bluuebunny/crossref_metadata_2025_split huggingface dataset:
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