bluuebunny/crossref_metadata_2025 huggingface dataset:
Enfermedad de castleman unicéntrica: revisión breve de una enfermedad poco conocida
Authors: Vílchez León Mariana , Cortés Mejía Melvin , Espinoza Artavia Andrea , Webb Webb Kembly
Published: April 2019

La enfermedad de Castleman es una entidad patológica rara, que abarca un grupo heterogéneo de desórdenes histopatológicos de los ganglios linfáticos. Puede clasificarse en enfermedad de Castleman unicéntrica, cuando se trata del crecimiento de un solo ganglio linfático o de ganglios linfáticos de una misma región, o en enfermedad de Castleman multicéntrica si afecta adenopatías de diferentes regiones ganglionares. Ambos tipos de enfermedad de Castleman difieren en cuanto a incidencia, epidemiología y curso clínico. La enfermedad de Castleman unicéntrica tiene una incidencia calculada en Estados Unidos entre 15.9 a 19.9 casos por millón personas-año, se presenta principalmente en personas jóvenes, alrededor de la tercera década de la vida y es más frecuente en mujeres. Los factores causales de esta patología son desconocidos. Las manifestaciones clínicas dependen de la variante histológica, siendo más frecuente la variante hialino vascular, que suele ser asintomática. El diagnóstico confirmatorio de la enfermedad de Castleman unicéntrica es histológico. La resección nodular completa es el tratamiento de elección, mientras que en las lesiones no resecables la radioterapia y la quimioterapia son opciones terapéuticas. El pronóstico de la enfermedad es benigno, con una mortalidad asociada a 10 años del 4% y porcentajes de curación que rondan el 95%.
Educational environment: concept and content
Authors: Rudomiotova Liliia Tarasovna
Published: April 2019

This article deals with the analysis of the educational environment. We considered main definitions of this term, gave its characteristic and its functions were determined.
Medialization and Stabilization of the Middle Turbinate using a Nasal Septal Flap in Endoscopic Sinus Surgery
Authors: Abelardo Edgardo , Sanuki Tetsuji , Yumoto Eiji
Published: April 2019

Objectives: To propose a simple technique to preserve, medialize and stabilize the middle turbinate through a planned medial synechiae formation using a nasal septal flap

 

Methods:

Study Design: Case series, surgical innovation

Setting: Tertiary hospital (Kumamoto University Hospital, Japan)

Participants, Patients or Population: Six patients suffering from chronic sinusitis unresponsive to medication. The indication for doing this technique was unstable turbinates after removal of diseased mucosa.

 

Results: Twelve weeks after surgery, the patients reported significant resolution of symptoms (headache, nasal congestion, rhinorrhea, post-nasal drip and loss of smell). CT and endoscopic findings likewise revealed clear ostio-meatal complex, drained sinuses, and complete removal of polypoid mucosa. No major side effects were noted.

 

Conclusions: This technique is especially encouraged when surgeons encounter an unstable middle turbinate after removing massive pathologic mucosal lesions. This is a preliminary report and further investigations are being carried out to validate the technique.

 

Keywords: medial synechiae, nasal septal flap, ostio-meatal complex
Intranasal Corticosteroids for the Medical Management of Nasal Polyps in Adults: a Meta-Analysis
Authors: Almazan-Aguilar Natividad A.
Published: April 2019

Background:   This systematic review aims to strengthen evidence of beneficial effects of intranasal corticosteroids on the medical treatment of adults diagnosed with nasal polyps. 

 

Objectives: (1) To determine the efficacy of short term (2 to 4 weeks) and long term (4 to 12 weeks and > 12 weeks) of intranasal corticosteroids in the reduction of polyp size and rhinitis symptoms. (2).  To determine the difference in efficacy of a 400 ug and 800 ug dose. (3) To determine adverse effects of intranasal steroids.

 

Study Design and Selection Criteria:  Meta-analysis of randomized controlled trials on intranasal steroids for nasal polyps. Patient-oriented outcomes were reduction of polyp size and overall reduction of rhinitis symptoms.

 

Search Strategy: Comprehensive search of Cochrane's Controlled Trials Registry (CCTR) Issue 2, 2003, Medline 1966 to 2002, and Embase 1974 - 2002 bibliographic review, requests for information from authors and pharmaceutical companies.

 

Data collection and analysis:  Sixteen studies were evaluated for inclusion, and trial quality, validity assessment, and completion of data extraction were done. Ordinal data on rhinitis and polyp scores for each study were pooled to generate relative risks. Homogeneity was assessed using approximate chi-square tests.  Preset p value of < 0.10 was deemed significant for heterogeneity. Data were analyzed using software program Revman 4.1(Update Software, Oxford).  Sensitivity analysis was done for those outcomes with significant heterogeneity.

 

Results and Conclusion: Fourteen studies found significant benefit for the use of intranasal steroids in reduction of polyp size with 2-4 weeks treatment (RR=3.00; 95% Cl: 2.39, 3.77).

            Overall rhinitis symptoms decreased significantly (RR=1.64; 95% Cl: 1.25, 2.14) with 4-12 weeks treatment, with a tendency for reduction of rhinitis symptoms (RR=1.41; 95% Cl: 1.05, 1.91) with more than 12 weeks treatment. Throat irritation was significantly increased (RR=2.06; 95% Cl 1.31, 3.25). There was no difference in overall rhinitis symptoms (RR=0.91; 95% Cl:0.77, 1.07) with 400 ug and 800 ug doses.

 

Keywords: polyp, nose, steroids, intranasal steroids, glucocorticosteroid
Self-Retaining Harpoon Tympanostomy Tube with Applicator
Authors: Aguila Konrad P.
Published: April 2019

Objective: To describe a novel harpoon design for a low cost, self retaining tympanostomy tube with applicator used in a 38-year-old female for otitis media with effusion.

Methods:   

Study design: Instrumental Innovation/Case Report

Setting:  Tertiary Hospital in Metro Manila

Results:   The tympanostomy tube was inserted under endoscopic guidance within 10 seconds, remained in place for two months with relief of symptoms, and spontaneously extruded by the seventh month of follow-up.

Conclusion:  The harpoon-designed tube with applicator provided ease of insertion and good anchorage in the tympanic membrane.  Maximizing the use of a stylet-needle as both perforator and applicator simplified the tympanostomy and ventilating tube insertion procedures into a single maneuver.

 

 

Key words: middle ear ventilation, tympanostomy tube insertion, grommet  insertion, instrumentation
Competency in End-of-Life Care among ENT – HNS Consultants and Residents: A Multi-Center Study
Authors: Quiambao Arnelle Y. , Pio-Gulapan Flordelina E.
Published: April 2019

Objectives: To determine the competency in end of life care of Ear, Nose, Throat – Head and Neck Surgery (ENT-HNS) consultants and residents using the domains of knowledge, skills and attitudes as measures of competency and to identify opportunities for improvement in end of life care education

 

Method:

Design:  Cross- sectional survey

Setting:  Five tertiary hospitals in Metro Manila

Subjects: 52 ENT-HNS consultants and residents

 

Results: The majority of the respondents scored low across the knowledge, attitude and skills domains. Majority the respondents (67%) were low in the knowledge domain. More than half of the respondents (58%) demonstrated negative attitudes towards end- of-life care while majority of the respondents (56%) had low skills scores. Similarly, more than half (67%) of the respondents showed low over-all competence in end of life care.

 

Conclusion: The majority of the respondents scored low across all three domains that were used to measure the competency in end of life care. These findings may suggest a need to strengthen the ENT- HNS practitioners’ education in end-of-life care.

 

Keywords: end of life care, palliative care, terminal care
Coblation for Congenital Microglossia in Beckwith-Wiedemann Syndrome
Authors: Marino Melanie Y. , Vicente Gil M. , Chua Antonio H.
Published: April 2019

Objective: To present a rare case of congenital macroglossia managed with radiofrequency ablation.

Methods:

Design:  Case report

Setting:  Tertiary government hospital   

Patient:   One

Results: A case of a congenital macroglossia in a 4-year old female with Beckwith-Wiedemann Syndrome is presented. Neither breathing nor swallowing difficulty was associated with the enlarged tongue.  Coblation-assisted ablation of the tongue deformity was performed. There was minimal bleeding, pain and swelling postoperatively. Tongue mobility and taste sensation were unaffected.

Conclusion:  A new and more conservative approach to surgery for congenital macroglossia using radiofrequency ablation (coblation) has been described. Coblation-assisted ablation of lingual tissue may be an effective therapy for patients with macroglossia providing satisfactory functional and cosmetic outcome.

Key words: macroglossia, Beckwith-Wiedemann Syndrome, coblation
Radial Forearm Flap for Tongue Reconstruction
Authors: Aragon Rodney Oliver J. , Soriano –Castaneda Samantha , David Joselito F.
Published: April 2019

Objective: To present a case of tongue reconstruction using radial forearm free flap.

Methods:

Design: Case Report

Setting:  Tertiary government hospital

Patient: One

Results: A 52-year- old female with a T3N2cM0 Stage IVa right tongue carcinoma underwent tracheotomy, right hemiglossectomy with modified radical neck dissection type III and extended supraomohyoid neck dissection on the left with radial forearm free flap reconstruction. After 1 month, the radial forearm free flap reconstruction in the tongue had acceptable appearance and good tongue mobility with intelligible speech. The patient did not complain about the appearance and function of the left forearm.

Conclusion: The radial forearm free flap is a viable reconstructive option for tongue defects

especially where a thin, pliable flap is needed. There is acceptable form and functional restoration with minimal donor site morbidity.

Keywords: radial forearm free flap, tongue reconstruction
Pneumolabyrinth: Radiologic Evidence of Labyrinthine Injury
Authors: Yang Nathaniel W.
Published: April 2019

A U.S. serviceman presented with a three month history of unsteadiness on ambulation and increasing episodes of vertigo whenever he turned his head rapidly to the right. He had previously been injured in a bomb blast while stationed in Iraq four months prior to consultation. Aside from multiple soft tissue and bone trauma, he had also experienced vertigo and nearly complete deafness in the right ear immediately after the blast. Medical records indicated the presence of a traumatic perforation of the right tympanic membrane and spontaneous nystagmus on initial emergency medical assessment after the incident. Physical examination on consultation revealed bilaterally intact eardrums, a positive right head impulse test, and a normal Romberg test. Audiometry showed a severe right SNHL. A presumptive diagnosis of a persistent perilymph fistula secondary to inner ear barotrauma was entertained, and supported by findings on temporal bone CT imaging.

Figure 1 is the axial CT image of the patient's inner ear at the level of the basal turn of the cochlea. Two linear lucencies are visible within the cochlea (arrowheads). These have the same signal characteristics as the normal external auditory canal and middle ear space. As such, they indicate the presence of air within the cochlea – a condition termed pneumolabyrinth. Figure 2 shows a normal cochlea at the same level for comparison. Note the uniform soft tissue density within the cochlear lumen, representing the endocochlear fluids. The lucency in the round window niche (thin arrow) also represents air, but this is a normal finding.

 

Barotrauma from blast injuries and traumatic tympanic membrane perforations may cause perilymph fistulas. This is probably due to a sudden pressure wave transmitted through the tympanic membrane that results in an inward rupture of the round window membrane or an inward displacement of the stapedial footplate.1 Pneumolabyrinth has been identified in patients suffering from perilymph fistulas due to barotraumas,2 and therefore can bolster the diagnosis when identified in the appropriate clinical setting. It has also been identified in patients with perilymph fistulas from other causes, including iatrogenic stapes fractures during mastoid surgery, temporal bone fractures, cholesteatoma, neoplasms of the temporal bone, stapedectomy, and after cochlear implantation.3
Extramedullary Plasmacytoma in the Maxillary Sinus
Authors: De Silva-Leonardo Jennifer , Bito-Ricalde Rosario R. , Claridad Jose Roberto V. , Llanes Erasmo Gonzalo DV.
Published: April 2019

Objective: To describe an intranasal mass initially diagnosed and treated as benign, that eventually turned out to be a malignant extramedullary plasmacytoma of the maxillary sinus, and to review the literature on its presenting signs and symptoms, diagnosis, management and pathophysiology.

Methods:

Design: Case Report 

Setting: Tertiary Public Hospital

Patient: One

Results: A 45-year-old male with persistent nasal obstruction and intermittent epistaxis underwent several biopsies of a mass shown on computed tomography scans as heterogeneously enhancing, expansile, occupying the left maxillary sinus with extension into the left nasal cavity with areas of erosion.  Immunohistochemical staining was negative for cytokeratin (CK) and leukocyte common antigen (LCA). Complete excision yielded a final histopathologic interpretation of plasmacytoma. Laboratory examinations excluded multiple myeloma. The final diagnosis was extramedullary plasmacytoma and he was treated with post-operative adjuvant radiotherapy. 

Conclusion:  Plasmacytoma may present in the sinu-nasal region and be part of a systemic disease like multiple myeloma. A high index of suspicion and thorough initial histopathological work-up may help in establishing a definitive diagnosis and providing optimum treatment.

Keywords: Plasmacytoma, plasma cell tumor, multiple myeloma, plasma cell myeloma, extramedullary plasmacytoma
Measurement of the Handicap of Dysphonic Patients using the Filipino Voice Handicap Index
Authors: Lim Aimee Caroline E. , Hernandez Melfred L. , Llanes Erasmo Gonzalo DV.
Published: April 2019

Objectives: 1) To describe patterns of Filipino Voice Handicap Index (VHI) scores in relation to the demographic data of dysphonic patients; 2) To describe patterns of Filipino VHI scores in relation to the different pathologies of dysphonia as determined by videostroboscopy. 

Methods:

Study design: Cross-Sectional Study

Setting: Philippine General Hospital 

Population: Adult patients (≥18 years old), proficient in Filipino. 

 

A group of 124 dysphonic patients seen at the Videostroboscopy Unit completed the Filipino VHI.  Demographic data were collected. Videostroboscopy diagnoses were classified into six groups: normal, mass lesions, inflammatory, mucosal irregularities, functional and neurogenic.  The T-test was used to determine differences in scores among the demographic parameters and the pathology groups.  ANOVA one-way factor was used to determine difference of subscale scores within each pathology group, and to determine difference of pathology scores in each subscale.  Differences were considered statistically significant if p<0.05. 

Results: Statistical analyses showed that Filipino VHI scores were affected by age, gender, educational status and occupation.  Younger patients significantly scored higher than patients >40 years old.  Females had significantly higher scores than males in the functional, physical and total subscales.  Patients with lower educational status scored higher compared to college graduates.  Voice professionals significantly scored higher than the non-voice professionals.  Dysphonic patients significantly scored higher than normal volunteers.  Among the pathological groups, neurogenic lesions had the highest scores.  Physical subscale scores were significantly higher in all lesions except in functional lesions. 

Conclusion:  The Filipino VHI measured handicap to be higher among young females with voice-dependent occupations.  Patients with neurogenic lesions demonstrated the most severe handicap.

Keywords:  dysphonia, voice handicap index, videostroboscopy
Nasopharyngeal Tuberculosis in a Patient Presenting With Upper Airway Obstruction
Authors: Nieves Cristina S. , Onofre Rubiliza D. , Aberin-Roldan Fortuna Corazon A. , Gutierrez Rene Louie C.
Published: April 2019

Objective:  To report a rare case of upper airway obstruction from multiple pharyngeal masses due to nasopharyngeal tuberculosis in a 22-year-old male.

Methods:

Design:  Case Report

Setting:  Tertiary Government Hospital

Patient:  One

 

Result: A 22-year-old Filipino male with upper airway obstruction from multiple pharyngeal masses was diagnosed to have nasopharyngeal tuberculosis by histopathology. He improved after six months of anti-tuberculosis medications.

Conclusion: Tuberculosis should not be overlooked in the differential diagnoses of nasopharyngeal masses because of the difference in its management, and swift and adequate cure, compared to other nasopharyngeal pathologies.

Keywords:  tuberculosis, nasopharynx, mycobacteria, hypopharyngeal mass, upper airway obstruction
The “Sail” Excision Technique: A Modified Alar Lift Procedure for Southeast Asian Noses
Authors: Baladiang Dennis Eusebio A. , Olveda Mildred B. , Yap Eduardo C.
Published: April 2019

Objective: To describe a new “sail” shaped excision technique for alar lift surgery and present the outcome of this technique through photo documentation.

Methods:

Study Design: Surgical Innovation; Case series

Setting: Tertiary Government Hospital

Participants:   Four patients underwent alar rim lift procedure using “sail” excision technique performed by the senior co-author.  The indication for “sail” excision technique was a hanging ala (type IV) based on the classification of alar-columellar discrepancies by Gunter et al.  The outcomes were described with comparison of pre-operative and post-operative photographs.

Results:           Post-operative improvement of the alar-columellar relationship and counter-rotation of the tip, the “gull’s wing in flight” was further enhanced.  There were no scar contracture or vestibular stenosis, and scars were aesthetically acceptable.

Conclusion:    Alar lift surgery demands an accurate diagnosis and analysis of the alar-columellar discrepancies.  In Southeast Asian noses, unlike Caucasian noses, the most common indication for alar surgery are wide and overhanging ala.  Our proposed technique is an easy and safe method of correcting alar overhang.  This procedure with its advantages represents a new, reliable and simple way of achieving predictable results in many rhinoplasty cases.

 Keywords: alar lift, hanging ala, alar-columellar relationship, alar-columellar discrepancies, counter-rotation of tip, vestibular stenosis
Clinical Profile of Post-Tonsillectomy Bleeding: A 30-Month Institutional Review
Authors: Moral Sarah D. , Barlin Ann Kathleen C. , Acuin Jose M.
Published: April 2019

Objective:  To determine the prevalence of post-tonsillectomy bleeding in our institution and to describe the clinical characteristics, tonsillectomy techniques and post-tonsillectomy bleeding intervention in these patients.

Methods: 

Study Design:  Observational descriptive study

Setting: Tertiary private hospital

Population:  All patients who were treated for post-tonsillectomy bleeding were retrospectively reviewed from medical records of all patients who had undergone tonsillectomy between January 1, 2007 and June 30, 2009.  Age and sex, indication for surgery, tonsil grade, Body Mass Index (BMI),  surgical technique, post-operative medications, length of hospital stay, interval between tonsillectomy and onset of bleeding and interventions to address post-operative bleeding were noted.

Results:  Of the 662 patients who underwent tonsillectomy, 37 (5.6%) were managed for post-operative hemorrhage. Most had grade 2 or 3 tonsils (18 or 48.6% and 16 or 43.2% respectively) and were obese (25 or 67.5%). The highest proportion of post-operative bleeding was 9.2% for bipolar cauterization technique (18 of 196 patients) followed by 7.4%  with cold knife, monopolar cauterization and suturing (11 of 148 patients); 6.9% with harmonic scalpel (2 of 29 patients); 6.5%  with monopolar and bipolar cauterization (3 of 46 patients), and 2.8% for cold knife or Fischer knife (3 of 109 patients). Seven patients (18.9%) required blood transfusion. Onset of bleeding occurred between 4-12 days following surgery (mean: 8 days). Possible causes of bleeding included heavy physical activity and cough but most had no identifiable cause.   Majority of the patients (29 out of 37) required surgical exploration under general anesthesia.

Conclusion:  Post tonsillectomy bleeding is still a clinically significant complication despite advances in surgical techniques. Surgeons must always consider trade-offs between benefits and risks of the procedure and be continually vigilant of this potentially serious complication.

 

Key Words: Post-tonsillectomy bleeding, tonsillectomy techniques
Informed Consent In Patients Undergoing ENT Surgery: What Do Patients Want To Know?
Authors: Shrestha Bikash lal
Published: April 2019

Objective: To determine patient satisfaction with the informed consent process in ear, nose and throat (ENT) diseases requiring surgery. Specifically, to determine relationships between educational levels of patients and their satisfaction with information given by doctors versus self-gathered information; whether complications of the operation were explained to, and could be listed by patients; the types of complications patients expected to be informed about and the importance of this information to them; their familiarity with the term “informed consent” and their preference for written or spoken information; and whether they were convinced about what they consented to.

Methods: 

Design: Cross-sectional Descriptive Study

Setting: Tertiary Public Hospital

Patients: One Hundred  

Results:  There were 55 males and 45 females (average age 26.7 years, range 4 - 74 years). Ten percent (all children) had no formal education, 56% had primary to high school education, 23% had certificate level education, and 11% had a baccalaureate or masters degree. Ninety-five percent claimed they knew what informed consent was. Ninety percent were satisfied with the information given to them by doctors. Eighty percent, mainly with educational levels of high school and above, preferred to receive written information from doctors. Twenty three percent accessed other sources of information. Those with certificate level education talked with previously operated patients (10%) or read magazines (2%), while the internet was favored by almost all of those with baccalaureate degrees (8%) and all those with masters degrees (2%). Of those who accessed self-gathered information, 21% were not satisfied while only 2% were satisfied. Seventy percent considered the information given by doctors very important. Similarly, seventy percent (mostly from the higher educational levels) considered the impact of information provided by the doctor completely convincing for decision making, while thirty percent (mostly from lower educational levels) only found the information partly convincing. Forty nine percent (again from the lower educational levels), could not list even a single complication. Nineteen percent, with educational levels of certificate and above, wanted to know all complications of surgery, including those that were very rare while fifty six percent wanted to know most of the complications.

 Conclusion: We should not underestimate the importance of the outpatient consultation, the importance of written material and non medical information sources as patients’ expectations are quite high and the majority of them wanted to be informed about most complications.  We should also find ways to improve the provision of patient information, and where possible and appropriate, as per specific patient groups.

 

Key words: Informed consent, otorhinolaryngology, surgical procedures
Prevertebral Soft Tissue Thickness among Pediatric Patients
Authors: Reyes Manuelito M. , Ricalde Rosario R. , Tanalgo Jennifer B. , Baldoz Concepcion J.
Published: April 2019

Objective:  This study aimed to determine the prevertebral soft tissue thickness among normal patients aged 0-14 years old in a tertiary government training hospital, to compare these values with divergent criteria in the standard otorhinolaryngology and radiology texts used in our institution, and to recommend adoption of a set of criteria based on the results. 

Methods

Study Design:  Descriptive Study

Setting: Tertiary Government Hospital 

Subjects and Methods:  Lateral cervical radiographs taken from May 2007 to August 2009 which were initially read as normal were collected.   Fifty (50) patients, 39 males and 11 females, aged 0-14 years old meeting inclusion criteria were reviewed and prevertebral soft tissue thicknesses (PVST) and cervical vertebral body diameter at levels C2, C5, C6 were measured and compared to criteria set by standard otorhinolaryngology and radiology textbooks. 

Results:  The average PVST at C2 ranged from 4.02 mm for 2–3 year-olds (n= 2) to 8.16 mm for 1 –2 year-olds (n=2).   The average PVST at C5 ranged from 8.11mm for 1–2 year-olds to 10.75 mm for for 0-1 year-olds. The average PVST at C6 ranged from 7.13 mm for 1 – 2 year-olds to 10.36 mm for  0-1 year-olds. Only 12% of the patients satisfied the criteria set by Keats and Lusted, while 100% satisfied Duncan’s criteria, 94% and 98% satisfied Wippold’s 1st and 2nd criteria respectively. 

Conclusion: All of the PVST criteria mentioned in Cummings’ Textbook of Otorhinolaryngology Head and Neck Surgery had a more than 90% accuracy compared to only 12% for those mentioned in Keats and Lusted’s Atlas of Roentgenographic Measurement.  Therefore, we recommend the use of any criteria for  PVST contained in the former over the latter. 

Keywords:  Prevertebral soft tissue thickness, cervical vertebra
Mandibular Metastasis from Nasopharyngeal Carcinoma
Authors: Chong Hon Syn , Yunus Mohd Razif Mohd , Lun Chee Lun
Published: April 2019

Objective:  To describe a case of mandibular metastasis from nasopharyngeal carcinoma and review the literature.

Methods:

Design:  Case Report

 

Setting:  Tertiary Public University Hospital

 

Patient:  One

 

Result:  A 42 year-old Malay gentleman underwent concurrent chemoradiotherapy (CCRT) for T4N2M0 (Stage IVa) nasopharyngeal carcinoma (NPC) non-keratinizing type (WHO II). Upon completion of CCRT, he developed metastasis to the left body of the mandible that increased in size despite 3 cycles of adjuvant intravenous chemotherapy. Hemi-mandibulectomy was deferred due to recent irradiation and a further 15 fractions of boost radiotherapy reduced the mandibular metastasis in size, but it has remained the same after six months follow up.

Conclusion:  Nasopharyngeal carcinoma (NPC) is a common malignancy in Oriental Asia and the South East Asian regions. It has the highest rates of nodal and distant metastases among all head and neck cancers. Distant metastasis to bone is common, but we could find no previous report of mandibular bone involvement in the literature.  Radiotherapy remains the main treatment modality and combination with chemotherapy has been shown to improve survival of patients. There are studies on nasopharyngeal carcinoma tumour markers for diagnosis and disease process follow up, but these are still inconclusive.

Keywords: Nasopharyngeal carcinoma, Bones, Mandible, Metastasis.
Nasopharyngeal Carcinoma Presenting as a Dual Territory Stroke: The Hyperdense Artery Sign
Authors: Bickle Ian C.
Published: April 2019

This 63 year-old chinese female, with both diabetes and hypertension, underwent CT imaging of the brain after presenting with a progressive left sided hemiplegia. 

The ‘hyperdense artery sign’ is a generic description that can be evident in any artery of the body on unenhanced CT, occurring due to the presence of intraluminal thrombosis (Figure 1).  It is a well-established sign, most commonly described in CT imaging of the brain, where it is visualised in the vast majority of cases in the middle cerebral artery in the context of an acute cerebral infarction.1   It occurs uncommonly elsewhere, with the internal carotid artery (ICA) and basilar artery being other clinically significant sites. The ‘hyperdense ICA’ sign has been reported to be a reliable and highly specific marker of thromboembolic occlusion of the internal carotid artery.2  The ‘hyperdense artery sign’ is related to the attenuation value of intraluminal thrombus.  The CT attenuation value (Hounsfield unit or HU) of normal blood is dependent on the haematocrit, ranging from 20 to 30 HU.  As the process of thrombus retraction occurs, its water content decreases, increasing the concentration of haemoglobin within the clot.  As a result this raises the attenuation value of the thrombus to 50–80 H. So the term ‘hyperdense’ is given.3

In this case, it proved to be the presenting symptom for an undiagnosed nasopharyngeal tumour, the thrombus likely developing as a complication of the surrounding tumour within the nasopharyngeal recess.  The resultant outcome was a dual territory cerebral infarction of the anterior and middle cerebral artery territories, both supplied by branches of the internal carotid artery (Figures 2a & 2b).
Cerebral Abscess with Rupture into the Ventricles due to Chronic Otitis Media
Authors: Bickle Ian C. , Mohamed Diyana
Published: April 2019

This 43-year-old man with a known history of schizophrenia presented with a one-week history of left ear pain accompanied by a purulent discharge from the external auditory canal over the last 3 days. Shortly afterwards he became confused.

On direct examination, the left ear canal was oedematous containing granulation tissue.

This 43-year-old man with a known history of schizophrenia presented with a one-week history of left ear pain accompanied by a purulent discharge from the external auditory canal over the last 3 days. Shortly afterwards he became confused.

On direct examination, the left ear canal was oedematous containing granulation tissue.
Topical Cepae Extract-Heparin Sodium-Allantoin Gel versus Placebo on Hypertrophic Thyroidectomy Scars: A Randomized, Double- Blinded, Split-Scar Controlled Trial
Authors: Tapangco Michael Paolo M. , Destriza Waynn-Nielsen , Dimacali Bernardo D. , Olveda Mildred B.
Published: April 2019

Objective:  Topical cepae extract-heparin sodium-allantoin gel is one of the  many non-invasive scar treatments available to improve the appearance and physical attributes of scars. This paper aims to compare the effectiveness of topical cepae extract-heparin sodium-allantoin gel versus placebo based on appearance and physical attributes of hypertrophic thyroidectomy scars.

Methods:

            Design: Randomized, double-blinded, split-scar controlled trial

            Setting: Out-Patient Department of a Tertiary Government Hospital

            Participants:  20 patients with hypertrophic thyroidectomy scars had each side of the scar randomly assigned treatment with topical extract.-cepae-heparin sodium-allantoin gel or placebo (glycerine gel). Each product was applied two times daily for 6 weeks, and scars were evaluated prior to initiation of treatment and after 6 weeks by patients and one observer. Pre- and post-treatment photo documentation and scar evaluation using a local language translation of the Patient and Observer Scar Assessment Scale  (POSAS) were completed for each side of the scar.  

Results:  There was no significant  difference in effectiveness of topical cepae extract-heparin sodium-allantoin gel versus placebo for both the patient scale (p = 0.91)  and observer scale (p = 0.87)  in appearance and physical attributes of a thyroidectomy scar.

Conclusions: Topical cepae extract-heparin sodium-allantoin gel was not proven to be superior to the placebo as scar therapy in all parameters assessed by the Filipino translation of POSAS. The small sample size, duration of hypertrophic scar, duration of treatment, and validity and reliability of the Filipino translation of POSAS may have affected our results; and periodic subjective and objective assessments with multi-observer evaluation of scars and pre- and post- treatment photographs may be considered for further studies.

Keywords: Topical Cepae Extract-Heparin Sodium-Allantoin Gel, Glycerine, Patient and Observer Scar Assessment Scale, thyroidectomy scar, scar
Middle Ear Carcinoma Masquerading as an Aural Polyp
Authors: Yong Doh Jeing , Nasir Abd Majid Md , Goh Bee See
Published: April 2019

Objective: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology.

Methods:

Design: Case Report

Setting: Tertiary Public Hospital

Patients: One

Result: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.

Conclusion: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible.

Keywords: Middle ear carcinoma; aural polyp; temporal bone carcinoma
Glottal Function Index and GRBAS Scale of Patients Undergoing Vocal Cord Medialization: A Series of Five Patients
Authors: Papa Enrique C. , Samson Emmanuel S. , Victoria Francisco A.
Published: April 2019

Objectives: Vocal cord paralysis or immobility is a debilitating condition that may result from neural injury or mechanical fixation of the vocal cord (VC).  When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre - and post - operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.

Methods:

Study Design: Descriptive Case Series

Setting: Tertiary Government Hospital

Patients: Five

Results:  Five patients (3 females, 2 males) consulting due to hoarseness underwent rigid endoscopy.  Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord.  One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 from thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice.  The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated well with the improvement of the patient’s subjective symptoms from the GFI scores. However, case 5 with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.

Conclusion: For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.

Keywords: Hoarseness, unilateral vocal cord paralysis, medialization thyroplasty, Glottal Function Index, Hirano GRBAS Score
Transorbital Removal of Foreign Body in the Sphenoid Sinus
Authors: Mendoza Daniel Jose C. , Chua Antonio H. , Castañeda Samantha S.
Published: April 2019

Objective: To report a case of foreign body lodged within the sphenoid sinus and its extraction.

 

Methods:

            Design: Case Report

            Setting: Tertiary Government Hospital

            Patient: One

 

Results: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache, without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized, probably fractured or ruptured.  Transorbital enucleation of the left eye and endoscopic-guided removal of the foreign body (a glass marble) were performed with no intra – operative and post – operative complications.

Conclusion:  Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.

Keywords: Sphenoid sinus foreign body, Computed Tomography (CT), Endoscopic-guided, transorbital approach
Polymorphous Low-Grade Adenocarcinoma
Authors: Bernido Joy B. , Carnate Jose M.
Published: April 2019

A 60-year-old woman with a 3-year history of a gingivoalveopalatal mass underwent an incision biopsy.

Microscopically, the lesion centered in the stroma is infiltrative (Fig. 1) and architecturally diverse, having cystic (Fig. 2), linear or “Indian file” (Fig. 3), solid, and tubular (Fig. 4) patterns.  The cells are uniform in size, round to oval, and have bland cytologic features, with vesicular nuclei and inconspicuous nucleoli (Figure 4). The clinical data and histomorphologic features characterized by architectural diversity yet cytologic blandness lead us to the diagnosis of polymorphous low-grade adenocarcinoma.  

Polymorphous low-grade adenocarcinoma (PLGA) is a malignant epithelial tumor characterized by cytologic uniformity, morphologic diversity, an infiltrative growth pattern, and low metastatic potential.1 It is the second most common intraoral malignant salivary gland tumor 1 following mucoepidermoid carcinoma.  The tumor is found almost exclusively in minor salivary glands and is rare in extraoral locations, including major salivary glands.2 The tumor affects a wide age range (16 – 95 years; mean 60 years), with only 2 pediatric cases reported,1 and has a female predilection.3,4  It usually presents as a painless mass located within the oral cavity,3 60% of which are located in the palate.1  They are characteristically unencapsulated, although well-circumscribed.3 

 

This entity is architecturally diverse (“polymorphous”) even within a single tumor, with solid, tubular, trabecular, cribriform, papillary and linear patterns being described. Perineural invasion is common although it was not seen in this case.  The tumor cells are small to medium sized, and uniformly round to polygonal.  The nuclei are bland and vesicular, with occasional small inconspicuous nucleoli. Mitotic figures can be found occasionally but are never numerous.3, 8

 

The morphologic heterogeneity in small biopsies and frozen section samples can be confused with pleomorphic adenoma and adenoid cystic carcinoma.6,7 Glial fibrillary acid protein may help as PLGA is typically non-reactive in contrast to pleomorphic adenoma.2  De Araujo and others site that uniformly positive vimentin, CK7, and S100 staining favors PLGA over adenoid cystic carcinoma.6  Tumor cytology and histology are quite characteristic - recognizing the constant cytological appearance despite the diversity of architectural tumor patterns should aid one in diagnosing PLGA.

PLGA, despite its infiltrative growth pattern and propensity for perineural invasion, usually runs an indolent course.  Nodal metastasis and distant spread are rare, occurring in less than 1% of cases.4 Seethala and others report that extrapalatal location is associated with a more aggressive clinical course.5 Complete surgical excision is the primary treatment with neck dissection reserved for nodal metastasis.1 One-third of patients may have a local recurrence and lifelong monitoring is suggested. Re-excision is amenable in these cases.5,6
CNS Imaging is Essential in Acquired Bilateral Vocal Fold Dysfunction in Children
Authors: Berkowitz Robert
Published: April 2019

Dear Sir,

 

I greatly enjoyed reading the paper by David and Lim on “Congenital Bilateral Vocal Fold Paralysis”1 and complement the authors on their excellent surgical outcome.  They also very appropriately underscored the primacy of careful clinical assessment over costly investigations, particularly in an environment of scarce resources.

 

We have previously reported on the MRI findings in 23 children with bilateral vocal fold dysfunction (BVFD) as an isolated abnormality that was present at birth.  We found MRI abnormalities in 35%, but these were all non-specific.2 This study indicated that MRI was of research and clinical value, but did not identify any major CNS structural abnormalities in this patient group.

 

However, the case reported by David and Lim involved the delayed onset of symptoms at 2 years of age that may have increased over the next 3 years.  This acquired and possibly progressive disease process differs from that of congenital BVFD.  The likelihood of Arnold-Chiari malformation or another significant structural CNS abnormality being present would appear to be higher when symptoms of BVFD are acquired later in life compared to when they are present at birth.

 

Anecdotally, I have been involved with a case of acquired BVFD presenting at a similar age where the underlying cause was found to be a posterior fossa tumour.  The 3 year history of symptoms in the child in the case report would very likely preclude this diagnosis, but certainly another CNS cause needs to be considered to explain the development of delayed-onset brainstem dysfunction, and this would require MRI.

 

 

Robert Berkowitz

Department of Otolaryngology

Royal Children’s Hospital

Melbourne, Australia
3D Stereolithographic Modeling of Inverted Papilloma
Authors: Bickle Ian C.
Published: April 2019

This middle-aged woman presented for the first time to ENT clinic with a complaint of nasal stuffiness.

Computed Tomography (CT) of the paranasal sinuses was performed following clinical review that revealed a left intranasal mass.

Due to a radiological suspicion of an inverted papilloma, Magnetic Resonance Imaging (MRI) of the paranasal sinuses was performed.

This, combined with endoscopic biopsy confirmed an inverted papilloma.

Following referral to oral maxillofacial surgery (OMF), 3D modelling was performed using the original CT data to aid surgical planning.

DISCUSSION

Dramatic technological advancements in the fields of medical imaging and computer aided design (CAD) in the past decade have enabled sterolithographic 3D modelling to evolve from a research aspiration to everyday reality.

The widespread availability of high-resolution volumetric data sets, providing isotropic imaging from cross-sectional imaging studies allows for exquisite 3D model production using rapid prototyping techniques.1

Although its domains are ever widening, its use is most established in the fields of oral maxillofacial (OMF) surgery and otolaryngology enabling surgical planning in anatomically complex areas which often require lengthy and complex surgery.2 Similarly, in these fields the 3D modelling assists in prosthesis design and production, with additional professional advantages, such as teaching aids and aiding patient consent.

In this illustrative case a mass occupies the left ethmoidal and frontal sinuses with destruction of the floor of the anterior cranial fossa (Figure 1 A,B) with further delineation on MRI (Figure 2 A,B). This case of an inverted papilloma illustrates the tremendous assistance that 3D modelling offers to the surgeon in examining the anatomical extent of the tumor, visualising their surgical approach and planning the operative procedure. (Figure 3)  For example, in this case a combined procedure between the OMF and the neurosurgery departments was undertaken with a bifrontal craniotomy and maxillectomy.  Operating times have also been shown to improve following the use of 3D models as preparation prior to surgery is more robust.3
Chemodectoma and Tetralogy of Fallot
Authors: Santiago Kathleen Joy B. , Samio Lian Melissa R. , Roldan Rodante A. , Castañeda Samantha S.
Published: April 2019

Objectives: To describe a rare case of chemodectoma, its clinical features and management, and to discuss its relationship chronic hypoxia from Tetralogy of Fallot.

Methods:

Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

Result: A 23-year-old woman presented with a painless, slow growing, movable right submandibular mass, initially diagnosed as a lipoma by fine needle aspiration biopsy.  Computed tomography scan showed a solid nodule with ill-defined margins from the angle of the mandible to the level of the hyoid bone along the carotid sheath. There was also an incidental finding of patent ductus arteriosus and Tetralogy of Fallot on pre-operative clearance. Excision of the mass under general anesthesia revealed adherence to the posterior portion of the carotid trunk enveloping both the internal & external carotid artery. Final histopathological diagnosis was chemodectoma.

Conclusion: Although rare, chemodectoma should be considered as one of the differentials in a patient with a submandibular mass. Hyperplastic chemodectoma may result from chronic hypoxia due to Tetralogy of Fallot.  Surgical excision is the treatment of choice.

 

Keywords: Carotid Body Tumor, Chemodectoma, Paraganglioma, Tetralogy of Fallot