Objective: To describe an improvised optical myringotomy knife essential in creation of an incision in a myringotomy simulator. Methods: Study Design: Instrumental Innovation Setting:           Tertiary Private Hospital Subject:          None Results: The optical myringotomy knife was able to create incisions on mock membranes made up of polyethylene film (Cling Wrap) in a myringotomy simulator. The incisions measured approximately 2 mm with sharp edges indicating that the myringotomy knife was able to penetrate the mock membrane with ease. It provided good control in performing myringotomy incisions under endoscopic visualization of the tympanic membrane.   Conclusion: Our initial experience with this optical myringotomy knife for tympanostomy tube insertion suggests that it may greatly improve the performance of myringotomy especially among less experienced surgeons. Further studies may establish its accuracy and replicability in vitro, after which formal in vivo trials can be attempted.   Keywords: tympanostomy, middle ear ventilation, endoscopy, instrumentation

Objective: To fabricate a single instrument that can be used to perform myringotomy and insert a pressure equalizing tube at almost the same time.   Methods: Study Design: Surgical Instrumentation Setting: Tertiary Private Hospital Subject: A chicken egg membrane was used as a tympanic membrane model   Result: The fabricated instrument was able to perforate the egg membrane and apply the modified polyethylene pressure equalizing tube in less than one minute without complications.   Conclusion: The prototype applicator can facilitate myringotomy and pressure equalizing (PE) tube insertion at only a fraction of the time it usually takes to do the standard myringotomy and subsequent ventilating tube insertion.   Keywords: Myringotomy, pressure equalizing tube, ventilating tube, acute otitis media, otitis media with effusion, polyethylene tube

Objective: To describe our reconstruction of an orbital roof and lateral wall defect using a split- thickness calvarial bone graft with titanium mesh complex after resection of a meningioma of the left greater wing of the sphenoid with extension to the left frontotemporal bone and left orbital roof and lateral wall. Methods:             Study Design: Surgical Innovation             Setting: Tertiary Private University Hospital             Patient: One Results: A 44-year-old woman with a left frontotemporal mass associated with left eye proptosis and epiphora underwent reconstruction of the left orbital roof and lateral wall defect using split-thickness calvarial bone graft with titanium mesh and screws after a left frontotemporal craniectomy, superior and lateral orbital wall resection of a mass of the sphenoid wing with orbital and frontotemporal extension. Final histopathology was consistent with meningioma. Surveillance of the mass and orbital reconstruction showed evidence of bone growth and osteointegration of the titanium mesh into the bone grafts. Conclusion: The initial good outcome of orbital roof and lateral wall reconstruction using split-thickness calvarial bone graft with titanium mesh is evidenced by osteointegration of the titanium mesh and revascularization leading to new bone growth. This autogenous-alloplastic complex may provide a more stable option for orbital reconstruction, but long term follow-up is needed for surveillance of recurrence and monitoring the status of orbital reconstruction.

Objective: To measure the average distances from anterior lacrimal crest (ALC) to anterior ethmoidal foramen (AEF), anterior ethmoidal foramen to posterior ethmoidal foramen (PEF) and posterior ethmoidal foramen to optic canal (OC) using plain paranasal sinus (PNS) computed tomography (CT) scans of adults in a tertiary private hospital in the Philippines. Methods:             Design: Retrospective review of plain PNS CT scans             Setting: Tertiary Private Teaching Hospital            Participants: One hundred four (104) plain PNS CT scans from January 2018 to December 2020 were considered for inclusion. Results: Of the 104 PNS CT scans, 35 were excluded - seven for age less than eighteen, six for undistinguishable PEF and twenty-two for chronic rhinosinusitis. The remaining 69 PNS CT scans demonstrated identifiable structures, with overall average distances from ALC to AEF of 23.71 ± 2.43 mm, AEF to PEF of 10.87 ± 2.39 mm and PEF to OC of 7.39 ± 2.28 mm. Conclusion: Our study suggests average distances for localization of vital structures such as the anterior ethmoidal artery, posterior ethmoidal artery and optic nerve among Filipinos. Because of considerable variation between and within sexes, individual measurements should still be obtained for each patient in performing endonasal, skull base and orbital surgery.

Objective: To present a case of a non-traumatic cerebrospinal fluid (CSF) rhinorrhea from a midline sphenoid sinus roof that presented as a persistent postnasal drip and was previously managed as allergic rhinitis for 43 years.   Methods:             Design:           Case Report             Setting:           Tertiary Private University Hospital             Participants:   One   Results: A 58-year-old obese and hypertensive man presented with persistent post nasal drip and intermittent clear watery rhinorrhea. He had been managed as a case of allergic rhinitis for 43 years and was maintained on nasal steroid sprays without relief. Nasal endoscopy revealed pulsating clear watery discharge from the sphenoid ostium. On trans-sphenoidal surgery, a midline sphenoid sinus roof defect was sealed using a Hadad-Bassagasteguy flap.   Conclusion: CSF rhinorrhea is uncommon and may mimic more common diseases such as allergic rhinitis. Because misdiagnosis can then lead to life threatening complications, physicians should be vigilant when seeing patients with clear watery rhinorrhea to be able to arrive at a proper diagnosis and provide prompt treatment.   Keywords: cerebrospinal fluid rhinorrhea; cerebrospinal fluid leak; sphenoid sinus midline roof defect