Garuda - Garba Rujukan Digital

Head and Neck Cancer in Bali: A Retrospective Study on Patient Characteristics, Predominant Sites, and Histopathology at a Tertiary Referral Hospital Komang Soniananda Pradnyana Putri; I Gde Ardika Nuaba; I Ketut Suanda
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (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.v5i4.757

Head and neck cancers (HNCs) represent a significant global health burden, with distinct epidemiological patterns observed across different geographical regions. In Indonesia, HNCs are among the leading malignancies, yet detailed regional data, particularly from areas like Bali, remain limited. This study aimed to delineate the characteristics of HNC patients at a tertiary referral hospital in Denpasar, Bali. A retrospective descriptive study was conducted using medical records of patients diagnosed with head and neck malignancies at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar, between January 1st, 2021, and December 31st, 2023. Data collected included age, gender, occupation, primary tumor site, and histopathological findings. A total sampling method was employed. Descriptive statistics were used for analysis. A total of 290 patient records were analyzed. Males comprised 69% (n=201) of cases, and females 31% (n=89). The predominant age group was 45–65 years (63%, n=183). Farmers were the most common occupational group (27%, n=77). Nasopharyngeal cancer was the most prevalent malignancy, accounting for 80% (n=232) of cases. Nonkeratinizing squamous cell carcinoma was the most frequent histopathological diagnosis (80%, n=231). In conclusion, head and neck malignancies in this Balinese cohort predominantly affected middle-aged to elderly males, with farming being a common occupation. The strikingly high prevalence of nasopharyngeal cancer, primarily nonkeratinizing squamous cell carcinoma, underscores a significant regional health concern that warrants further etiological investigation and targeted public health strategies.

Reconstructive Challenges and Outcomes Following Radical Resection of Sinonasal Squamous Cell Carcinoma via Weber-Ferguson Approach: A Case Study Ni Putu Deby Rathasari; I Gde Ardika Nuaba; I Ketut Suanda
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.v6i3.749

Sinonasal squamous cell carcinoma (SCC) is an uncommon malignancy characterized by diagnostic delays and complex management. Advanced-stage disease often necessitates radical surgical resection, leading to significant anatomical defects and formidable reconstructive challenges. The Weber-Ferguson approach provides wide surgical exposure for extensive tumors but results in considerable midfacial defects requiring meticulous reconstruction to restore function and aesthetics. This case study details the reconstructive challenges and outcomes following total maxillectomy with this approach for an advanced sinonasal SCC. A 53-year-old male presented with a one-month history of right cheek pain and swelling, preceded by a year of right upper molar pain and progressive facial masses. Clinical and radiological evaluations revealed an extensive mass originating from the right maxillary sinus, destructing surrounding bony structures and involving regional lymph nodes. Biopsy confirmed poorly differentiated keratinizing squamous cell carcinoma. The patient underwent a right total maxillectomy via a Weber-Ferguson approach with Lynch modification, extended to involve the mandible, along with reconstruction. The final staging was T4aN3M0. Postoperatively, the patient experienced minor wound dehiscence, which was managed conservatively. He was planned for an obturator and adjuvant radiochemotherapy, but he declined further oncological treatment. Radical resection of advanced sinonasal SCC using the Weber-Ferguson approach, while oncologically necessary, presents substantial reconstructive dilemmas. Addressing these defects is crucial for functional rehabilitation, including speech, deglutition, and acceptable cosmesis. This case underscores the complexity of managing such extensive defects and the importance of a multidisciplinary approach, even when patients decline standard adjuvant therapies. The long-term prognosis in such cases remains guarded, particularly without adjuvant treatment.

Esophageal Squamous Cell Carcinoma Masquerading as Achalasia: A Case Report on Diagnostic Pitfalls and Therapeutic Strategies Renata Timoty Pasaribu; I Gde Ardika Nuaba; I Ketut Suanda; Ida Ayu Alit Widiantari; I Wayan Lolik Lesmana
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.v6i3.760

Esophageal squamous cell carcinoma (SCC) is an aggressive malignancy often diagnosed at an advanced stage, leading to a poor prognosis. Its initial symptoms can be nonspecific, occasionally mimicking benign esophageal disorders such as achalasia, thereby posing significant diagnostic challenges. This report details such a case, emphasizing the diagnostic pitfalls and discussing therapeutic approaches. A 43-year-old male presented with a 5-month history of progressive dysphagia and odynophagia, initially suspected to be achalasia. Clinical findings, including significant weight loss and specific laboratory abnormalities, are detailed. Esophagogastroduodenoscopy revealed an obstructing tumor, confirmed as esophageal SCC by biopsy. Staging investigations, including Multi-Slice Computed Tomography (MSCT), characterized the disease as Stage IVA (T4N1M0). The patient underwent feeding gastrostomy for nutritional support and commenced systemic chemotherapy with docetaxel, carboplatin, and cetuximab. The treatment course and initial follow-up are described. In conclusion, this case underscores the critical importance of maintaining a high index of suspicion for malignancy in patients presenting with symptoms suggestive of achalasia, especially if accompanied by atypical features or risk factors. A meticulous and timely diagnostic evaluation, incorporating early endoscopy and biopsy, is paramount for accurate diagnosis and staging. Multidisciplinary management, including robust nutritional support and carefully selected systemic therapy, remains central to addressing advanced esophageal SCC.

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.

Solitary Sinonasal Neurofibroma in an Elderly Male: A Rare Presentation and Surgical Management Jessica Filbertine; I Gde Ardika Nuaba; I Ketut Suanda; Ida Ayu Alit Widiantari; I Wayan Lolik Lesmana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (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.v5i6.794

Solitary sinonasal neurofibromas are rare peripheral nerve sheath tumors whose diagnosis is frequently confounded by non-specific symptoms and radiological features that mimic common inflammatory conditions. In the elderly, a unilateral sinonasal mass necessitates a high index of suspicion for neoplasia, yet diagnostic pitfalls remain a significant clinical challenge. A 65-year-old male with no stigmata of neurofibromatosis type 1 presented with a three-year history of progressively worsening unilateral nasal obstruction. Endoscopy revealed a large, pale, firm, non-friable mass. Computed tomography (CT) demonstrated an extensive, non-enhancing soft tissue mass originating in the left maxillary sinus, causing significant expansile bone remodeling and extending into multiple adjacent sinuses. The initial radiological impression was extensive sinonasal polyposis. However, an incisional biopsy followed by a comprehensive morphological analysis confirmed the diagnosis of a benign spindle cell tumor consistent with neurofibroma. The patient underwent complete tumor excision via a left lateral rhinotomy. The postoperative course was uneventful, with no recurrence at 12-month follow-up. In conclusion, this case underscores the critical importance of a thorough diagnostic workup for unilateral sinonasal masses in the elderly, where radiological findings can be misleading. Histopathological analysis is indispensable for the definitive diagnosis of spindle cell tumors in this location. For massive, maxillary-based neurofibromas with extensive lateral and anterior involvement, the lateral rhinotomy remains a vital and superior surgical approach, providing the necessary exposure to uphold the fundamental principle of complete oncologic resection and maximize the probability of a curative outcome.

Squamous Cell Carcinoma of External Auditory Canal with Intracranial Infiltration Damayanthi, M. Ayu Dwi; Nuaba, I Gde Ardika; Suanda, I Ketut; Widiantari, Ida Ayu Alit
Jurnal Sehat Indonesia (JUSINDO) Vol. 7 No. 2 (2025): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/.v7i2.362

Squamous cell carcinoma of external auditory canal (SCC EAC) is a rare malignancy with the incidence of <0.2% of all malignancies of the head and neck region. This disease often mimics the features of other diseases as in chronic suppurative otitis media of the dangerous type with cholesteatoma. SCC EAC the most common malignancy pathology, reaching 90% of malignancies in the temporal bone and external auditory canal. This case report describes a patient with SCC in EAC with infiltration to intracranial. A 42 years old man with a history of discharge and blood from his left ear. Based on the history, clinical presentation and Computed Tomography (CT) Scan of the mastoid, found there was a mass in the left ear with intracranial infiltration. The results of histopathological examination obtained SCC EAC stage IV (T4N2M0) + infiltration of the cerebellum region S + non-communicating hydrocephalus. The patient already done a surgery. This case represents a rare presentation of SCC EAC with intracranial involvement in a relatively young patient (42 years), which is uncommon as most cases occur in patients aged 60-69 years. The aggressive nature with cerebellar infiltration and non-communicating hydrocephalus demonstrates the importance of early detection and multidisciplinary management. This case contributes to the limited literature on advanced SCC EAC with CNS involvement and emphasizes the need for comprehensive staging and aggressive surgical intervention.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
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.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
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.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

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.

Divergent Carcinogenic Risks of Domestic versus Ritual Combustion on Nasopharyngeal Carcinoma in Bali: A Matched Case-Control Study Made Prani Windasari; I Gde Ardika Nuaba; Made Lely Rahayu
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.v7i1.841

Nasopharyngeal carcinoma (NPC) is endemic in Indonesia, particularly among the ethnically distinct Balinese population. The interplay between Epstein-Barr virus (EBV) and environmental co-factors remains critical to its pathogenesis. A unique cultural duality exists in Bali regarding inhalant exposure: the utilitarian combustion of firewood and tobacco versus the ritual combustion of incense. This study aims to distinguish the carcinogenic risks of these disparate smoke sources using robust statistical methods to account for sparse data bias. A matched case-control study was conducted at a tertiary referral center in Denpasar, Bali. Forty-two patients with histopathologically confirmed WHO Type III Undifferentiated NPC were matched by age and sex with 42 non-cancer controls screened via Digby score. Exposures to firewood, passive and active smoking, and ritual incense were assessed. To address quasi-complete separation due to high exposure prevalence, Firth’s Penalized Likelihood Logistic Regression was employed to determine Adjusted Odds Ratios (AOR). Firewood smoke exposure emerged as the predominant risk factor (AOR 14.21; 95% CI 4.82–42.15; p < 0.001), significantly higher than previously estimated by standard models. Passive smoking was confirmed as a substantial independent risk factor (AOR 11.54; 95% CI 3.91–33.82; p < 0.001). Conversely, despite universal usage, ritual incense exposure showed no association with NPC (AOR 0.92; 95% CI 0.35–2.41; p = 0.865), likely due to the open-air ventilation of Balinese shrines. Salted fish consumption remained a significant co-factor (AOR 6.80; p = 0.002). In conclusion, the study establishes a clear etiological hierarchy: chronic domestic pollutants such as biomass and tobacco smoke are potent drivers of NPC in Bali, likely acting as tumor promoters via EBV reactivation. Ritual incense, in the context of Balinese architecture, is not a significant risk. Public health interventions must prioritize healthy kitchen ventilation and tobacco control.

Title

Found 20 Documents
Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title Search

Found 20 Documents Search

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Title

Found 20 Documents
Search