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Non-Keratinizing Sinonasal Squamous Cell Carcinoma Extending to the Skull Base: Surgical Management with Total Maxillectomy - A Case Study Anak Agung Wira Ryantama; Eka Putra Setiawan; Wayan Lolik Lesmana; Agus Rudi Asthuta; Komang Andi Dwi Saputra; Luh Sartika Sari
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.745

Sinonasal squamous cell carcinoma (SNSCC) is an uncommon malignancy arising within the nasal cavity and paranasal sinuses, representing approximately 3% of head and neck cancers. The non-keratinizing subtype (NKSCC) presents unique diagnostic and therapeutic challenges, particularly when exhibiting locally advanced disease with extension towards critical structures like the skull base. Management typically involves a multimodal approach centered around surgical resection, often followed by adjuvant therapy. We present the case of a 51-year-old female, employed in the wood furniture industry, presenting with a progressively enlarging right nasal mass initially noted four years after removal of a right cheek lesion. Symptoms included unilateral nasal obstruction, epistaxis, anosmia, and loosening of maxillary teeth. Clinical examination revealed a large, friable mass obliterating the right nasal cavity and extending onto the palate. Computed tomography confirmed an extensive destructive mass involving the right nasal cavity, maxillary sinus, ethmoid sinus, extending to the nasopharynx, parapharyngeal space, masticator space, buccal space, frontal sinuses, and abutting the right internal carotid artery. Biopsy confirmed Non-Keratinizing Squamous Cell Carcinoma. The patient was staged as T4bN2cM0 according to the AJCC 8th edition criteria. Following neoadjuvant chemotherapy, the patient underwent total maxillectomy via a Weber-Ferguson approach with Lynch modification, including placement of a dental obturator. In conclusion, advanced NKSCC involving the skull base requires aggressive, multidisciplinary management. This case highlights the necessity of radical surgical resection, such as total maxillectomy via extended approaches like the Weber-Ferguson with Lynch modification, to achieve oncologic control in extensive T4b disease. Despite the challenges posed by proximity to vital structures, surgery remains the cornerstone of treatment, often requiring adjuvant therapy to optimize outcomes. Long-term follow-up is crucial due to the inherent risk of recurrence.

Salvage Total Laryngectomy with Bilateral Deltopectoral Flap Reconstruction for Metastatic (Stage IVC) Laryngeal Carcinoma: A Case Report Steven Yohanis Latupeirissa; I Wayan Lolik Lesmana; Eka Putra Setiawan; I Gde Ardika Nuaba; Made Lely Rahayu; I Ketut Suanda
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 5 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i5.781

The management of advanced laryngeal squamous cell carcinoma (SCC) that persists or recurs after definitive chemoradiotherapy presents a significant clinical challenge. This challenge is profoundly amplified in the setting of distant metastatic disease (Stage IVC), where the goals of treatment shift from curative intent to palliation and quality of life preservation. Surgical salvage in this context is controversial and reserved for highly selected cases with severe, unmanageable local symptoms. We present the case of a 58-year-old male, a long-term smoker, with Stage IVC (T3N2cM1) laryngeal SCC, complicated by bone metastases. He initially underwent definitive chemoradiotherapy. Ten months later, he presented with progressive local disease, including a fungating cervical mass and impending airway compromise. A palliative salvage total laryngectomy with bilateral Modified Radical Neck Dissection (MRND) was performed to control severe local symptoms. The extensive pharyngocutaneous defect was reconstructed using bilateral pedicled deltopectoral fasciocutaneous flaps. The final histopathology confirmed viable, moderately differentiated SCC with extensive cartilage invasion and, critically, a positive deep resection margin. The postoperative course was managed successfully, with the patient showing significant improvement in local symptoms and quality of life at short-term follow-up. This case highlights the complex decision-making required for palliative surgery in metastatic head and neck cancer. The discussion focuses on the justification for aggressive local intervention to palliate debilitating symptoms, the rationale for selecting the robust bilateral deltopectoral flap for reconstruction in a hostile, irradiated field, and the profound prognostic implications of a positive surgical margin in the salvage setting. In conclusion, palliative salvage total laryngectomy can be a viable strategy to improve quality of life in selected patients with Stage IVC laryngeal cancer and overwhelming local disease. However, achieving complete oncologic clearance is a formidable challenge, and management must be tailored within a multidisciplinary framework.

Perbandingan Temuan Anatomi Mastoid Tipe Pneumatik dan Diploik Hasil Diseksi Tulang Temporal Peserta Didik Program Studi Ilmu Kesehatan THT-BKL Wahyu Widiantari, I Gusti Ayu Putu; Eka Putra Setiawan; Komang Andi Dwi Saputra; I Gde Ardika Nuaba; Rahayu, Made Lely
Oto Rhino Laryngologica Indonesiana Vol. 55 No. 2 (2025): VOLUME 55, NO. 2 JULY - DECEMBER 2025
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v55i2.729

Background: Simple mastoidectomy is the most common approach to managing chronic suppurative otitis media (CSOM). This procedure aims to partially or completely remove mastoid cells, to overcome the infection in the middle ear. However, the mastoid bone pneumatization type may influence the result of simple mastoidectomy or temporal bone dissection. Purpose: To determine the difference in the anatomical findings of pneumatic and diploic mastoid types in the temporal bone dissections. Method: This cross-sectional study assesed on pneumatic and diploic types of mastoid bone, on temporal bone dissections findings. The mastoid bones used in this study were temporal bone of the Indonesian cadavers. Data were obtained from direct observation of the number of anatomical landmarks found during temporal bone dissections on each type of mastoid bone; and the maximal anatomical landmark found in each bone was seven. The number of anatomical landmarks between pneumatic and diploic mastoid bone was compared using the Mann-Whitney U test. Result: The mean of overall anatomical landmarks found during temporal bone dissection was 4.50±1.70. No significant difference in the number of anatomical landmarks was found between pneumatic and diploic mastoid bone (4.57±0.79 vs. 4.43±0.53; p=0.827). Conclusion: There was no significant difference in anatomical findings between pneumatic and diploic mastoid bone in temporal bone dissections. Broad knowledge is vital for successful mastoidectomy in all types of mastoid bone.

Bronchoscopic Resolution of Refractory Atelectasis in a Toddler with Polymicrobial MDR Pneumonia: A Case Report I Wayan Sucipta; Eka Putra Setiawan; Komang Andi Dwi Saputra; Freddy Stanza Purba
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.840

Pediatric acute respiratory distress syndrome (PARDS) complicated by ventilator-associated pneumonia (VAP) poses significant management challenges, particularly when caused by multidrug-resistant organisms such as Stenotrophomonas maltophilia and Pseudomonas aeruginosa. A frequent and deleterious complication is plate-like atelectasis, which may prove refractory to conservative management due to anatomical constraints in the pediatric airway and biofilm formation. A 23-month-old male presented with severe PARDS and polymicrobial VAP. Despite extubation to High-Flow Nasal Cannula (HFNC), the patient developed persistent right upper lobe plate-like atelectasis refractory to aggressive physiotherapy and targeted antibiotic therapy with Levofloxacin and Ceftazidime for 21 days. On Day 75 of illness, a flexible bronchoscopy was performed. Intraoperative findings revealed hyperemic mucosa without macroscopic mucus plugging. However, the procedure, involving saline lavage and suctioning, resulted in immediate recruitment. Within 24 hours, the respiratory rate decreased from 45 to 24 breaths per minute, and the SpO2/FiO2 ratio improved significantly from 185 to 310, allowing weaning from respiratory support. In conclusion, in toddlers with multidrug-resistant VAP, atelectasis may persist due to biofilm-mediated micro-obstruction rather than macroscopic plugging. Flexible bronchoscopy is a safe and effective therapeutic adjunct in these cases, facilitating distal airway recruitment and breaking the cycle of chronic infection.

Structural Restoration of the Empty Nose: A Quantitative Case Report on Post-Infectious Saddle Nose Deformity Using Autologous Sixth Costal Cartilage Made Dalika Nareswari; Agus Rudi Asthuta; Eka Putra Setiawan; I Wayan Sucipta; I Ketut Suanda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1569

Background: Septal abscess represents a catastrophic failure of the nasal structural framework, often resulting in rapid ischemic necrosis of the quadrangular cartilage and a severe saddle nose deformity. This empty nose phenomenon poses unique reconstructive challenges due to the total loss of the L-strut and compromised mucosal envelope. Case presentation: We report the case of a 34-year-old female presenting with a Type IV saddle nose deformity and bilateral nasal valve collapse following a septal abscess. Preoperative assessment demonstrated a severe Nasal Obstruction Symptom Evaluation (NOSE) score of 85 out of 100 and compromised Minimum Cross-Sectional Area (MCA) on acoustic rhinometry (mean 0.365 cm2). The patient underwent open septorhinoplasty utilizing autologous sixth costal cartilage. The graft was fabricated using the concentric carving principle to create extended spreader grafts and a columellar strut, re-establishing the dorsal and caudal support. Conclusion: At the 6-month postoperative follow-up, the NOSE score improved by 82.3% (score 15 out of 100), and objective acoustic rhinometry confirmed a 54% expansion in mean MCA. Physical examination revealed a stable dorsal profile with no early evidence of graft warping or resorption. Autologous sixth costal cartilage provides the necessary biomechanical bulk and structural rigidity for restoring the post-infectious nasal skeleton, though long-term monitoring for cartilage memory remains essential.

Structural Restoration of the Empty Nose: A Quantitative Case Report on Post-Infectious Saddle Nose Deformity Using Autologous Sixth Costal Cartilage Made Dalika Nareswari; Agus Rudi Asthuta; Eka Putra Setiawan; I Wayan Sucipta; I Ketut Suanda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1569

Background: Septal abscess represents a catastrophic failure of the nasal structural framework, often resulting in rapid ischemic necrosis of the quadrangular cartilage and a severe saddle nose deformity. This empty nose phenomenon poses unique reconstructive challenges due to the total loss of the L-strut and compromised mucosal envelope. Case presentation: We report the case of a 34-year-old female presenting with a Type IV saddle nose deformity and bilateral nasal valve collapse following a septal abscess. Preoperative assessment demonstrated a severe Nasal Obstruction Symptom Evaluation (NOSE) score of 85 out of 100 and compromised Minimum Cross-Sectional Area (MCA) on acoustic rhinometry (mean 0.365 cm2). The patient underwent open septorhinoplasty utilizing autologous sixth costal cartilage. The graft was fabricated using the concentric carving principle to create extended spreader grafts and a columellar strut, re-establishing the dorsal and caudal support. Conclusion: At the 6-month postoperative follow-up, the NOSE score improved by 82.3% (score 15 out of 100), and objective acoustic rhinometry confirmed a 54% expansion in mean MCA. Physical examination revealed a stable dorsal profile with no early evidence of graft warping or resorption. Autologous sixth costal cartilage provides the necessary biomechanical bulk and structural rigidity for restoring the post-infectious nasal skeleton, though long-term monitoring for cartilage memory remains essential.

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