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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
I Wayan Sucipta
Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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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

Abstract

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.
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

Abstract

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.
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

Abstract

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.
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

Abstract

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.
Co-Authors Agus Rudi Asthuta Eka Putra Setiawan I Dewa Gede Arta Eka Putra I Gde Ardika Nuaba I Ketut Suanda I Putu Santhi Dewantara Janris Sitompul Made Dalika Nareswari