Objective: To report an alternative combined gingivobuccal and endoscopic endonasal approach to treating ossifying fibroma of the left maxilla. Methods: Design: Case Report. Setting: Tertiary Private University Hospital. Patient: A 19-year-old girl with a progressively enlarging left cheek mass for 3 years. Results: Our patient underwent left medial maxillectomy via a combined gingivobuccal and endoscopic endonasal approach with complete resection and significant improvement of symptoms, with good functional outcome. Conclusion Large ossifying fibromas of the maxilla can be completely and successfully excised via a combined gingivobuccal and endoscopic endonasal approach.
Cementoma ; Sino-Nasal Outcome Test ; Visual Analog Scale

p style=text-align: justify;strongOBJECTIVE:/strong To describe an unusual presentation of undifferentiated nasopharyngeal malignancy with immunohistochemical features of both diffuse B-cell lymphoma and undifferentiated carcinomastrong./strongbr /br /strongMETHODS:/strongbr /strongDesign:/strong Case Reportbr /strongSetting/strong: Tertiary Private University Hospital br /strongPatient:/strong Onebr /br /strongRESULTS:/strong A 49-year-old female whose initial nasopharyngeal biopsy interpretation was diffuse large B-cell lymphoma underwent three cycles of Rituximab, Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisone (R-CHOP). Post-chemotherapy Computed Tomography (CT) scan of the nasopharynx revealed no change in tumor size or appearance. Repeat nasopharyngeal (NP) biopsy findings suggested an epithelial tumor lineage or post-chemotherapy reactive mucosal epithelial cells. No residual lymphoma was noted and immunostaining was positive for cytokeratin. The patient underwent 35 fractions of radiotherapy. Re-evaluation by Magnetic Resonance Imaging (MRI) with contrast after four months showed significant tumor shrinkage. Repeat NP biopsy revealed necrotic tissues with foci of high-grade squamous cell carcinoma. Two months after the biopsy, repeat MRI with contrast of the nasopharynx and neck showed increase in the bulk of the nasopharyngeal tumor with inferior extension to the level of the orophaynx and possible contralateral involvement. A nasopharyngectomy via left maxillary swing was performed and the final histopathology was undifferentiated carcinoma.br /br /strongCONCLUSION:/strong Undifferentiated malignancies of the nasopharynx may contain lymphoma or carcinoma and rarely, both lineages in coexistence. In such cases, the possibility of a collision tumor should be considered. Immunohistochemical distinction is important for treatment and prognostication./p
Human ; Female ; Middle Aged ; NASOPHARYNGEAL NEOPLASMS-drug therapy ; NASOPHARYNX ; LYMPHOMA ; CARCINOMA ; Cyclophosphamide ; Vincristine ; Prednisone

Background and Objectives: This case series is aimed to introduce a new term, antrovestibular polyp (AVP), for an antral polyp herniating anteriorly toward the nasal vestibule and to describe an antral polyp direction of growth through the anterior and posterior fontanelles.Materials and Method: This is a retrospective study involving review of patients who underwent surgery due to maxillary sinus polyp herniating anteriorly toward the nasal vestibular area or posteriorly toward the choana at a tertiary training hospital from January 2007 through July 2016. Their demographic data, computed tomography scan findings, and endoscopic evaluations were analyzed. Results This study included 49 subjects; 8 (16.33%, 6 males) with AVP and 41 (83.67%, 24 males) with antrochoanal polyps (ACP). The mean ages of AVP and ACP patients were 9 and 14.4 years, respectively (p=0.006). The subjects were identified as AVP when computed tomography scan showed an antral polyp directed anteriorly toward the nasal vestibular area, while polyps growing toward the choana were identified as ACP. Endoscopic review showed that AVP grew out through an accessory ostium located anterior to the uncinate process at the area of the anterior fontanelle, while ACP started from an accessory ostium of the posterior fontanelle or a widened maxillary natural ostium.

OBJECTIVES: This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease. METHODS: This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed. RESULTS: The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016). CONCLUSION: With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.
Aging ; Atrophy ; Humans ; Mucous Membrane ; Nasal Mucosa ; Retrospective Studies ; Turbinates

Objective: This study aims to determine the prevalence of supraorbital ethmoidal cells (SOEC) among Filipinos in a single tertiary government institution. Methods: Study Design: Retrospective review of CT scan images. Setting: Single Tertiary Institution. Patients: 123 patients aged 13-years-old and above. Results: A total of 474 CT scans (60 PNS and 414 Craniofacial) performed during the study period were considered, with 55 excluded for age < 13, and 296 excluded for craniofacial fractures. None had congenital craniofacial deformities. Eighty-five of 123 CT scans (69.11%) or 147 of 246 sides (59.76%) demonstrated supraorbital ethmoidal cells. There were 62 (72.94%) males and 23 (27.06%) females, ages ranging from 13 to 83 (mean age between male and female was 39.53 and 43.57). The scans showed 62 (50.41%) patients with bilateral and 23 (18.70%) with unilateral SOEC. Twenty-two (25.9%) patients were identified with chronic rhinosinusitis and two of whom were considered to have maxillary sinus mass. Two out of 5 patients with SOEC presented with aplastic/hypoplastic frontal sinus. Conclusion Our study suggests that Filipinos may have a higher prevalence rate of SOEC than their Chinese, Japanese and Korean counterparts and bilateral SOEC are more predominant than unilateral SOEC.
Tomography, X-Ray Computed ; Frontal Sinus

Background: Olfactory dysfunction (OD) in COVID-19 presents as a sudden onset smell loss commonly seen in mild symptomatic cases with or without rhinitis but can occur as an isolated symptom. The reported prevalence of OD among COVID-19 patients ranged from 5% to 98%. Although numerous studies have been conducted about their association, these were mainly based on self-reported cases and subjective questionnaires. Objective: This study investigates whether there is a significant difference in the prevalence of olfactory dysfunction between self-reported and objective testing using validated objective olfactory tests among RT-PCR confirmed COVID-19 patients. Methods: PubMed (MEDLINE), Cochrane, Web of Science, and Google Scholar were searched for studies investigating the prevalence of OD by using objective olfactory tests among patients who self-reported OD (November 1, 2019 to July 31, 2020). All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of objective olfactory test, and results of self-reported OD and objective testing were reported. Results: Nine studies encompassing 673 patients met the inclusion criteria. Validated objective olfactory tests used in the included studies were CCCRC, SST and SIT. Overall prevalence of OD among patients who self-reported was higher after objective testing (71% versus 81%). This was also seen in when we performed subgroup analysis based on the objective tests that were used. However, meta-analysis using random effects model showed no significant difference in the overall prevalence of OD (p value=.479, 95% CI 56.6 to 84.0 versus 71.2 to 89.8) as well as in the subgroups. Conclusion To the best of our knowledge, this is the first meta-analysis that statistically reviewed articles that evaluated the difference between self-reported and objective tests done on the same patients. Results showing that self-reporting OD approximates the results of the objective tests among COVID-19 positive patients may imply that self-reporting can be sufficient in contact tracing and triggering swabbing and self quarantine during the time of COVID-19 and objective tests can be used as an adjunct in the diagnosis particularly in research. However, this study was limited by small sample size and articles done in European countries hence, interpretation and application of the results of this study must be approached with care. Further studies documenting the difference between self-reporting and objective test in large scale setting involving different countries may be helpful in establishing a definitive consensus.
Anosmia ; SARS-CoV-2 ; Pandemics

Objective: To compare the radiographic features of the nasal septal swell body (NSB) with the laterality of nasal septal deviation and investigate whether there is a correlation between the severity of the septal deviation and difference in NSB size. Methods: Design: Retrospective Observational Study. Setting: Tertiary Private University Hospital. Participants: 30 paranasal sinus computerized tomography scans from January to October 2017. Results: A septal deviation was present in 60% of the subjects. In 78% of cases with septal deviation, the NSB was noted to be significantly larger on the side opposite the nasal septal deviation (p < .05). Conclusion The correlation between the severity of the septal deviation and difference in NSB size had a value of (r = 0.37) therefore, no positive correlation was established. Subjects with almost symmetric NSB measurements tend to have no septal deviation. On the other hand, the NSB is more prominent contralateral to a septal deviation.
Paranasal Sinus Diseases ; Hypertrophy ; Turbinates

Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis.
Ophthalmic Artery ; Blindness

Objective: To determine the relationship between olfactory function threshold and quality of life (QOL) among adult Filipinos with perceived olfactory dysfunction (OD). Methods: Design:Cross - Sectional Study. Setting:Tertiary Government Training Hospital. Participants: 98 adults who had self-perceived olfactory dysfunction described as “poor” or “no sense” of smell Results: We analyzed data from 98 participants, with a mean age of 35.91 + 12.58 years old, composed of 46 men (47%) and 52 women (53%), with 82 normosmic, six hyposmic and ten anosmic as categorized by their BTT scores. Twenty-seven percent (27%) identified themselves as having poor QOL based on Fil 17 QODNS. Differences were exhibited between sexes’ BTT scores - [t(96) = -2.32; p = .022; females, M: 9.25; SD: 2.33 vs. males, M: 7.76; SD : 3.91], civil status - Fil17QODNS scores [t(96)= 3.05, p < .003; married M: 11.72, SD: 13.74 vs. single, M: 4.71; SD: 8.66), and the presence of ENT symptoms BTT [t(96) = -7.15; p < .0001; symptomatic, M: 5.62; SD: 4.54, vs. asymptomatic, M: 9.78; SD: 1.14] and Fil 17 QODNS scores [t(96)= 3.94; P < .00001; symptomatic, M: 14.86; SD: 13.97] vs. asymptomatic, M: 5.217; SD: 9.60]. Significant risk factors were the presence of ENT symptoms [OR= 0.15; 95% CI: 0.02-0.97; P = .046] for poor smell threshold, and comorbidities [OR= 3.36; 95% CI: 1.04-10.85; P = .043] for poor QOL. A negative correlation was observed between Fil-QOD-NS scores and BTT scores [r = -0.477, p < .001; rs = -0.292, p = .004], signifying that the presence of olfactory dysfunction has an inverse relationship with the quality of life. Conclusion Individuals with olfactory dysfunction in this study population had poor quality of life as determined by the translated Filipino 17-item QOD-NS which has an inverse relationship with their smell threshold as represented by the BTT results. Among the factors studied, significant differences were found between sexes, civil status and presence of ENT symptoms in the BTT and Fil 17 QODNS scores. However, only presence of comorbidities and ENT symptoms are significant risk factors for quality of life and smell threshold, respectively, in this population.
Smell ; Quality of Life