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Introduction: Majority of parotid tumor requires parotid surgery and complications following parotidectomy are multiple namely facial nerve paresis, Frey's syndrome, retromandibular depression and hypoesthesia of ear lobule. Parotidectomy with sternomastoid (SCM) flap may play significant roles in preventing these complications. Objectives: The objectives of this study were to compare the occurrence of Frey's syndrome, esthetic outcome, facial nerve paresis and ear lobe paresthesia between the two groups, parotidectomy with sternomastoid flap and parotidectomy without sternomastoid flap. Methodology: This was a comparative cross-sectional study performed at Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah from June 2016 until October 2018, after ethical committee approval (USM/JEPeM/17020092). The patient was recruited prospectively for the SCM flap group and retrospectively for non-flap group. Frey's syndrome was evaluated both subjectively and objectively by patient's complaint assessment and Minor Starch Iodine test. Evaluation of esthetic outcome was conducted using Visual Analog Score (VAS). In addition, assessment of facial nerve was performed by using the House-Brackmann grading system, whereas hypoesthesia of ear lobe numbness was evaluated by patient complaints documentation. All data were entered and analyzed using the software IBM SPSS version 24. Descriptive analysis and Pearson's Chi-square test were used in analyzing the obtained data. Results: Occurrence of Frey's syndrome in parotidectomy without SCM flap was higher compared to parotidectomy with SCM flap group. Results showed that 13 patients (72.2%) in the non-SCM flap group had Frey's syndrome whereas only 2 patients (11.8%) in SCM flap group had the syndrome. The aesthetic result showed that patients with parotidectomy with SCM flap had lower mean score of 1.21 (SD=0.36) at day 14, 0.06 (SD=0.24) at day 30 and 0.03 (SD=0.12) at day 60 respectively. Both outcomes were statistically significant (p<0.05). While incidence of facial nerve palsy and cervical/ear lobe numbness were the same in the two studied groups. Conclusion: There was a significant difference in Frey's syndrome and aesthetic outcomes of the parotidectomy with SCM flap compared to those without SCM flap. Partial-thickness sternomastoid flap should be routinely practiced especially in young patients with benign big tumor going for parotidectomy. [ABSTRACT FROM AUTHOR]

The binary-based algorithms including the binary gravitational search algorithm (BGSA) were designed to solve discrete optimization problems. Many improvements of the binary-based algorithms have been reported. In this paper, a variant of GSA called multi-state gravitational search algorithm (MSGSA) for discrete optimization problems is proposed. The MSGSA concept is based on a simplified mechanism of transition between two states. The performance of the MSGSA is empirically compared to the original BGSA based on six sets of selected benchmarks instances of traveling salesman problem (TSP). The results are statistically analyzed and show that the MSGSA has performed consistently in solving the discrete optimization problems. [ABSTRACT FROM AUTHOR]

Particle swarm optimization (PSO) has been successfully applied to solve various optimization problems. Recently, a state-based algorithm called multi-state particle swarm optimization (MSPSO) has been proposed to solve discrete combinatorial optimization problems. The algorithm operates based on a simplified mechanism of transition between two states. However, the MSPSO algorithm has to deal with the production of infeasible solutions and hence, additional step to convert the infeasible solution to feasible solution is required. In this paper, the MSPSO is improved by introducing a strategy that directly produces feasible solutions. The performance of the improved multi-state particle swarm optimization (IMSPSO) is empirically evaluated based on a set of travelling salesman problems (TSPs). The experimental results are statistically analyzed and show that the IMSPSO is promising and consistently outperformed the binary PSO algorithm. [ABSTRACT FROM AUTHOR]

Introduction: Lingual osteoma is a rare clinical entity has been found mainly in the posterior part of tongue. Histologic features are usually those of a well-circumscribed mass of vital mature bone beneath the surface epithelium. Most patients presented in their third or fourth decade of life with male to female ratio is 1:4. The most common single presenting complaint is 'lump in the throat'. Two hypotheses to explain the possible cause of this condition are developmental malformation and post-traumatic reaction. Method: A review of medical case report. Results: We reported a young lady presented with lump in the throat since childhood without obstructive symptoms. On examination revealed mass at posterior third of the tongue. Ultrasound thyroid confirmed presence of normal thyroid tissue at anterior neck. The tumor was completely excised and histopathological examination reported as lingual osteoma. Conclusion: Even though it's a rare entity, lingual osteoma should be considered as one of the differential diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Tracheostomy is a surgical airway management procedure that involves making an incision on the anterior neck and opening a direct airway through an incision in the trachea. Aim: We report a case of a difficult tracheostomy complicated by massive immediate bleeding from the innominate artery that required a median sternotomy for vascular access and control. Case study: A 26-year-old lady with a short neck underwent a tracheostomy in a semi-emergency setting in view of prolonged intubation and frequent intubation prior. The tracheal incision was performed in between the 3rd and 4th tracheal rings and was complicated by massive bleeding from the innominate artery tear that was located below the sternum and necessitated a midline sternotomy procedure to access the artery. The artery was then repaired primarily and covered with a strap muscle that was swung over to the right and sutured to the periosteum of the right clavicle. She lost 6 L of blood, prompting a massive blood transfusion. Postoperatively, there was no bleeding from the wound, but she had an infected sternotomy wound that was managed with antibiotics and dressings. The tracheostomy tube care was uneventful. Results and discussion: The short-neck hyperextension during trachea exposure can cause major thoracic vessels and tracheal rings to move upward, leading to tracheal incisions being made lower than intended and risking major vessel injury. Conclusions: Imaging before surgery is recommended to delineate the anatomy and detect any major vessels present in the case of anticipated difficult tracheostomy. [ABSTRACT FROM AUTHOR]