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All Journal Open Access Indonesian Journal of Medical Reviews Archives of The Medicine and Case Reports
Made Lely Rahayu
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Health Professions Medicine & Pharmacology Nursing Public Health

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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

Abstract

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.
Squamous Papilloma of the External Auditory Canal as a High-Fidelity Mimic of Malignant Otitis Externa: A Case Report I Gusti Ayu Mahaprani Danastri; Ketut Tadeus Max Nurcahya Pinatih; Made Lely Rahayu
Archives of The Medicine and Case Reports Vol. 6 No. 4 (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.v6i4.816

Abstract

Malignant otitis externa (MOE) is a life-threatening osteomyelitis of the skull base, typically affecting geriatric patients with diabetes mellitus. Its initial presentation of otalgia, otorrhea, and an external auditory canal (EAC) mass demands an immediate, high index of suspicion. Squamous papilloma, a benign human papillomavirus (HPV)-related neoplasm, is exceedingly rare in the EAC. This report details a case where this rare benign entity presented as a high-fidelity clinical and laboratory mimic of MOE. We present the case of a 71-year-old female with poorly controlled Type 2 Diabetes Mellitus who presented with a three-week history of severe, refractory otalgia. A systematic diagnostic evaluation was performed, including clinical examination, full audiological assessment, serum inflammatory markers, and high-resolution computed tomography (HRCT) of the temporal bones. The patient's presentation was a textbook surrogate for MOE, including severe otalgia, purulent otorrhea, a friable EAC mass, and markedly elevated erythrocyte sedimentation rate (ESR) (78 mm/hr) and C-Reactive Protein (CRP) (45.2 mg/L). However, HRCT demonstrated an occluding soft-tissue mass without the hallmark finding of temporal bone erosion. The patient underwent transcanal excisional biopsy. Histopathological (H&E) analysis provided the definitive diagnosis of a benign squamous papilloma, with pathognomonic koilocytosis consistent with HPV infection. The patient's severe symptoms resolved completely upon excision. In conclusion, this case highlights a critical diagnostic pitfall. A secondarily infected EAC squamous papilloma can create a clinical and laboratory picture indistinguishable from early-stage MOE. The absence of bony erosion on HRCT is the single most critical finding to pivot the diagnosis away from invasive osteomyelitis. This report underscores the mandatory role of a systematic diagnostic pathway combining imaging and histopathology to prevent misdiagnosis and avoid unnecessary, prolonged, and toxic systemic antimicrobial therapy.
Co-Authors Eka Putra Setiawan I Gde Ardika Nuaba I Gusti Ayu Mahaprani Danastri I Ketut Suanda I Wayan Lolik Lesmana Ketut Tadeus Max Nurcahya Pinatih Steven Yohanis Latupeirissa