ABSTRACT Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction. Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by  histopathologic examination Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.

Objective: To describe the clinical and demographic profile of patients who underwent pediatric Endoscopic Sinus Surgery (ESS), and the indications for which the procedure was performed. Methods: Design: Cross-sectional Study Setting: Tertiary Government Hospital Subjects: Using the medical record registry, all patients below 18 years of age who underwent ESS under the Department of Otorhinolaryngology – Head and Neck Surgery of a tertiary government hospital in Metro Manila between December 31, 1999 and January 1, 2008 were reviewed. The age, sex, clinical presentation, and indications for doing ESS, and extent of surgery done were described. The Lund MacKay Grading for nasal polyposis and Scoring for sinusitis were also applied and cross-referenced. Results: Twenty-seven children aged 7 to 17 years underwent ESS. The mean age was 12.9 years, with most (15 patients) belonging to the adolescent age group (13-17 years). Male to female ratio was 1.45:1. The mean interval from onset of symptoms to the first outpatient consultation was 1.5 years; the most common presenting symptoms were nasal obstruction (85.2%) and discharge (59.3%). All of the patients who underwent pediatric ESS had chronic rhinosinusitis: either with nasal polyposis (85.2%), an antrochoanal polyp (11.1%), or both (3.7%). The Lund Mackay Grading for nasal polyps and sinusitis scores were cross-referenced: patients with larger, grade III nasal polyps tended to have more extensive sinus disease than those with grade II polyps. On their first consultation, the patients tended to present with extensive nasal polyp and sinus disease, indicating the need for surgery. All patients with CRS and nasal polyposis underwent polypectomy with ethmoidectomy, uncinectomy and maxillary antrostomy, with additional frontal sinusotomy for a 17 year old male and a 17 year old female, both with grade 3 polyposis. The three patients who had antrochoanal polyps underwent polypectomy with uncinectomy and maxillary antrostomy. There were no operative complications such as cerebrospinal fluid leak and orbital injury reported. Conclusion: Most of the patients who underwent pediatric ESS were older children who were brought for consultation with long-standing, extensive nasal polyp and sinus disease or with antrochoanal polyps, necessitating surgical management. Patients with larger polyps tended to have more extensive sinus disease. They all underwent conservative surgery, with extent of the procedure limited to the extent of the disease present. Efforts to raise public awareness about chronic rhinosinusitis and nasal polyposis in children may result in seeing such cases at an earlier, conservatively treatable stage   Keywords: Pediatric Endoscopic Sinus Surgery, Nasal Polyposis in Children

Objective: To present a rare case of laryngeal extranasopharyngeal angiofibroma, discussing its diagnosis, treatment and differences from the more typical juvenile angiofibroma.             Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One   Result: A 51-year-old male with a two-year history of hoarseness developed difficulty of breathing. Direct laryngoscopy showed a 2x2x1cm glistening, multinodular, pedunculated, firm, pink mass attached to the posterior half of the right true vocal fold obstructing the glottic opening and extending superiorly to the ventricle. Microlaryngeal excision was done. Histopathology showing numerous vascular channels surrounded by dense paucicellular fibrous tissue was consistent with angiofibroma.  Conclusion: Primary extranasopharyngeal angiofibroma is rare, with only 4 previously reported cases occurring in the larynx. We presented what may possibly be the first locally reported case. Although histopathologically similar to the more common juvenile nasopharyngeal angiofibroma, this was atypically seen in the larynx of an older adult patient. Direct laryngoscopy provided excellent exposure for identification as well as complete surgical resection. Unlike the nasopharyngeal type, no massive bleeding was encountered. Prognosis for this extranasopharyngeal angiofibroma is excellent as recurrence is noted to be rare, however, long term follow-up is recommended. Keywords: extranasopharyngeal angiofibroma, laryngeal angiofibroma

Objective: To fabricate an inexpensive, reproducible and portable ringlight with flexible, quick-release mount for use with point-and-shoot consumer digital cameras in intraoral photodocumentation Materials and Methods: Design: Instrumentation Setting: Tertiary Care Hospital Procedure: A commercially-available battery-powered mountaineer’s LED (Light Emitting Diode) headlight (manufacturer, place) was converted into a portable ringlight with a flexible, quick-release mount for intraoral photodocumentation. Results: The Flexmount Ringlight delivered an even and white illumination of the oral cavity and oropharynx at a working distance of more than 5cm from the subject in focus. It resulted in sharper pictures due to its constant illumination that assisted the camera’s autofocus system in getting accurate focusing intraorally. It also allowed the camera to use smaller apertures that have put more elements in focus, and faster shutter speeds that have markedly reduced motion blur. Conclusion:  The Flexmount Ringlight is an inexpensive, easy-to-assemble and portable ringlight that can be used in point-and-shoot consumer digital cameras. Its constant and even illumination resulted in reproducible, sharp, shadowless photographs of the oral cavity and oropharynx. Keywords: ringlight, flexmount, intraoral photodocumentation