bluuebunny/crossref_metadata_2025_split huggingface dataset:
When is a Vestibular Aqueduct Enlarged?
Authors: Yang Nathaniel W. 
Published: April 2019

A ten-year-old boy with bilateral moderate sensorineural hearing loss underwent computerized tomographic (CT) imaging (GE Brightspeed, Wisconsin, USA) of the temporal bone as part of the work-up to determine the etiology of his condition. The formal radiologic interpretation of the scan stated that the vestibular aqueducts were not enlarged. However, independent review of the axial CT images appeared to indicate the presence of enlarged vestibular aqueducts. (Figure 1) This can be contrasted with a scan from another patient with no evidence of sensorineural hearing loss. (Figure 2)
What can explain the discrepancy between the two?

If simple visual inspection of the vestibular aqueduct (VA) can lead to conflicting interpretations, then what radiographic parameters can be used to resolve the issue? Is there a more objective means of determining the presence of a clinically significant vestibular aqueduct enlargement?

In 1978, Valvasorri and Clemis1 first described an association between congenital sensorineural hearing loss and an abnormality in vestibular aqueduct anatomy which they labelled as the “large vestibular aqueduct syndrome.” In this landmark study that utilized hypocycloidal polytomographic temporal bone studies, they proposed that a vestibular aqueduct is enlarged when its midpoint diameter is greater than 1.5 mm. Although this parameter is generally considered to be the defining characteristic of the condition, one must realize that this measurement was based on less accurate imaging technology and measurement tools. Contemporary studies utilize high-resolution CT imaging with digital workstation measurement software to evaluate vestibular aqueduct anatomy. Currently, the two most commonly used radiographic parameters are the VA midpoint (MP) width and the VA opercular (OP) width. (Figure 3)
More recently, Boston et al.2 in 2007 published normative values for these parameters based on a study population of 73 children without known sensorineural hearing loss. They considered a vestibular aqueduct enlarged when one or both of the measured widths were above the 95th percentile of the normal study group measurements. On this basis, a VA midpoint width of >0.9 mm and/or a VA opercular width of >1.9 mm was the criteria established to define an enlarged vestibular aqueduct.

The patient’s measured vestibular aqueduct midpoint width on the right was 2.1 mm, while the vestibular aqueduct opercular width was 2.9 mm. (Figure 4) These measurements, when evaluated against either the original Valvassori criteria or the newer criteria of Boston et al., confirm what was visually apparent– the presence of a clinically significant enlargement of the vestibular aqueduct as the etiology of the patient’s sensorineural hearing loss.
Spindle Cell Carcinomas of the Upper Aerodigestive Tract
Authors: Carnate Jose M. 
Published: April 2019

A 65-year-old male with a two-month history of cough and hoarseness underwent direct laryngoscopy which showed a 1.5 cm diameter polypoid glottic mass. A polypectomy was performed revealing spindle cell carcinoma.

The World Health Organization (2005) defines a spindle cell carcinoma as “a biphasic tumor composed of a squamous cell carcinoma, either in-situ and/or invasive, and a malignant spindle cell component with a mesenchymal appearance, but of epithelial origin.”1 Spindle cell carcinomas go by a variety of synonyms such as sarcomatoid carcinoma, spindle cell squamous carcinoma and carcinosarcoma.

The larynx is a preferred site of involvement where they often present as polypoid masses.1,3 Microscopic examination often shows predominance of the sarcomatoid, spindle-cell component, which can range from fairly bland, reactive-looking fibroblastic-proliferation-like processes, to cytologically malignant and mitotically active proliferations that mimic other spindle-cell sarcomas such as leiomyosarcoma, fibrosarcoma or malignant fibrous histiocytoma.1,2,3 (Figure 1, double arrows) The squamous cell carcinoma component may be in the form of an overlying carcinoma-in-situ, or of a focal keratinizing invasive squamous cell carcinoma that requires multiple sections to disclose.1,2 (Figure 1, single arrow) Cytokeratin-reactivity in the spindle cells, which may be quite focal as in this case, points to their epithelial derivation.1,2,4 (Figure 2)
Favorable prognostic findings include polypoid morphology and, like conventional laryngeal squamous cell carcinomas, a low-stage and a glottic site of origin. Reported 5-year survival rates range from 65 – 95%.1
Ectopic Thyroid Tissue: A Case Series
Authors: Saha Somnath , Ghosh Anirban , Pal Sudipta , Saha V Padmini 
Published: April 2019

Objective: To describe the clinical presentation and course of seven ectopic thyroid patients.
Methods:
Design: Retrospective Chart Review
Setting: Tertiary Government Teaching Hospital
Subjects: Seven patients
Results: Five patients were female and two were male (ratio of 5:2). Three belonged to the 20 to 30 year-old age group, whereas two were below 10 years of age. All seven were biochemically hypothyroid and ectopic thyroid was found to be the only functioning thyroid tissue.Three patients were managed medically with levothyroxine, while ectopic thyroid was excised in four. Ectopic thyroid tissue was autotransplanted in two cases following excision.
Conclusion: The ages of presentation in the present series correspond with the increased physiological demand of thyroid hormone. Thyroid substitution therapy is a must in the presence of clinical and/or biochemical hypothyroidism. Surgical excision should be avoided as far as possible especially if the ectopic tissue is the only functioning thyroid in the body. Surgery is required in selected cases presenting with obstructive symptoms or hemorrhage which are unresponsive to substitution therapy. Auto transplantation of the ectopic thyroid may not provide significant benefit to the patient and more research is warranted in this aspect.
Keywords: ectopic thyroid, lingual thyroid, thyroid replacement therapy, ectopic thyroid surgery.
Vocal Cord Paralysis and Dysphagia as Sequelae of Gradenigo Syndrome
Authors: Macasaet Mary Ann V. , Cruz Emmanuel Tadeus S. 
Published: April 2019

Objectives: To present a case of vocal cord paralysis and dysphagia developing in Gradenigo syndrome and to discuss its clinical presentation, differential diagnosis and therapeutic approach.

Methods:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One

Results: A 54-year-old lady was admitted with a six month history of left-sided otorrhea, cheek and jaw pain, three months otalgia, and recent-onset hoarseness, dysphagia and diplopia on a background of mastoidectomy at age 6. Otoscopy revealed granulation tissue and chlolesteatoma occupying the left external auditory canal. There was left vocal cord paralysis with pooling of saliva in the pyriform sinus, left lateral gaze paralysis, and left facial nerve paralysis. CT scan revealed sclerosis of the left petrous apex and leptomeningeal enhancement on the left temporal lobe. Chronic suppurative otitis media with cholesteatoma and Gradenigo syndrome was diagnosed, and canal wall down mastoidectomy was performed Postoperatively, the otalgia and pain over the left jaw diminished in intensity while hoarseness and left lateral gaze palsy remained.

Conclusion: Gradenigo syndrome is known for its triad of retro-orbital pain, lateral gaze paralysis, and chronic middle ear infection due to petrous apicitis. Although rare, vocal cord paralysis and dysphagia may develop when infection traverses and encroaches on the jugular foramen where cranial nerves IX, X, and XI are lodged. Knowledge of the syndrome should not be limited or confined to the classic triad. Practicing ear specialists should be vigilant and cognizant of the clinical manifestations and sequelae of chronic middle ear infection. Prompt surgical intervention is crucial while resolution of the disease may vary for different individuals.

Keywords: Chronic otitis media, Gradenigo syndrome, vocal cord paralysis, petrous apicitis
Tomas C. Carvajal, MD (1936 - 2013)
Authors: Carvajal Theodore M. 
Published: April 2019

“My Mentor… My Inspiration… My Dad”

“The righteous who walks in his integrity—blessed are his children after him! ”
Proverbs 20:7

Dr. Tomas Carvajal at 76 years old, had practiced for over 40 years as an Emeritus Consultant at Our Lady of Lourdes Hospital in Sta. Mesa, Manila, where he started his Residency Training. Early on, he learned to love the ENT specialty and underwent preceptorship under the wing of Dr. Ariston Bautista. At that time, there was no training program in the Philippines. He went abroad and was accepted to train in Berlin, Germany at the Rodolf Virchow Krankenhaus Department of Ear Nose and Throat under Professor Peffniz. After his training in Germany, to further hone his knowledge and skills, he underwent post graduate training at the Royal National Ear, Nose and Throat Hospital in London, England and Wakayama Medical Center in Osaka, Japan specializing in Nasal Allergy.
On returning to Manila, he was invited to be an Assistant Professor in Otorhinolaryngology at the Far Eastern University – College of Medicine and a Consultant at the FEU Hospital then in Morayta, Manila. He was also appointed Medical Specialist Examiner under the then Ministry of Health. Later, he became the first Chairman of the Department of Ear Nose Throat – Head and Neck Surgery (1986-1993) at the FEU Hospital. During the same time he was also Chairman at the Quirino Medical Center Department of Eye Ear Nose and Throat (EENT).
Since then he had helped a lot of people-- including colleagues, friends and neighbors, and he was thus invited by former President Erap Estrada and Senator Jinggoy Estrada to run for city councilor in San Juan City where he served for two consecutive terms (2000-2006).
My father lived a fruitful and blessed life. He was loved and praised by everyone. It was he who inspired me to become an ENT doctor, it was he who guided me, giving me pointers during my residency training, and it was he who taught me too about LIFE….
“Thank you Dad!”
Effectivity of Guava leaves (Psidium guajava) as Mouthwash for Patients with Aphthous Ulcers
Authors: Guintu Ferdinand Z. , Chua Antonio H. 
Published: April 2019

Objective: To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers
Methods:
Study Design: Randomized prospective open label clinical study
Setting: Tertiary Government Training Hospital
Subjects: Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash, given thrice a day for seven days. Patients were evaluated using a 10 point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on day 1 and day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test, and Fisher Exact test.
Results: Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on days 1 and 2. However, the VAS scores from day 3 to 7 had p values ranging from 0.02 - 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution.
Conclusion: Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended.
Keywords: Guava leaves (Psidium guajava), aphthous ulcers, mouthwash
Nasal Glial Heterotopia: Unsuspected Brain Tissue in the Nasopharynx
Authors: Daffon Dan Valeriano F. , Calderon Alberto F. , Victoria Francisco A. 
Published: April 2019

Objective: To report a case of ectopic brain tissue in the nasopharynx; discuss the differential diagnoses for and management of, this unilateral nasal mass in a pediatric patient, and describe the diagnostic difficulties and eventual treatment.
Methods:
Study Design: Case Report
Setting: Tertiary Government Hospital
Participant: One

Results: A 13-year-old boy consulted with an obstructing mass in the nasopharynx and severe muscle wasting, weight below his age and concurrent anemia. CT-scan revealed a soft-tissue mass occupying a maxillary sinus and nasopharynx consistent with an antrochoanal polyp. Initial biopsy revealed a papilloma, but the clinical picture warranted preoperative preparations for a possible vascular tumor such as juvenile angiofibroma. Transpalatal excision and final histopathology yielded nasal glial heterotopia.
Conclusion: When confronted with a unilateral nasal mass in a pediatric patient, aside from the usual considerations, embryologic anomalies particularly those of the intracranial protrusion variety should be strongly considered. Scrupulous preoperative evaluation and sufficient diagnostic modalities must be pursued in order to arrive a correct diagnosis, treatment plan and prevent possible complications especially those related to intracranial communication.
Keywords: Nasal glioma, glial heterotopia, congenital nasal masses
Congenital Maxillomandibular Fusion: A Rare Case of Isolated True Bony Syngnathia
Authors: Aguiling Patrick O. , King-Chao Nikki Lorraine Y. , Veloro Lyra V. 
Published: April 2019

Objective: To present a rare case of congenital maxillomandibular fusion or syngnathia.
Methods:
Study Design: Case report
Setting: Tertiary Private Teaching Hospital
Patient: One
Results: A 3-year-old girl with oral adhesion (syngnathia) caused by a mandibular to maxillary fibrous band underwent successful surgical division of maxillomandibular bony fusion. Subsequent monitoring and serial oral dilations were performed post operatively, resulting in mouth opening of 24mm over a period of 3 months. Currently, the patient is able to tolerate a general liquid diet.
Conclusion: Congenital maxillomandibular fusion is a very rare condition with few cases reported. We hope this report contributes to its diagnosis and management in other children.
Keywords: Congenital maxillomandibular fusion, syngnathia
A Rare Case of Vertebrobasilar Dolichoectasia Presenting with Ipsilateral Facial Paresis and Concomitant Severe Sensorineural Hearing Loss
Authors: Tang Mee Ling , Revadi Govindaraju , Rajagopalan Raman , Brito-Mutunayagam Sushil 
Published: April 2019

Objective: To report a case of vertebrobasilar dolichoectasia presenting with ipsilateral facial nerve paresis and concomitant severe sensorineural hearing loss.

Methods:
Design: Case Report
Setting: Secondary Government Hospital
Patient: One

Results: We report a case of vertebrobasilar dolichoectasia with concomitant ipsilateral facial nerve paresis and severe sensorineural hearing loss in an elderly female. She presented to us with left facial nerve palsy House-Brackmann Grade III with prior history of ipsilateral sensorineural hearing loss. MRI of the brain showed normal inner ear structures, but revealed a dilated and tortuous basilar artery with compression on the left medulla and possible branches of anterior inferior cerebellar artery as it coursed superiorly, and possible partial thrombosis of proximal basilar artery.

Conclusion: Concommitant facial nerve paresis and sensorineural hearing loss can be the clinical presentations of this rare but important condition. MRI is vital in diagnosing vertebrobasilar dolichoectasia.

Keywords: Vertebrobasilar dolichoectasia, facial nerve palsy, sensorineural hearing loss, basilar artery
Calcifications in Thyroid Ultrasonography and Thyroid Carcinoma
Authors: Sio Maria Christina D. , Uy Jacqueline Austine U. , Soriano Ronaldo G. 
Published: April 2019

Background: Thyroid nodules are a common disease entity occurring in 5-10% of the general population and increasing with age. Their detection on ultrasonography ranges from 13% to 67%. Calcifications on ultrasound may occur in both benign and malignant diseases, but have been cited for increased risk of thyroid carcinoma.
Objective: To determine the association of calcifications found on thyroid ultrasonography and the different types of calcifications with thyroid carcinoma.
Method:
Study Design: Retrospective Study
Setting: Tertiary Private Hospital
Participants: 126 patients with pre-operative thyroid or neck ultrasonography who subsequently underwent thyroidectomy (total or subtotal, with or without frozen section) were selected from a database covering a one-year period from January to December 2012. The presence and type of calcification on ultrasonography was correlated with the final histopathologic report for a diagnosis of thyroid carcinoma. Sensitivity, specificity, positive and negative predictive values were obtained.
Results: 51 out of 126 studies (40%) were observed to have calcifications of any description, in both histologically benign (41%) and malignant (59%) nodules. Calcifications seen in malignancy arose from papillary carcinoma (86%). Follicular carcinoma and others (Plasmacytoma and Lymphoma) accounted for 7% each. The peripheral type of calcification was most prevalent accounting for 37% (11 out of 30). The sensitivity of detecting calcifications on ultrasonography is 58.82%, specificity 81.33%, positive predictive value 68.18% and negative predictive value 74.38%. Chi square test computed was 21.54 (P <0.05).
Conclusion: There was an association between calcification found on ultrasonography and thyroid carcinoma and 86% of the calcifications were peripheral patterns, mostly found in papillary thyroid carcinomas. Ultrasonography alone is not sufficient in diagnosing thyroid carcinoma, but may increase the suspicion of malignancy depending on the type of calcification.
Keywords: Thyroid carcinoma, papillary carcinoma, calcifications, ultrasonography
Sensorineural Hearing Loss: What Lies Beneath? Neurovascular Conflict Secondary to a Dural Arteriovenous Malformation
Authors: Bickle Ian C. 
Published: April 2019

This middle-aged gentleman with no previous medical history presented to the local ENT outpatient clinic complaining of right-sided hearing loss. No history of trauma or previous head and neck surgery was elicited.
Following clinical and auditory assessment a right sensorineural hearing loss was confirmed. A right-sided facial palsy was additionally identified on examination.
A MRI of the internal auditory meati was performed (Figure 1a & 1b). Following radiologist review, MRI and MRA of the brain was undertaken.

DISCUSSION

Auditory impairment is a condition with a legion of potential causes. One of the routine aspects of the assessment process for those with sensorineural hearing loss is MR imaging (MRI) of the internal auditory meati (IAMS).

The vast majority of MRI studies are normal, however one of the more commonly identified pathologies are cerebrovascular abnormalities. The most well recognised is neurovascular conflict of the vestibulocochlear nerve by a vascular loop at the root entry zone (REZ), however a broader range of potential responsible structural abnormalities are known. A wide range of processes for auditory dysfunction have been outlined.1 These include; cerebral ischaemia events, subarachnoid haemorrhage, cerebrovascular malformations and rarely dural arteriovenous fistulas (dAVFs).

Dural AVF's are abnormal vascular communications between the dural venous sinuses and an arter(ies) - most frequently branches of the external carotid artery. Sensorineural hearing impairment is one of the rarer presenting symptoms. The mechanism for hearing impairment is believed to result from either direct vascular compression on the vestibulocochlear nerve from an enlarged aberrant draining vein or from a vascular steal phenomenon (Figures 2a & 2b). An engorged draining vein from the dAVF causing mechanical compression on the nerve is the most well recognized.2 A single prior case has been reported of compression from an intraossesous dAVF of the skull base.3

The arteriovenous fistula may be directed identified (Figure 3) along with the associated signs of enlarged cerebral cortical veins and white matter change of venous hypertension (Figure 4).
Pterygopalatine Fossa Infiltration: A Radio-Anatomic Study among Adult Patients in a Tertiary Private Hospital
Authors: Apale Neil Louis L. , Romualdez Joel A. , Rivera Rodolfo E. , Lu Joseph Benjamin M. 
Published: April 2019

Objective: As a guide to the clinical practice of infiltration of local anesthesia into the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the mean CT scan measurements of the following: 1) palatal mucosal thickness, 2) length and width of greater palatine canal, and 3) length and width of pterygopalatine fossa, among adult patients in a private tertiary hospital in Quezon City.
Method:
Study Design: Retrospective, Descriptive Study
Setting: Tertiary Private Hospital
Participants: Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.
Results: Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99 mm greater palatine canal length, 18.75 mm pterygopalatine fossa length, 2.37 mm greater palatine canal width, and 2.58 mm pterygopalatine fossa width. Comparison of average measurements by sex was not statistically significant. There was statistical significance when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm, with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the left side at 19.01 mm, showed statistical significance with p-value of 0.01.
Conclusion: As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from the tip in a 45 degree angle, for adult patients who will undergo sinus surgery, control of posterior epistaxis, trigeminal nerve block, and minor oral cavity surgeries.
Keywords: pterygopalatine fossa infiltration, greater palatine canal, greater palatine foramen, regional anesthesia blocks