Philippine Journal of Otolaryngology Head and Neck Surgery

TracheoSense: Innovation in Endotracheal Tube Cuff Pressure Monitoring with a Three-Dimensional Printed Electronic Manometer-Syringe Device

2024-10-30T00:51:07+00:00

Objective:To design and validate TracheoSense, a 3D-printed manometer-syringe device for measuring endotracheal tube (ETT) cuff pressure, by assessing its accuracy and precision compared with a commercially available standard manometer.

Methods:

Design: Instrument Innovation

Setting: Tertiary Private Training Hospital

Participants: None

Results:The study compared the TracheoSense device with the VBM Analog Manometer, the reference standard, for measuring cuff air volume at target pressures of 20 and 30 cmH2O across tracheal model diameters of 19 mm, 21 mm, and 23 mm. At 20 cmH₂O, mean cuff volumes measured by TracheoSense ranged from 4.04 ± 0.09 mL to 5.82 ± 0.07 mL, with coefficients of variation (CV) between 1.15% and 2.18%, and minimal bias compared to the reference device (−0.02 to 0.09 mL). At 30 cmH₂O, mean volumes ranged from 4.51 ± 0.11 mL to 6.31 ± 0.23 mL, with CVs of 1.62% to 3.58% and biases between −0.07 and 0.02 mL.

Conclusion:The TracheoSense 3D-printed manometer-syringe device demonstrated comparable accuracy and precision in measuring ETT cuff pressures when compared with a commercially available analog manometer. These results support this device as a reliable and practical tool for cuff pressure monitoring.

Contents Vol. 41 No. 1 January-June2025

2026-04-21T04:31:07+00:00

EDITORIAL

Alleluia in April and a Sakura Spring
Lapeña JFF

ORIGINAL ARTICLES

Clinical Otologic Profile, Awareness, Knowledge, and Literacy on Hearing Health Among Employees of the Philippine General Hospital
Dela Cruz JMG, Kollin KT, Ong-Nelson KMC

Outcomes of Endoscopic Endonasal Transsphenoidal Surgery of Pituitary Adenomas at the Philippine General Hospital
Seng KS, Cabungcal ACA, Malilay ORM, Dela Cruz APC, Baticulon RE

Mapping the Filipino Pediatric Skull Base: A Computed Tomography-Based Analysis of Anatomical Parameters and Nasoseptal Flap Reconstruction Feasibility from a Single Tertiary Hospital in the Philippines
Ng CJC, Chua RU, Laxamana MM

Late versus Very Late Tracheostomy Timing for Prolonged Intubated ICU Patients: Implications for Prognosis and Mechanical Ventilator Weaning
Calansingin MJC, Enriquez HM

Clinical Factors Associated with Immediate Postoperative Hypocalcemia After Total Thyroidectomy at the Philippine General Hospital: A Case Series with Planned Data Collection
Plando LAK, Dela Cruz APC

Knowledge, Attitudes and Practices of Selected Filipino Surgeons Regarding the Clinical Practice Guidelines on the Management of Isolated Mandibular Body Fractures In Adults
Edora BDE, Lapeña JFF

CASE REPORTS

High-Grade Mucoepidermoid Carcinoma with Sarcomatous Features of the Tongue in a Seven-Year Old Boy: A Case Report
Alberto AFJ, Dizon EG, Soriano RG, Aragon MC III

SURGICAL INNOVATIONS AND INSTRUMENTATION

TracheoSense: Innovation in Endotracheal Tube Cuff Pressure Monitoring with a Three-Dimensional Printed Electronic Manometer-Syringe Device
Rabinetas CAP, Chua AH, Reyes TNF

FEATURED GRAND ROUNDS

A Case of Complex Bilateral Comminuted Mandibular Fractures in a Young Man Following a High-Velocity Motorcycle Collision
Ng CJC, Cachola DRR

FROM THE VIEWBOX

Secondary Middle Turbinate: An Anatomic Variation
Tongol EA

UNDER THE MICROSCOPE

Sinonasal Tract Angiofibroma - Revisited
Valera JSN, Carnate JM

PRACTICE PEARLS

How to Approach Patients with Smell-Related Complaints?
Hernandez AKM

PASSAGES

Manuel A. De Jesus, MD (1965-2026)
De Jesus, KMG

CAPTOONS

DokNet’s World
Billones WU

Staff Box; Notice to Readers and Contributors

2026-04-21T04:26:27+00:00

DokNet’s World

2026-04-21T04:09:34+00:00

Manuel A. De Jesus, MD (1965 - 2026)

2026-04-21T03:35:22+00:00

“A Life of Service and Quiet Love”

Born on November of 1965, he was the 5th of 7 siblings to a former soldier and a strong willed housewife/storekeeper, both hailing from Cavite. He took his primary education in Fort Bonifacio Elementary School and secondary education in Pateros Catholic School. Growing up, he was also the mischievous one in the group and would often get punished

– but he never forgets his responsibilities. Back then, they had a sari-sari store and a pig farm and as the eldest son, my dad would help out my grandmother. He would also tell stories of how he used to be a working student being a jeepney driver, together with my grandfather. He eventually took his pre-medicine course in Biology and finished his Doctor of Medicine in University of Santo Tomas.

After passing his boards, he became a field physician in an offshore oilfield company in Palawan for 2 years to help my grandparents financially. In 1995, he began his training in Otorhinolarynology Head and Neck Surgery and served both as Chief Resident of the Department and of the Hospital, at the same time during his senior year. He started his practice in an EENT clinic in Claridad, Cavite City until 2006, then later settled his private practice in Manila Doctors Hospital and Pasay City General Hospital.

He met my mom in 1994 and they would have me in the following year, with my sister coming 2 years after. I don’t have a clear memory of those early years but there were stories of how he would bring me along to the hospital as a child where I would meet several of our alumni while he worked. This continued as I grew older - he would let me observe in his OR procedures, until the time finally came when I got to stand side by side with him in the OR having witnessed his steady hands and skills firsthand. I’m immensely grateful that I got to share the same space and vocation as him.

He was a beloved mentor and a respected colleague, both in Medicine and Residency. He served as a Training Officer in Manila Doctors Hospital for 5 years. He wasn’t just a father to me and my sister – he was also a “father figure” for many of our alumni and residents. He was always welcoming, especially to the new trainees. What remained constant about him is that he always had time for teaching – when he visited during OPD hours, during patient rounds, in the OR and Endoscopy Center, even at home. This value echoed through to all those who were under his guidance, even after their training.

My dad was a man of few words, as those who knew him can attest. Weekends were peaceful where he would make coffee for me and my sister. He reminded us to eat fruits at every meal. He’d bring home our laundry during Thursday. He would check up on us with simple messages like“Uwi ka na” or “Ingat kayo.” He loved sharing historical facts and spends his free time cleaning our family car. During family gatherings, he would rarely follow the color theme and he would always crack a joke just before a picture is take

For our family, money was his love language. He believed that financially stability was the ultimate gift of security he could provide for us, and that my sister and I are taken care of. I didn’t fully understand it then, but that was how he showed his love for us. One thing about my dad, though, is that he never sought consult regarding his health. His symptoms of fatigue and restlessness came about on one Wednesday evening. We all came and stayed by his side and brought him to the hospital the next day. Everything happened so suddenly and he eventually joined our Creator on the morning of Friday.

As a family, we continue to get through each day but at times, it still feels heavy and painful without him. We are sincerely grateful to everyone who paid their respects and offered their prayers. The support from the community that surrounded us showed just how much of an impact my dad had. His legacy of caring for patients will live on through my sister and I, and through all those he mentored and were under his wings.

You were an angel in the shape of my dad. We love you, Papa.

How to Approach Patients with Smell-related Complaints?

2026-04-21T03:23:48+00:00

Olfactory dysfunction (OD) affects approximately 20-30% of the general population¹and can significantly impact daily life, including the enjoyment of food and drinks, detection of environmental hazards, social interactions and overall well-being. Olfactory dysfunction is also associated with several medical conditions, including neurodegenerative diseases (e.g., Alzheimer's and Parkinson's disease),² as well as psychiatric conditions like depression.³Despite limited local data on prevalence and constraints in diagnostic resources and treatment options, clinicians should be prepared to evaluate patients effectively. A brief, structured clinical assessment allows early recognition, guide management, and helps identify patients who may benefit from specialist referrals.

What is Smell Loss?
Olfactory dysfunction can be classified into quantitative (hyposmia, anosmia) and qualitative disorders (parosmia, phantosmia). See Table 1.

Clinical Evaluation
A detailed history is the cornerstone of a good evaluation. Onset and duration of dysfunction are important to clarify, as sudden loss often suggests post-viral or post-traumatic causes, while gradual decline may indicate a chronic condition like neurodegenerative disease. Fluctuating olfactory changes may suggest chronic rhinosinusitis or allergic disease. Associated symptoms, such as nasal obstruction, congestion, rhinorrhea or headache; along with relevant past medical history (e.g., prior head trauma), or findings such as neurological deficits, are also important to note, as they provide additional diagnostic clues. Safety-related questions are important to ask. For example, are patients able to detect threats in their environment (e.g., smoke, gas, spoiled food)? Clinicians should also ask about appetite and any weight changes⁵ which may indicate the severity of the condition. A review of medications and medical history, including prior sinonasal surgery, head trauma, chemotherapy or illicit intranasal drug use, may help identify contributing factors.

Sinonasal Tract Angiofibroma - Revisited

2026-04-21T03:02:50+00:00

A 16-year-old boy presented with a two-year history of nasal obstruction. Further work up revealed a right nasopharyngeal mass. The mass was excised through transoral approach revealing a tan, nodular, rubbery, irregularly shaped mass measuring 8.2 x 6.6 x 3.2 cm. Cut sections of the mass show cream white nodular surfaces interspersed with tan fibrous tissues.

Microscopically, the mass consists of variably sized vascular spaces interspersed within a collagenized fibrous stroma with fibroblasts. Some of the vascular spaces are slit-like, while others are dilated or branching. On higher magnification, the spindle to stellate cells interspersed within the stroma have bland oval nuclei. No mitoses or necrosis are seen. (Figure 1) Immunohistochemistry studies for Smooth Muscle Actin, beta-catenin, S100, and Androgen Receptor were subsequently performed. The stromal fibroblasts show strong diffuse nuclear staining with beta-catenin and androgen receptors, while SMA and S100 are both negative. (Figure 2) Given the histomorphology features and the immunohistochemistry results, the case was signed out as sinonasal tract angiofibroma.

Sinonasal tract angiofibroma is a benign mesenchymal tumor with a tendency to be locally aggressive. The tumor commonly affects adolescent males and typically arises in the posterolateral roof of the nasal cavity or the lateral wall of the nasopharynx. Patients usually present with progressive nasal obstruction, a visible nasal mass, and recurrent episodes of epistaxis. Computed tomography and magnetic resonance imaging are the imaging modalities of choice for evaluation. A characteristic radiologic feature is the Holman–Miller sign which refers to anterior bowing of the posterior wall of the maxillary sinus caused by tumor expansion. Grossly, angiofibromas often appear as firm, polypoid to lobulated masses.^1-3

For the pathogenesis, androgens may play an important role for this neoplasm due to the expression of androgen receptors in the tumor. The involvement of androgens in this tumor may explain the strong predilection for adolescent males. In the majority of cases of sinonasal tract angiofibroma, mutations in CTTNB1 gene are observed.¹ Aberrance in WNT signaling is involved in cases of sinonasal angiofibroma that are occasionally linked in patients with Familial Adenomatous Polyposis.^1,3,4

The microscopic features of sinonasal tract angiofibroma consist of a loose to fibrous stroma with vascular spaces of different sizes. The bland fibroblasts within the stroma are usually stellate or bipolar in morphology. Occasional multinucleated giant cells may be seen in the stroma.^1,3For immunohistochemistry, the tumor shows positivity for Androgen Receptor and B-catenin.¹

The morphologic differential diagnosis for sinonasal tract angiofibroma includes hemangioma, inflammatory sinonasal polyp and solitary fibrous tumor. Hemangiomas are distinguished by their relatively uniform vessel caliber and less prominent stromal components. Solitary fibrous tumors typically exhibit characteristic staghorn-shaped vessels which are not a feature of angiofibroma. Inflammatory sinonasal polyps usually show prominent inflammatory infiltrates and lack the marked vascular proliferation seen in angiofibroma. Lastly, sinonasal tract angiofibroma shows positivity in Androgen Receptor immunohistochemistry, which is negative for the other entities stated.^5,6

Secondary Middle Turbinate: An Anatomic Variation

2026-04-21T02:46:03+00:00

A 30-year-old man underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. He initially presented with a five-year history of gradually worsening nasal congestion, more pronounced on the left side. During surgery, after debulking the severe polyposis on the left, a junior otolaryngology surgeon felt confident upon identifying what appeared to be the middle turbinate, a key surgical landmark. However, on closer inspection, confusion arose when an additional structure resembling the middle turbinate was noted immediately lateral and inferior to it. (Figure 1) Upon review of the patient’s Computed Tomography (CT) scan images (Figure 2), the surgeon was able to identify the primary middle turbinate by viewing the axial cuts and locating the basal lamella.

A Case of Complex Bilateral Comminuted Mandibular Fractures in a Young Man Following a High-Velocity Motorcycle Collision

2026-04-21T02:26:07+00:00

Objective: To describe the clinical presentation, surgical management and postoperative outcomes of a patient with complex bilateral comminuted mandibular fractures, which resulted from high-velocity motorcycle trauma, and to highlight the role of preoperative planning using three-dimensional modeling in fracture management.

Methods:
Design: Case Report
Setting: Tertiary Academic Medical Center
Patient: One

Results: A 26-year-old man sustained severe mandibular trauma following a high-velocity motorcycle collision with a bus. Clinical evaluation, craniofacial computed tomography imaging, and intraoral examination revealed bilateral comminuted mandibular fractures involving the left body, angle, and ramus as well as the right symphysis, parasymphysis and body. Preoperative planning included review of computed tomography imaging and simulation using a three dimensional printed mandibular model to facilitate pre-bending of fixation plates. Surgical management consisted of maxillomandibular fixation followed by open reduction and internal fixation using titanium reconstruction plates and miniplates through combined submandibular and transoral approach. Successful reduction and fixation of the fracture segments were achieved with restoration of pre-injury occlusion and mandibular continuity. Postoperative recovery was uneventful, with no evidence of facial asymmetry, neurological deficits, or hardware complications. Follow-up examinations demonstrated satisfactory functional and cosmetic outcomes with progressive improvement in occlusion and mandibular mobility

Conclusion: Complex bilateral mandibular fractures resulting from high-energy trauma require careful preoperative evaluation and stable surgical fixation to restore mandibular anatomy and function. The use of three-dimensional printed models may serve as a valuable adjunct in surgical planning and plate adaptation in complex mandibular fracture management.

Alleluia in April and a Sakura Spring

2026-04-19T21:42:32+00:00

Alleluia!

The Lord has risen!

Luke 24:34¹

Sakura Sakura Cherry blossoms, cherry blossom
Noyama mo sato mo The hills and fields and countryside
Miwatasu kagiri also as far as you can see
Kasumi ka kumo ka Is it a mist? Is it a cloud?
asahi ni niou Fragrant in the morning sunlight
Sakura sakura Cherry blossoms, cherry blossoms
Hanazakari Flowers in full bloom

Japanese Traditional Songs- Sakura²

Message

2026-04-19T21:10:08+00:00

Dear colleagues and partners in scholarship,

Warm greetings from the Philippine Society of Otolaryngology–Head and Neck Surgery.

It is with great pride and deep appreciation that I extend my warmest congratulations to the Philippine Journal of Otolaryngology Head and Neck Surgery (PJOHNS) on the occasion of its Blue Sapphire Anniversary

This milestone is not merely a celebration of years, but a testament to the journal’s unwavering commitment to advancing knowledge and elevating the standards of our specialty. From its humble beginnings to its current stature, the PJOHNS has become a vital platform where the voice of Filipino ORL–HNS resonates both locally and globally.

We commend the journal’s significant achievements—most notably its successful indexing in Scopus and EBSCO—which affirm the quality, relevance, and growing international recognition of our scientific contributions. These milestones reflect the dedication of its editors, reviewers, authors, and the entire academic community who have worked tirelessly to uphold excellence.

As we celebrate this Blue Sapphire Anniversary, we do so alongside the Platinum Year of the PSO–HNS—a year that symbolizes not only longevity but leadership, transformation, and global aspiration. In this shared moment of reflection and vision, we look forward to even greater heights for PJOHNS: indexing in PubMed Central, MEDLINE/PubMed, and SCIE/Web of Science—benchmarks that will further solidify our place in the international scientific landscape

As we move forward in this Platinum Era, may we continue to champion research, uphold integrity, and strengthen our collective voice in advancing ORL–HNS

Congratulations once again to the PJOHNS team. The future is bright and the journey continues.

Ang PSO–HNS matatag, malakas, mahalin natin!

Clinical Otologic Profile, Awareness, Knowledge, and Literacy on Hearing Health Among Employees of the Philippine General Hospital

2025-06-30T23:39:19+00:00

Objectives: To estimate the prevalence of hearing loss and otologic diseases and to establish the awareness, knowledge, and literacy towards hearing care among University of the Philippines –Philippine General Hospital employees.

Methods: A non-probability voluntary sampling design included 235 employees regardless of contract-type of the Philippine General Hospital, University of the Philippines Manila. Outsourced personnel were excluded. The participants were interviewed with a pretested questionnaire to assess the knowledge, awareness, and prioritization of hearing health. Otoscopic assessment was done and hearing was evaluated using pure tone audiometry (PTA).

Design: Cross-Sectional Study
Setting: Tertiary National University Hospital
Participants: 235 employees

Results: The prevalence of mild or worse hearing loss across the whole sample was 51.5% with 5.5% having disabling hearing loss. Whereas, the majority of respondents knew the normal range for vision and blood pressure, only 14.5% reported knowing the “normal” hearing level. Despite more than 1/4 of the employees having a subjective complaint of hearing loss, hearing health was a low priority for the respondents when compared to other health conditions and life activities. Majority would go to their healthcare providers for information about hearing loss but 71.9% had never discussed their hearing with a doctor in the past 10 years. Furthermore, the most commonly cited reasons for not having their hearing evaluated were: (1) not experiencing hearing loss and (2) not having their physician recommend a hearing evaluation. Majority of the respondents strongly acknowledged the potential impacts of hearing loss on their safety, quality of life, and overall health and were aware that it is treatable and preventable. However, there was limited awareness on the long-term negative health sequelae of hearing loss.

Conclusion: This study highlights limited awareness and prioritization of hearing health among participants. The population’s lack of appreciation of the long-term health sequelae of untreated hearing loss should be addressed. Concerted efforts to improve patient’s understanding of hearing health and their healthcare providers’ effort to discuss and evaluate hearing should be improved.

Outcomes of Endoscopic Endonasal Transsphenoidal Surgery of Pituitary Adenomas at the Philippine General Hospital

2025-08-31T20:56:07+00:00

Objective: To review the surgical outcomes of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas in our institution and compare them with the results of previous studies

Methods:
Design: Retrospective Review of Records
Setting: Tertiary National University Hospital
Participants: Records of 56 adult pituitary tumor patients who underwent EETS at the Philippine General Hospital in Manila, Philippines from January 2020 to December 2023 were retrospectively reviewed. Their age, sex, tumor size, presenting symptoms, resection rates, surgery duration and length of stay and complications were recorded. Multivariate linear regression analysis identified factors influencing rates of gross total resection (GTR), surgical
duration and hospital stay.

Results: GTR was achieved in 82% (n=46/56). The median surgery duration was 260 minutes (IQR 160-329 minutes), and the median hospital stay was 10 days (IQR 19.75-23.25 days). Complications arose in 35.7% (20/56), commonly diabetes insipidus (25%, 14/56) and meningitis (3.6%, 2/56)), but there were no mortalities (0%, 0/56 at 24 months follow-up). No factors were associated with GTR. Galactorrhea ((β = 1.769, 95% CI: 0.531-3.007, p=.010) and tumor size up to 6 cm (β = 0.572, 95% CI: 0.076-1.068, p=.032) were associated with more than 400 minutes operative time. Preoperative visual loss was associated with shorter admissions (-7.4 days, 95% CI: -11.994, -2.853, days, p=.004), while preoperative seizures (+19.4 days, , 95% CI: 6.447-32.327, p=.007), hypercortisolism (+10.9 days, 95% CI: 0.700-21.130, p=.040), and acromegaly (+7.1 days, 95% CI: 0.723-13.523, p=.037) were associated with longer stays. Each centimeter increase in tumor size predicted an increase in hospital stay by 1.1 days (95% CI: 0.071-2.169, p=.049).

Conclusion: EETS for pituitary adenomas in the Philippines led to high rates of GTR and manageable complication rates compared to previous studies. However, longer operative times and hospital stays were observed, which may reflect local practices, logistics, and demographics. Improved surgical infrastructure and experience may further optimize outcomes.

Mapping the Filipino Pediatric Skull Base: A Computed Tomography-Based Analysis of Anatomical Parameters and Nasoseptal Flap Reconstruction Feasibility from a Single Tertiary Hospital in the Philippines

2025-11-28T17:05:44+00:00

Objective: To establish radiographic baseline measurements of key anatomical parameters of the Filipino pediatric skull base using computed tomography (CT); compare these anatomical parameters across different pediatric age groups and between sexes; and determine the feasibility of nasoseptal flap reconstruction for sellar defects in a Filipino pediatric population by calculating the nasoseptal flap to sellar defect length ratio (NSR).

Methods:
Design: Review of Records
Setting: Tertiary Academic Medical Center
Participants: Digital Imaging and Communications in Medicine (DICOM) images of patients aged 0-17 years who had high-resolution head CT scans done at the University of Santo Tomas Hospital during the period of January 2019 – January 2024 were retrieved and reviewed. The following measurements were obtained: piriform aperture width (PAW), nare to sella distance (NSD), sphenoid to sella distance (SSD), sphenoid pneumatization type (SP), sphenoid sinus width (SW), olfactory fossa depth (OFD), lateral lamella cribriform plate angles (CPA), intercarotid distances (ICD) at the superior clivus (ICD-SC) and cavernous sinus (ICD-CS), potential nasoseptal flap length (NSF), potential sellar defect length (SDL) and nasoseptal flap length to sellar defect length ratio (NSR). Participants were stratified into three age groups (<5years, 5-12 years, 13 years and older), and sex (males, females). Between-group comparisons were performed using ANOVA, chi-square and independent t-tests (α = 0.05).

Results: Among the 111 participants (median age 12 years, IQR 7-15), 63.06% were males. For children <5 years (n = 23), mean values were: PAW 1.82 ± 0.15 cm, NSD 5.84 ± 0.37 cm, SSD 1.40 ± 0.35 cm, SW 1.78 ± 0.44 cm, OFD 0.53 ± 0.18 cm, ICD-SC 1.04 ± 0.20 cm, ICD-CS 1.64 ± 0.18 cm, NSF 4.95 ± 0.45 cm, and SDL 4.21 ± 0.64 cm. For ages 5-12 years (n = 39), values were: PAW 2.06 ± 0.23 cm, NSD 6.71 ± 0.50 cm, SSD 1.67 ± 0.24 cm, SW 2.55 ± 0.54 cm, OFD 0.61 ± 0.16 cm, ICD-SC 1.19 ± 0.21 cm, ICD-CS 1.86 ± 0.18 cm, NSF 5.63 ± 0.59 cm, and SDL 4.70 ± 0.85 cm. For ages ≥13 years (n = 49), values were: PAW 2.21 ± 0.26 cm, NSD 7.22 ± 0.63 cm, SSD 1.86 ± 0.33 cm, SW 3.04 ± 0.66 cm, OFD 0.64 ± 0.23 cm, ICD-SC 1.23 ± 0.26 cm, ICD-CS 1.92 ± 0.24 cm, NSF 6.50 ± 0.50 cm, and SDL 5.59 ± 0.90 cm. Most participants had sellar-type sphenoid pneumatization (n = 48, 43.24%) and Type 2 Keros classification (n = 74, 66.67%). Sphenoid pneumatization differed significantly across age groups (p = .001), with conchal type predominant in <5 years (n = 22, 95.65%), presellar in 5-12 years (n = 18, 46.15%), and sellar in ≥13 years (n = 38, 77.55%). The mean nasoseptal flap to sellar defect ratio (NSR) was 1.21 ± 0.22 overall and did not differ across age groups (p = .677), indicating adequate flap length for reconstruction across all ages.

Conclusion: In this sample, Filipino pediatric skull base anatomy demonstrates significant age-related dimensional changes but no sex-dependent differences. Despite smaller absolute dimensions in younger children, nasoseptal flap reconstruction appears radiographically feasible across all pediatric age groups. Our findings provide population-specific normative data to guide preoperative planning for pediatric endoscopic endonasal skull base surgery.

Late versus Very Late Tracheostomy Timing for Prolonged Intubated ICU Patients: Implications for Prognosis and Mechanical Ventilator Weaning

2025-08-06T03:33:23+00:00

Objective: To compare late (10–21 days) and very late (>21 days) tracheostomy in adult ICU patients with prolonged intubation in terms of success of mechanical ventilator weaning, ICU and hospital stay, and mortality.

Methods:
Design: Retrospective Cohort Study
Setting: Tertiary Government Training Hospital
Participants: Adult Intensive Care Unit (ICU) patients (≥18 years) from 2016 to 2024 who underwent tracheostomy after ≥10 days of intubation. Patients were divided into late (10-21 days) and very late (>21 days) timing of tracheostomy groups.

Results: A total of 128 patients were included (48 Late, 80 Very Late). No significant differences were found in mechanical ventilator weaning success, ICU discharge rate, 30-day mortality, or overall mortality between groups. Time to weaning, ICU stay, and time to mortality were longer in the very late group but was not statistically significant. Post-tracheostomy hospital stay was significantly longer in the very late group (M = 25.8 ± 26.1 vs. 37.6 ± 40.7 days, t(125.4) = −2.00, p = .048). Subgroup analyses of pulmonary and neurologic patients showed similar results. Ventilator-associated pneumonia was a common pre-operative comorbidity and was the leading cause of mortality. Older age and prior cerebrovascular disease were associated with decreased odds of weaning success and survival respectively.

Conclusion: The results of our study may challenge the assumption that further delays in tracheostomy timing lead to worse outcomes. Tracheostomy done earlier within 10-21 days of intubation leads to shorter post-operative hospital stay, but was not accompanied by improved odds of ventilator weaning, ICU discharge, or survival. Timing of tracheostomy may not be the primary determinant of prognosis in these patients as much as the confounding co-morbidities, especially ventilator-associated pneumonia.

Clinical Factors Associated with Immediate Postoperative Hypocalcemia After Total Thyroidectomy at the Philippine General Hospital: A Case Series with Planned Data Collection

2025-08-06T04:11:05+00:00

Objective: To identify clinical factors, may it be patient, procedure, or tumor-related, associated with hypocalcemia post-thyroidectomy
Methods:
Design: Case Series with Planned Data Collection
Setting: Tertiary National University Hospital
Participants: Total enumeration reviewed records of 664 patients aged 19 years old and above, previously admitted under the Philippine General Hospital Department of Otolaryngology – Head and Neck Surgery from 2019 to 2023 who underwent total thyroidectomy (including completion thyroidectomy and those with neck dissection) and had serum calcium determination done both 6 and 24 hours post-operation. Cumulative incidence of hypocalcemia was determined, and patient-related, procedure-related, and tumor-related factors were investigated, with multivariable logistic regression analysis performed to identify the association between clinical factors and postoperative hypocalcemia.

Results: The cumulative incidence of hypocalcemia at 6 hours and 24 hours post-operation was 28.92% (95%CI: 25.49%–32.53%) and 19.49% (95%CI: 16.01%–23.36%), respectively. The clinical factors with notable increased odds for postoperative hypocalcemia were female sex (adjusted OR: 3.5; 95%CI: 1.2623–9.6362), total thyroidectomy as type of surgery (adjusted OR: 0.7; 95%CI: 0.2905–1.6805; adjusted OR: 0.8; 95%CI: 0.2616–2.6670), histopathologic type of papillary thyroid carcinoma (adjusted OR: 1.4; 95%CI: 0.8949–2.0719; adjusted OR: 1.6, 95%CI: 0.8985 2.7771), and the presence of parathyroid tissue in the excised specimen (adjusted OR: 1.2; 95%CI: 0.7436–1.9002; adjusted OR: 1.6; 95%CI: 0.8406–2.9496). The only statistically significant factor out of all those investigated was female sex.

Conclusion: The only statistically significant clinical factor associated with hypocalcemia in our study was female sex, with total thyroidectomy as type of surgery, histopathologic type of papillary thyroid carcinoma, and presence of parathyroid tissue in the excised specimen as other factors noted with increased odds for hypocalcemia.

Knowledge, Attitudes and Practices of Selected Filipino Surgeons Regarding the Clinical Practice Guidelines on the Management of Isolated Mandibular Body Fractures In Adults

2026-04-20T21:37:49+00:00

Objectives: To initially assess the knowledge, attitudes and practices of selected target users of the Clinical Practice Guidelines on the Management of Isolated Mandibular Body Fractures in Adults nationwide. Specifically, to assess the level of awareness of selected Filipino surgeons who are expected to use this clinical practice guideline and to identify gaps in knowledge and practices among these surgeons using the key action statements in the clinical practice guideline.

Methods:
Design: Cross-Sectional Study
Setting: Platform-Based Online Survey
Participants: 295 Otorhinolaryngologists – Head and Neck surgeons (ORL-HNS)/Craniomaxillofacial surgeons (CMFS) and General surgeons (GS) / Plastic and Reconstructive surgeons (PRS) consultants and residents/fellows-in-training

Results: Among 295 surgeon respondents (47.46% ORL-HNS consultants), 75.25% were aware of PACMFS guidelines. In general, knowledge scores were high [median (IQR): 12 (11–13) vs 11 (IQR 9–13), U = 11726, n₁= 204, n₂= 91, p < .001; Mann-Whitney], with >90% accuracy for the tongue blade test (93.22%), non-contrast CT for fracture assessment (95.93%), closed reduction with maxillomandibular fixation for favorable fractures (98.31%), and ORIF with plates and screws for unstable fractures (98.64%); lower accuracy was observed for imaging modality sequencing (50.85%) and antibiotic selection (penicillin - 70.41%). Consultants and ORL-HNS/CMFS specialists demonstrated significantly higher knowledge and were guideline-concordant than trainees and other specialties. Attitudes toward multidisciplinary collaboration, evidence based practice updates, and cost-effectiveness were nearly universal (over 99%). Most self reported practices—such as requesting a panoramic radiograph (68.14%), obtaining plain mandibular radiographs when panoramic imaging was unavailable (91.53%), using Barton’s bandage for temporary immobilization (89.83%), administering prophylactic antibiotics for mucosal/ skin breach (98.31%), and initiating analgesia at 4/10 pain score (85.71%)—were also guideline-consistent.

Conclusion: Filipino surgeons in this survey demonstrated generally strong alignment with the published Philippine Academy of
Craniomaxillofacial Surgery (PACMFS) Clinical Practice Guidelines for the management of isolated mandibular body fractures in adults,
showing high knowledge and consistent self-reported adherence for key diagnostic steps, imaging selection when resources allow,
temporary stabilization, and definitive operative decision-making.

High-Grade Mucoepidermoid Carcinoma with Sarcomatous Features of the Tongue in a Seven-Year-Old Boy: A Case Report

2022-05-05T06:21:12+00:00

Objective: To report an unusually aggressive presentation of high-grade mucoepidermoid carcinoma (MEC) with sarcomatous features of the tongue base in a seven-year-old boy, characterized by early recurrence, rapid progression and poor response to treatment.

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

Results: A seven-year-old boy presented with a left tongue base mass that rapidly enlarged with associated dysphagia and weight loss. Biopsy of the pedunculated mass attached to the left tongue base, abutting the anterolateral tongue, revealed high-grade MEC. Following left subtotal glossectomy with radical neck dissection, histopathology confirmed high-grade MEC with sarcomatous features with negative margins but positive lymph nodes. Post-operative recurrent masses were twice excised at three weeks (left tonsil) and another 12 days (oropharynx extending to neck). Despite tumor debulking and three radiotherapy sessions, the residual mass enlarged further and metastasized to the lungs and liver six weeks postoperatively. The patient’s condition further deteriorated and he expired prior to starting chemotherapy.

Conclusion: High-grade MEC of the tongue base is exceedingly rare in children. This case exhibited sarcomatous features and demonstrated unusually aggressive behavior characterized by early recurrence, rapid progression, and poor response to treatment. Continued reporting of such rare presentations is vital to augment knowledge of pediatric MEC with sarcomatous features.