnya disaring dengan kriteria inklusi dan eksklusi. Hasil: Terapi utama ANB adalah pembedahan dengan arah pendekatan yang bervariasi tergantung dari lokasi massa tumor, yaitu pendekatan dari anterior, lateral, atau inferior. Dari pencarian literatur diperoleh satu penelitian retrospektif yang melaporkan 33 kasus ANB, dimana 25 kasus dilakukan intervensi pendekatan lateral dan 8 pasien dengan cara pendekatan lainnya, dan didapati 3 kasus dengan pendekatan lateral dan 2 kasus dengan pendekatan lain mengalami rekurensi. Kesimpulan: Pembedahan dengan pendekatan lateral merupakan cara pendekatan terbaik untuk mengangkat massa tumor sebersih mungkin dan mencegah terjadinya rekurensi pada kasus ANB dengan perluasan ke anterior maksila serta ke intrakranial.

Current Outcome of Adjuvant Platinum-Based Chemotherapy for Nasopharyngeal Carcinoma: A Systematic Review Namira Kesuma Jelita; Marlinda Adham; Saffanah Zahra
INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA Vol. 2 No. 03 (2020): International Journal of Nasopharyngeal Carcinoma
Publisher : TALENTA PUBLISHER

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijnpc.v2i03.4301

Introduction: Indonesia are among the top 5 countries with highest prevalence of NPC with a meta-analysis from 2018 stating prevalence as high as 13.084 cases. According to the latest guideline published by National Comprehensive Cancer Network (NCCN) in 2018. The main treatment for NPC remain radiotherapy, chemotherapy, and surgery. Induction or adjuvant chemotherapy place in treatment are still uncertain because variety of results from multiple clinical trial. Discussion: This review evaluates the current outcome of patient undergoing chemoradiotherapy with or without adjuvant chemotherapy and its usage in nasopharyngeal carcinoma patient. Search on online databases are performed with keywords including “nasopharyngeal carcinoma”, “chemotherapy”, “adjuvant” and “outcome” along with their synonyms. Studies in English from 2014-2019 are included. Quality assessment were done with Newcastle Ottawa Scale for Cohort studies and with CEBM for Randomized Controlled Trial Studies. Risk of bias assessed using Cochrane Method. A total of 7 studies were included in the final review with 1 RCT and 6 Cohort study. Most study have no significance in overall survival, progressive disease or distant metastasis free time, but differ in high stage and high risk patient. Three studies included toxicity as an outcome with adjuvant toxicity outweigh the need to add another round of chemotherapy. Conclusion: Adjuvant chemotherapy is believed to be necessary in eliminating residual cancer cells but current studies shows little improvement in overall survival and sometimes unbearable toxicities.

Neck Residue of Nasopharyngeal Carcinoma (NPC): Timing of Diagnosis and Treatment Ferucha Moulanda; Marlinda Adham
INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA Vol. 3 No. 01 (2021): International Journal of Nasopharyngeal Carcinoma
Publisher : TALENTA PUBLISHER

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijnpc.v3i01.5585

Introduction: Prognosis of patients with NPC has improved but the risk of persistence regional of disease is still a critical problem. Timing of diagnosis the condition along with immediate yet appropriate treatment should be considered. Case report: Female 35 year-old diagnosed with NPC T2N3M0 and had finished neo-adjuvant chemotherapy (NAC) continued with chemoradiation (CRT) from July until December 2020. Clinical follow up on January 2021 showed palpable and fixated lymph node at level V of right neck sized 3x3x2.5 yet no mass identified at nasopharynx area. Patient was clinically diagnosed as neck residue of NPC and further management choices between early neck dissections or adjuvant chemotherapy (AdjCT) was still debatable in the multidisciplinary team discussion. Conclusion: Neck residue diagnosis for high risk features of NPC should be made early. Immediate appropriate treatment should be considered since its associated with prognosis and overall survival of NPC patient

Salivary Gland Dysfunction and Dysphagia in Post-Chemoradiotherapy Head and Neck Malignancy Patients Susyana Tamin; Marlinda Adham; Elvie Z. Rachmawati; Sabda Ardiantara; Eka D. Safitri
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Radiotherapy can potentially cause damage to the salivary gland, muscles, and nerve that is important to oropharyngeal swallow, leading to xerostomia and dysphagia. Reporting a case of radiotheraphy-induced xerostomia and dysphagia in HNC patients. A 34 years old man with NPC stage IV B (T4N3M0) came with difficulty swallowing, dryness in the throat and mouth, coughing while eating and drinking, choking, hoarseness, and pain when swallowing. The patient had done 14 times of radiation administration with a total dose of 60 Gy with conformal 3D radiation technique. The amount of saliva measured 0.02 ml/minute. A standing secretion was found in the vallecula, right and left piriformis and postkrioid sinuses in preswallowing assessment. The presence of penetration or aspiration of secretions into the airway were detected. The patient was diagnosed with neurogenic dysphagia and advised to use NGT for diet and consult medical rehabilitation. Literature searching was conducted on March 31, 2021 in the 3 journal database, including PubMed, Cochrane, and EBSCOhost, using particular keywords based on PICO. The inclusion criteria were full text article, observational studies, case-control, cohort, randomized controlled trial, systematic review, written in English, and studies investigating the correlation between HNC patient with radiotherapy and dysphagia or xerostomia. There were 3 systematic reviews, 1 cohort, and 2 cross-sectional studies investigating the correlation between chemoradiotherapy in head and neck cancer and xerostomia/dysphagia. Chemoradiotherapy correlated with dysphagia and xerostomia in head and neck cancer. Xerostomia and disfagia were prevalent in HNC patients after radiotherapy. Besides, there was association between the dose of radiotherapy and incidence or severity of xerostomia and dysphagia.

Role of Radiotherapy in Oncologic Emergency Sebastian, Andreas Ronald Barata; Jayalie, Vito Filbert; Hanifah, Rizka; Adham, Marlinda; Munandar, Arie
Oto Rhino Laryngologica Indonesiana Vol. 53 No. 1 (2023): VOLUME 53, NO. 1 JANUARY - JUNE 2023
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v53i1.505

Background: Oncologic emergencies often occur in patients who have metastases. This condition requires a prompt and accurate diagnosis. Radiotherapy (RT) plays a substantial role in palliative aspect with the aim of reducing tumor size, reducing symptoms, and improving quality of life. Purpose: To discuss the role of radiotherapy in an oncologic emergency. Literature review: The most common cases requiring radiation in emergency management are superior vena cava syndrome, acute airway obstruction, uncontrolled tumor bleeding, spinal cord compression due to malignancy, and brain metastases. The selection of radiation dose and techniques may vary, taking into consideration patient factors such as poor general condition, the likelihood of receiving curative treatment afterward, severe comorbidities, tumor factors such as histology of malignancy, whether it is a metastatic disease or not, therapeutic factors such as previous radiation history and response to previous systemic therapy. Conclusion: Radiotherapy plays a significant role in oncologic emergency, particularly to reduce symptoms and improve quality of life. Several considerations should be evaluated before determining the appropriate radiation treatment are patient factors, previous radiation therapy and response to previous systemic therapy.

Surgical approach of juvenile nasopharyngeal angiofibroma Adham, Marlinda
Oto Rhino Laryngologica Indonesiana Vol. 52 No. 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.545

ABSTRACT Background: Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign tumor of blood vessels but clinically malignant, with distinctive growth patterns, and required various surgical approaches. The tumor arises from superior posterior sphenopalatine foramen with nasal obstruction and recurrent epistaxis symptoms. Purpose: To discuss the best surgical approach regarding the JNA stage. Case Report: A 13-year-old boy came complaining of recurrent unilateral epistaxis, unilateral nasal obstruction, and swelling of the right cheek. Tumor had expanded from nasopharynx to anterior maxillary region and intracranial. Clinical Question: Is open surgery with a lateral approach the best choice for clearing up the tumor mass and preventing recurrency in JNA which had expanded to anterior maxillary area and intracranial? Method: Literature search was conducted through PubMed, Clinical Key, Cochrane, and Google Scholar using keywords which were “juvenile nasopharyngeal angiofibroma”, “open surgery”, and “tumor recurrence”, obtained 71 papers which were screened using the inclusion and exclusion criteria. Result: The primary treatment for JNA is surgery, and the surgical approaches vary from anterior, lateral, and inferior. The literature search obtained one retrospective cohort study complied with this case, which reported 33 patients with JNA. Interventions on 25 patients with lateral surgical approaches and 8 patients with other approaches. There were 3 patients with lateral approach intervention and 2 patients with other approaches, had JNA tumor recurrence. Conclusion: The lateral approach is the best approach for clearing up the entire tumor mass and preventing recurrency in JNA cases with expansion to anterior maxillary region and intracranial. ABSTRAK Latar Belakang: Angiofibroma nasofaring belia (ANB) adalah tumor pembuluh darah yang secara histologis jinak tetapi klinis ganas, dengan pola pertumbuhan beragam dan membutuhkan teknik pendekatan pembedahan yang berbeda. Tumor berasal dari area superoposterior foramen sfenopalatina, mempunyai gejala klinik berupa sumbatan hidung dan epistaksis berulang. Tujuan: Menentukan tatalaksana pendekatan terbaik pembedahan ANB sesuai perluasan tumor. Laporan Kasus: Pasien laki-laki berusia 13 tahun dengan keluhan epistaksis berulang dari hidung kanan, hidung tersumbat, dan bengkak di daerah pipi kanan. Tumor sudah meluas ke nasofaring sampai ke intrakranial. Pertanyaan Klinis: Apakah pembedahan terbuka dengan pendekatan lateral merupakan pilihan terbaik untuk mengangkat seluruh massa tumor serta mencegah rekurensi, pada kasus ANB dengan perluasan ke area anterior maksila serta ke intrakranial? Metode: Pencarian literature menelusuri Pubmed, Clinical Key, Cochrane, dan Google Scholar menggunakan kata kunci “juvenile nasopharyngeal angiofibroma”, “open surgery”, dan “tumor recurrence” diperoleh 71 naskah yang selanjutnya disaring dengan kriteria inklusi dan eksklusi. Hasil: Terapi utama ANB adalah pembedahan dengan arah pendekatan yang bervariasi tergantung dari lokasi massa tumor, yaitu pendekatan dari anterior, lateral, atau inferior. Dari pencarian literatur diperoleh satu penelitian retrospektif yang melaporkan 33 kasus ANB, dimana 25 kasus dilakukan intervensi pendekatan lateral dan 8 pasien dengan cara pendekatan lainnya, dan didapati 3 kasus dengan pendekatan lateral dan 2 kasus dengan pendekatan lain mengalami rekurensi. Kesimpulan: Pembedahan dengan pendekatan lateral merupakan cara pendekatan terbaik untuk mengangkat massa tumor sebersih mungkin dan mencegah terjadinya rekurensi pada kasus ANB dengan perluasan ke anterior maksila serta ke intrakranial.

Peran radioterapi lokoregional pada kasus karsinoma nasofaring dengan metastasis jauh: laporan serial kasus berbasis bukti Mayangsari, Ika Dewi; Rahman, Muhammad Ade; Adham, Marlinda; Prajogi, Gregorius Ben; Cahyanur, Rahmat; Safitri, Eka Dian
Oto Rhino Laryngologica Indonesiana Vol. 53 No. 2 (2023): VOLUME 53, NO. 2 JULY - DECEMBER 2023
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v53i2.638

Background: Nasopharyngeal carcinoma (NPC) is a highly metastatic head and neck cancer primarilytreated with platinum-based chemotherapy. The oligometastasis hypothesis proposed by Hellman andWeichselbaum suggested that controlling the primary tumor through locoregional radiotherapy couldsignificantly improve prolonged disease-free survival. Purpose: To evaluate the effectiveness of combining locoregional radiotherapy with chemotherapy for metastatic NPC. Case series report: The first case involved a 57-year-old male with NPC at T4N3M1 (lungs) with partial response to chemotherapy, who then underwent concurrent chemoradiotherapy. However, his condition deteriorated after completing chemoradiation. The second case featured a 56-year-old male with NPC at T4N3M1 (liver), exhibiting partial response to chemotherapy and remaining at a stable condition after concurrent chemoradiotherapy. Method: Using specific keywords based on clinical questions in the PubMed, Cochrane, EBSCOhost, and Proquest databases. Inclusion criteria, exclusion criteria, and critical appraisal were carried out to find relevant studies. Result: Eleven articles were appraised critically based on the Oxford Centre for Evidence-based Medicine (CEBM) worksheet and include the validity, importance, and applicability in clinical scenarios. Conclusion: Metastatic NPC patients had better overall survival outcomes when treated with locoregional radiotherapy and systemic chemotherapy. Predictive factors influencing survival included oligometastasis, locoregional radiotherapy, chemotherapy response, lactate dehydrogenase, C-reactive protein, EBV DNA, total chemotherapy administration, Karnofsky performance score, number of metastatic lesions, and liver metastases. Platinum-based chemotherapy combined with locoregional radiotherapy could be considered as a management approach for cases of oligometastatic NPC.Keywords: nasopharyngeal carcinoma, chemotherapy, metastasis, overall survival, radiotherapy

Penggunaan Steroid Sebagai Pengobatan Preventif untuk Transient Facial Nerve Palsy pada Parotidektomi Adham, Marlinda; Sellina Windri; Ibrahim Agung
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.647

Background and Objective: One of the most reported complication of parotidectomy or other parotid surgery is facial nerve palsy. Steroids such as glucocorticoid have been known to help preserve nerve damage. But there’s lack of evidence that shows the use of steroids to help nerve recovery. So authors are determined to find the association between steroid intervention in parotidectomy patients to prevent or to help accelerate recovery rate in facial nerve palsy cases. Methods: This evidence-based case report used the PICO method for literature search in two databases (Ovid and PubMed). After selecting the article using inclusion and exclusion criteria, the author appraised the article using the Center of Evidence Based Medicine (CEBM) Oxford Appraisal Tools. Results: In total of 2 articles we found, we include all of them for analysis. Both of the articles shows that there’s no correlation between giving steroids to post-parotidectomy patients and faster recovery rate. In contrary, one study shows that placebo-treated groups had a faster facial nerve function recovery rate than steroid-treated patients. Conclusion: Giving steroids to post-parotidectomy patient won’t help accelerate the facial nerve function recovery rate. Prevention of facial nerve palsy in parotidectomy was preferred as treatment.

Peran radioterapi lokoregional pada kasus karsinoma nasofaring dengan metastasis jauh: laporan serial kasus berbasis bukti Mayangsari, Ika Dewi; Rahman, Muhammad Ade; Adham, Marlinda; Prajogi, Gregorius Ben; Cahyanur, Rahmat; Safitri, Eka Dian
Oto Rhino Laryngologica Indonesiana Vol. 53 No. 2 (2023): VOLUME 53, NO. 2 JULY - DECEMBER 2023
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v53i2.638

Background: Nasopharyngeal carcinoma (NPC) is a highly metastatic head and neck cancer primarilytreated with platinum-based chemotherapy. The oligometastasis hypothesis proposed by Hellman andWeichselbaum suggested that controlling the primary tumor through locoregional radiotherapy couldsignificantly improve prolonged disease-free survival. Purpose: To evaluate the effectiveness of combining locoregional radiotherapy with chemotherapy for metastatic NPC. Case series report: The first case involved a 57-year-old male with NPC at T4N3M1 (lungs) with partial response to chemotherapy, who then underwent concurrent chemoradiotherapy. However, his condition deteriorated after completing chemoradiation. The second case featured a 56-year-old male with NPC at T4N3M1 (liver), exhibiting partial response to chemotherapy and remaining at a stable condition after concurrent chemoradiotherapy. Method: Using specific keywords based on clinical questions in the PubMed, Cochrane, EBSCOhost, and Proquest databases. Inclusion criteria, exclusion criteria, and critical appraisal were carried out to find relevant studies. Result: Eleven articles were appraised critically based on the Oxford Centre for Evidence-based Medicine (CEBM) worksheet and include the validity, importance, and applicability in clinical scenarios. Conclusion: Metastatic NPC patients had better overall survival outcomes when treated with locoregional radiotherapy and systemic chemotherapy. Predictive factors influencing survival included oligometastasis, locoregional radiotherapy, chemotherapy response, lactate dehydrogenase, C-reactive protein, EBV DNA, total chemotherapy administration, Karnofsky performance score, number of metastatic lesions, and liver metastases. Platinum-based chemotherapy combined with locoregional radiotherapy could be considered as a management approach for cases of oligometastatic NPC.Keywords: nasopharyngeal carcinoma, chemotherapy, metastasis, overall survival, radiotherapy

Penggunaan Steroid Sebagai Pengobatan Preventif untuk Transient Facial Nerve Palsy pada Parotidektomi Adham, Marlinda; Windri, Sellina; Agung, Ibrahim
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.647

Background and Objective: One of the most reported complication of parotidectomy or other parotid surgery is facial nerve palsy. Steroids such as glucocorticoid have been known to help preserve nerve damage. But there’s lack of evidence that shows the use of steroids to help nerve recovery. So authors are determined to find the association between steroid intervention in parotidectomy patients to prevent or to help accelerate recovery rate in facial nerve palsy cases. Methods: This evidence-based case report used the PICO method for literature search in two databases (Ovid and PubMed). After selecting the article using inclusion and exclusion criteria, the author appraised the article using the Center of Evidence Based Medicine (CEBM) Oxford Appraisal Tools. Results: In total of 2 articles we found, we include all of them for analysis. Both of the articles shows that there’s no correlation between giving steroids to post-parotidectomy patients and faster recovery rate. In contrary, one study shows that placebo-treated groups had a faster facial nerve function recovery rate than steroid-treated patients. Conclusion: Giving steroids to post-parotidectomy patient won’t help accelerate the facial nerve function recovery rate. Prevention of facial nerve palsy in parotidectomy was preferred as treatment.

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