Acute laryngeal trauma is a great challenge for the otoloaryngologist. Early recognition, accurate evaluation and proper treatment may be crucial to immediate survival and long-term function. Objective:To describe an endoscopically-guided open reduction and adaptation plate fixation of an acute laryngeal fracture secondary to vehicular accident. Methods: a. Study Design: Surgical Innovation/ Case Report b. Setting:Tertiary Hospital in Metro Manila Results: Post-operative follow-up showed good vocal fold function and arytenoid position, with no food regurgitation, signs of aspiration or penetration on fiberoptic endoscopic evaluation of swallowing Conclusion: Endoscopic guidance allows higher magnification minimizing iatrogenic mucosal damage during manipulation. (Author)
LARYNX

The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis muscle-coronoid swing is rendered insufficient for orbital reconstruction. Objective: To describe a combination of forehead island flap and temporalis muscle-coronoid swing in orbital reconstruction. Design: Surgical Innovation/ Case Report. Subject: 12-year-old female with recurrent maxillary chondroblastic osteosarcoma one year after chemotherapy. Methods: The course of tumor excision and defect reconstruction is described. Results:There was no diplopia or other morbidity.There was minimal added operative time for reconstruction with acceptable results. Conclusion: Local flaps can be combined in order to repair the orbital floor. Acceptable function with minimal cosmetic deformity can be achieved with less extensive surgery. (Author)
FOREHEAD TEMPORAL MUSCLE ORBIT RECONSTRUCTIVE SURGICAL PROCEDURES SURGICAL FLAPS

Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97 percent to 2.54 percent. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)
AUDIOMETRY AUDIOMETRY ; PURE-TONE OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE LOGISTIC MODELS HEARING TESTS SUPPURATION

OBJECTIVE: To determine the types and prevalences of laryngeal pathology among patients undergoing videostroboscopy in the Philippine General Hospital.

METHODS: A systematic review of videostroboscopy records patients from January 2008 to December 2010 was perform Demographic data, risk factors, diagnosis and their associat were determined.

RESULTS: The following vocal cord pathologies were recorded the 507 subjects who underwent videostroboscopy during assessed time period: vocal cord nodules (17.4%) laryngopharygeal reflux (16.6%), vocal cord paralysis (12.8%) cyst (10.5%), polyp (8%) and laryngeal cancer (6%). Vocal cord nodules were found to be more common among professic voice users (odds ratio = 2.8). Risk factors found to be associated with cancer development include age, gender (male, odds ratio 19.8) and smoking history (odds ratio = 12.7).

CONCLUSION: The most common laryngeal pathology among patients undergoing videostroboscopy is vocal cord nodules. One out of 20 patients who underwent the procedure was given a diagnosis of laryngeal cancer.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Vocal Cords ; Vocal Cord Paralysis ; Laryngeal Neoplasms ; Philippines ; Smoking ; Larynx ; Glottis ; Polyps ; Cysts

Botolinum is a toxic polypeptide produced by the gram-positive anaerobic bacterium Clostridium botulinum that inhibits acetylcholine release from nerve endings, resulting in reduced neuromuscular transmission and local muscle activity, as well as cholinergic mediated parasympathetic activities.1 Its name is derived from the Latin word botulus, meaning sausage, as its toxicity was initially attributed to the oil of spoiled sausages. Of late, botolinum, packaged in various commercial forms such as onabotulinumtoxinA (Botox® type A, Allergan, Irvine, CA), is popularly used in several medical applications such as blepharospasm, hyperhidrosis and strabismus, and most famously in cosmetic surgery, where Botox® injections are used to eliminate and/or smoothen wrinkles.
Injections

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

OBJECTIVE: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.

METHODS:
Design: Descriptive, cross-sectional
Setting: University of the Philippines College of Medicine Anatomy Laboratory
Subjects: Fifty-four (54) preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into two variations: non-branching or branching prior to insertion at the cricothyroid joint under the inferior constrictor muscle. The ITA was also classified into non-branching and branching. The results were compared to two foreign studies using a Z-test for two proportions.

RESULTS: Fifty four (54) cadavers (108 sides) were dissected. Among the cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers. For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA. The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA but differs from those of Brazilians where the RLN is usually between ITA branches.

CONCLUSION: There are multiple anatomical variations regarding the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon's knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.

Human ; Male ; Female ; Adult ; LARYNGEAL NERVES ; CADAVERS-anatomy and histology ; DISSECTION ; surgery ; Thyroid Gland ; anatomy ;

OBJECTIVE: To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).
METHODS: Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.
RESULTS AND DISCUSSION: The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.
CONCLUSION: Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.

Intubation ; Problem-Based Learning

Background. Simulators in laryngology are an essential part of training. They provide an avenue for medical students and resident trainees to practice valuable psychomotor skills outside the realm of an actual patient encounter - thereby decreasing the risk of possible patient morbidity. Herein we present three locally manufactured simulation devices that can be used to train residents in laryngology procedures.

Objective. To present three simulation platform devices (Laser Box, Flexible Endoscopy Simulation, Thiel Cadaver Chair) and their applications in simulation-based learning

Methods. The Laser Box, Flexible Endoscopy Simulation, and Thiel Cadaver Chair were manufactured by outside parties designated as 'Laser Machinists'.

Results. Ten (10) units of the Laser Box, two (2) units of the Thiel Cadaver Chair, and two (2) units of the Flexible Endoscopy Simulation were constructed. They were used in a laryngology postgraduate course in our institution to teach the participants on endoscopies and laser phonosurgery.

Conclusion. Simulation for otolaryngologic procedures should be an essential part of training. The learning curve for procedures such as laryngoscopy and laser phonosurgery can be addressed with the production of simulation platforms. Most institutions in the Philippines still adopt the "see one, do one, teach one" approach, which lacks standardization and puts patients at risk. Various task trainers for laser phonosurgery and flexible endoscopy have been reported in the literature, but there seems to be no published data on the use of a cadaver chair for simulation. In the COVID-19 era, aside from being excellent teaching tools, simulation platforms derive their importance in helping train residents, educate medical students, and review consultants - maximizing skill development - and thereby decreasing repeated attempts, and indirectly, exposure to the SARS-CoV-2. Future validation studies are required for the models, with the eventual long-term goals to further standardize training, increase patient safety and incorporate a simulation-based curriculum for the specialty locally.

Laryngoplasty ; Larynx

OBJECTIVE: To develop a ventilation tube insertion simulator for training and evaluation of otorhinolaryngology residents in myringotomy with ventilating tube insertion.

METHODS:

            DESIGN:            Cross - Sectional Study

            SETTING:           Tertiary National University Hospital

            PARTICIPANTS:   Otologists and otorhinolaryngology resident trainees

A simulation tool for myringotomy with ventilation tube insertion was fabricated using silicone sealant, aluminum tube, rubber ball, plaster of paris and plastic sheet, and pretested by our expert panel. Residents were then evaluated using an objective structured clinical examination (OSCE) checklist while performing the procedure using the same model. Three trials were given, and OSCE scores were obtained, for each resident.

RESULT: The pinna, ear canal, tympanic membrane, malleus handle were deemed realistic by the expert panel. Residents performed the procedure at an average of 87 seconds. Average OSCE score for all residents was 17.17, with senior residents having a higher average score (18.3) than junior residents (16.6). However, this was not statistically significant (2 tailed t-value, significance level 0.05 = -1.27, p = .227). The most common cause of trial failure was dropping of the tube in the middle ear, while the most common error made was using more than 2 attempts at performing the incision.

CONCLUSION:  This simulation platform may be a valuable tool to use in educating and developing skills and proper technique of myringotomy with ventilation tube insertion. It is reproducible, affordable, realistic, sturdy and versatile in its applications. Residents who show adequate dexterity and consistency during simulation may eventually be allowed to perform the procedure on patients and provide feedback regarding the usefulness of the simulation.

Human ; Male ; Female ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Person 19-44 Years Of Age) ; Otitis Media With Effusion ; Middle Ear Ventilation ; Tympanic Membrane ; Simulation Training ; Patient Simulation