Background and Objectives: Surgical site infection (SSI) makes up the largest single group of postoperative infective complications. For surgeries classified as clean surgeries of the head and neck, such as a thyroidectomy, the routine administration of antimicrobial prophylaxis is not recommended. Despite this, extended usage of antibiotics is common in developing countries. This study evaluated the need for antibiotics in elective transcervical thyroidectomy for the prevention of SSI in a tertiary government hospital in a developing country. Methods: This is a retrospective cohort study that included patients who have undergone elective transcervical thyroidectomy at the Department of Otolaryngology - Head and Neck Surgery (ORL-HNS) of the University of the Philippines - Philippine General (UP-PGH) Hospital from August 1, 2020 to June 30, 2022. Data collection was conducted through review of both in-patient and out-patient records. Results: The data of 58 patients were analyzed. The mean (±SD) age was 42.5±14.5 years, with approximately 2:27 male to female ratio. Of the 58 patients, 26 were given postoperative antibiotics while 32 did not receive postoperative antibiotics. None of the 58 were noted to have SSI on the 3rd postoperative day. Only 54 patients completed the 7-day follow-up of the study and their data were further analyzed. One patient had SSI. There was no significant difference between the presence and absence of postoperative antibiotics in relation to SSI (p-value>0.05). Conclusion This study shows that in patients undergoing transcervical thyroidectomies, there is no significant difference in the occurrence of SSI among patients who received and did not receive postoperative antibiotics. Therefore, there is no need to administer postoperative antibiotics, as long as a sterile surgical technique is ensured.
Surgical Wound Infection ; Thyroidectomy

A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.
Laryngeal Neoplasms ; Laryngectomy ; Radiotherapy

Objective: To describe our clinical experience with, and functional outcomes of the nasolabial flap for reconstruction of orofacial defects. Methods: Design: Retrospective Case Series. Setting: Tertiary National University Hospital. Participants: Records of 11 patients on whom a nasolabial flap was performed for reconstruction of head and neck defects between January 2013 and December 2018 were analyzed. Results: All patients underwent wide excision with or without frozen section, with or without neck dissection, and nasolabial flap closure was performed by a single surgeon. There were no major complications. In two cases, the nasolabial flap was used as an adjunct for Abbé and deltopectoral flap reconstruction. One had poor oral competence due to the bulk of the deltopectoral flap. Acceptable aesthetics and functional outcomes were achieved. Conclusion The nasolabial flap is a viable alternative for reconstruction of orofacial defects following head and neck surgeries. Additional cases can help validate our initial experience
Nasolabial Fold ; Mouth ; Skin ; Surgical Flaps

OBJECTIVE: To determine the prognostic value of surgical interventions done among patients with anaplastic thyroid carcinoma (ATC)

METHODS: A five-year retrospective chart review of 25 patients was done and baseline characteristics determined. Patients discharged alive as of the time of last chart entry were followed up by phone interview or personal visit. Overall survival was the main outcome measure which was plotted as Kaplan-Meier estimates and compared via log-rank test. The incidence of complications surrounding tracheostomy and thyroidectomy were also noted.

Methods:

Design: Ambispective Cohort Study

Setting: Tertiary National University Hospital

Participants: All private and public (charity) patients seen at the wards or clinics diagnosed with ATC via fine needle cytology or tissue histopathology.

RESULTS: All patients presented with either stage IV-B or stage IV-C disease. A significant difference in survival curves was noted when comparing between the two stages (p<.05). Subgroup analysis per stage revealed no significant difference in overall survival when comparing patients who did not undergo surgery, those who underwent tracheostomy or those who underwent thyroidectomy for both IV-B (p=.244) or IV-C (p=.165) disease. The incidence of complications for tracheostomy was 60%, the most common being mucus plugging. For thyroidectomy, the incidence of complications was 80% with hypocalcemia being the most common.

CONCLUSION: The current available data fails to demonstrate any significant survival advantage of tracheostomy or thyroidectomy when performed among similarly staged patients.

Human ; Animal ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Anaplastic Thyroid Cancer ; thyroidectomy ; tracheostomy ; survival

A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.
Laryngeal Neoplasms ; Laryngectomy ; Radiotherapy

Objective: To establish preliminary demographic and clinicopathologic data on Maxillary Sinus Squamous Cell Carcinoma (SCC) in the Philippine General Hospital

Methods:       

Design:           Retrospective Case Series

Setting:           Tertiary National University Hospital

Participants: Socio-demographic and clinical data from records of 22 patients admitted at the Department of Otorhinolaryngology of the Philippine General Hospital from 2013-2016 and histopathologically confirmed to have Maxillary Sinus SCC, were collected and described using means and proportions.

Results: There were 15 males and 7 females with a mean age of 50-years-old (range 24 to 77-years-old). Maxillary mass/swelling was the most common chief complaint.  The mean gap between initial symptoms and consult was 6.77 months.  Initial biopsies were obtained from the maxillary sinus in 16 patients, with 1 patient noted to have undergone malignant transformation from a prior intranasal squamous papilloma.  Staging was advanced (Stage IVA in 16, IVB in 4, and III in 2), with no patients with Stage I or II disease.  Sixteen (16) patients underwent surgery and radiotherapy, while 6 patients received radiotherapy (RT) with or without chemotherapy.  Regional and distant metastases were uncommon.

Conclusion: In this series, maxillary sinus SCC occurs more in males, with a maxillary mass as the most common chief complaint.  Delay in treatment is common, with a mean gap of 6 months between initial symptoms and consult.  Neck node metastasis is uncommon, and most patients undergo surgery with radiotherapy as treatment.

 

Keywords: maxillary sinus cancer; paranasal sinus cancer; squamous cell carcinoma

Human ; Paranasal Sinus Neoplasms ; Carcinoma, Squamous Cell

OBJECTIVE: To describe a surgical technique in the treatment of arteriovenous malformations of the mandible

METHODS:

       Design:    Case Report

       Setting:    Tertiary National University Hospital

       Participant:        One

RESULT: A 16-year-old boy underwent resection, extracorporeal curettage, and immediate replantation of the hemimandible for intraosseous arteriovenous malformation. Postoperative follow up and imaging at one- and six-months showed no signs of recurrence, new bone formation and consolidation of the replanted right mandible with good symmetry and function.

CONCLUSION: Extracorporeal curettage followed by immediate replantation of the resected mandible seems to have yielded good early results in our case and may be a viable alternative especially when access to highly specialized microvascular surgical services is limited.

 

Human ; Mandible

OBJECTIVE: This study describes the quality of Thiel soft-embalmed cadavers as training model for endoscopic sinus surgery in terms of color and consistency of the tissues and similarity of performing the surgical steps to live surgery.

METHODS: This is a cross-sectional descriptive study. Six Thiel soft-embalmed cadavers from the University of the Philippines, College of Medicine, Department of Anatomy were used as training models. The Thiel-preserved cadavers utilized the soft embalming protocol being employed at the Virginia State Anatomical Program in Richmond, Virginia, USA. Ten otorhinolaryngologists were recruited to evaluate the cadavers using a questionnaire with three parts. The first two parts utilize a 10-point Likert scale with 1 as the least similar to live patient while 10 as simulating the live patient. The third part is an open-ended question regarding the suitability of Thiel soft-embalmed cadavers in the training for endoscopic sinus surgery.

RESULTS: Endoscopic sinus surgery was successfully performed in all cadavers. The Thiel soft-embalmed cadaver closely replicates the color and consistency of the anatomic structures important in endoscopic sinus surgery. All the surgical steps were performed with ease simulating live surgery.

CONCLUSION: Thiel soft-embalmed cadaver is a suitable model for training in endoscopic sinus surgery.

Models, Anatomic

OBJECTIVE: To  report  a  case  of  tumoral  calcinosis  from  secondary hyperparathyroidism  and  to describe its surgical management.
METHODS:
 Design: Case Report
 Setting: Tertiary Public University Hospital
 Patient: One
RESULTS: A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal  parathyroidectomy,  right  thyroid  lobectomy  with  isthmusectomy,  and  transcervical thymectomy.    Follow-up  revealed  marked  decrease  in  parathyroid  hormone,  and  progressive resolution of the tumoral calcinosis.
CONCLUSION: Subtotal  parathyroidectomy  and  transcervical  thymectomy  have  a  role  in  the management  of  tumoral  calcinosis,  and  in  this  case  led  to  excellent  post-operative  results. The rare  presentation  of  secondary  hyperparathyroidism  and  intervention  in  this  patient  may  have potential lessons for future management of similar cases.

Human ; Female ; Adult ; Calcinosis ; Parathyroidectomy ; Thymectomy

OBJECTIVES: The study aims to develop and validate a health-related quality of life (HRQoL) questionnaire for adult Filipinos with differentiated thyroid cancer (DTC) that can be used in combination with the European Organization for Research and Treatment of Cancer QLQ-C30 Questionnaire.
METHODOLOGY: The study had 4 phases. Phase I involved generation of HRQoL issues from literature review, focus group discussions with 6 DTC patients and 5 health care professionals (HCP). Subsequent assessment for relevance and importance of the HRQoL issues by 20 patients and HCP panel was done. Phase II was formulation of the HRQoL issues into questionnaire and subsequent translation into Filipino. Phase III was pilot testing of the questionnaire in 15 patients. Phase IV was validation of the pre-final questionnaire in 231 patients.
RESULTS: In Phase I, 28 HRQoL issues were generated. In Phase II, a 28-item Filipino questionnaire was created. In Phase III, 22 items that were not upsetting or confusing to patients and with good range of responses were retained. After Phase IV, a 22-item questionnaire with 5 conceptual scales (perceived fears, psychological distress/anxiety, functionality, voice complaints, neck complaints) was created.
CONCLUSIONS: The developed and validated 22-item questionnaire can be used to assess HRQoL issues in adult Filipinos with DTC.

Human ; Male ; Thyroid Gland ; Neoplasms ; Quality Of Life ; Philippines ; Validation Studies ; Patients ; Anxiety