JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Feb 2014
Comparative Study Observational StudyCorrelation of final evoked potential amplitudes on intraoperative electromyography of the recurrent laryngeal nerve with immediate postoperative vocal fold function after thyroid and parathyroid surgery.
Thyroid and parathyroid surgery are among the most common operations in the United States. Recurrent laryngeal nerve (RLN) injury is an infrequent but potentially detrimental complication. ⋯ Intraoperative nerve monitoring of the RLN with EMG provides real-time information regarding neurophysiologic function of the RLN and can predict immediate postoperative VFP reliably when a cutoff of 200 µV is used. The high negative predictive value means that the surgeon can presume with confidence that the RLN has not been injured in the presence of a potential of at least 200 µV. This information would be useful in patients for whom bilateral thyroid surgery is being considered.
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JAMA Otolaryngol Head Neck Surg · Feb 2014
Comparative StudyQuality of life among long-term survivors of head and neck cancer treated by intensity-modulated radiotherapy.
Radiation therapy to the head and neck has traditionally been associated with adverse effects that can affect oral health and physical functioning. Although intensity-modulated radiotherapy (IMRT) has been widely adopted as a means of decreasing toxic effects, limited clinical data exist on its potential effect on long-term quality of life. ⋯ Our findings add to the body of literature that supports the acceptance of IMRT as standard treatment for head and neck cancer. The fact that most 5-year survivors were satisfied with their quality of lives points to the ability of IMRT to preserve long-term functioning.
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JAMA Otolaryngol Head Neck Surg · Feb 2014
Choosing a fellow or fellowship: a survey of pediatric otolaryngologists.
The numbers of pediatric otolaryngology fellowship programs and applicants have increased over the past 5 years. However, the qualities desired in programs and applicants have not been explored. ⋯ Personal knowledge or a trusted colleague's recommendation may be the most important determinant when pediatric otolaryngology fellowship programs choose an applicant. When fellows choose a program, the opportunity to gain surgical experience in both otology and airway management is crucial, but ACGME accreditation status seems less important. Successful applicants ranked and interviewed at more fellowship programs than nonmatching applicants.
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JAMA Otolaryngol Head Neck Surg · Jan 2014
Treatment of severe porcine tracheomalacia with a 3-dimensionally printed, bioresorbable, external airway splint.
The study demonstrates use of a novel intervention for severe tracheobronchomalacia (TBM). ⋯ A multidisciplinary effort producing a computer-aided designed, computer-aided manufactured bioresorbable tracheobronchial splint was tested in a porcine model of severe TBM and was found to extend survival time. Mortality in the splinted group was ascribed to the TBM model based on the lack of respiratory distress in splinted pigs, long-term survival in animals implanted with the splint without TBM, and necropsy findings.
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JAMA Otolaryngol Head Neck Surg · Jan 2014
Development of the Connecticut Airway Risk Evaluation (CARE) system to improve handoff communication in pediatric patients with tracheotomy.
National attention has focused on the importance of handoffs in medicine. Our practice during airway patient handoffs is to communicate a patient-specific emergency plan for airway reestablishment; patients who are not intubatable by standard means are at higher risk for failure. There is currently no standard classification system describing airway risk in tracheotomized patients. ⋯ We propose an airway risk classification system for tracheotomized patients, CARE, that has high interrater reliability and is easy to use and interpret. As medical providers and national organizations place more focus on improvements in interprovider communication, the creation of an airway handoff tool is integral to improving patient safety and airway management strategies following tracheotomy complications.