The Laryngoscope
-
To determine the feasibility, reliability, and validity of an objective surgical assessment tool designed to measure the development of tonsillectomy skills by resident trainees in the operating room. A tonsillectomy evaluation instrument created previously serves as a basis for this tool, which incorporates many similar concepts but was optimized to maximize feasibility and reliability with simplified anchors and inclusion of global and task-specific sections. ⋯ This assessment tool is a feasible, reliable, and valid instrument for the assessment of surgical competency in tonsillectomy. It is effective in providing structured feedback at the end of each procedure, which encourages specific, targeted development.
-
Sinonasal adenoid cystic carcinoma (SNACC) is a rare malignancy that most commonly arises in the maxillary sinus. Characteristics of SNACC are slow growth, perineural invasion, and long clinical course. Because it is a rare tumor, population-based studies are limited. We analyzed the incidence and survival for SNACC using a national population-based database. ⋯ The overall incidence of SNACC is declining. Sex and race seem to influence the overall survival for this rare tumor. Future studies need to be conducted to investigate these dynamic trends related to SNACC.
-
Laryngotracheal stenosis usually occurs as a result of injury from endotracheal intubation or tracheostomy placement. With an estimated incidence of 1% to 22% after these procedures, chronic sequelae ranging from discomfort to devastating effects on quality of life, and even death, make this complication a potential litigation target. We examined federal and state court records for malpractice regarding laryngotracheal stenosis and examined characteristics influencing determination of liability. ⋯ Multiple cases mentioned previous intubation as a potential risk factor that may have led to laryngotracheal stenosis. Location of stenosis and requirement of reparative procedures may also influence outcomes. Cases not decided in the defendant's favor frequently included other extenuating circumstances, including severity of other injuries. Although the majority of cases were defendant decisions, the verdicts decided for the plaintiffs had considerable damages awarded.
-
The Centers for Medicare and Medicaid Services has identified 10 hospital-acquired conditions (HACs) for which they will not reimburse care. We sought to determine the incidence of HACs in head and neck cancer (HNCA) surgery and the association with in-hospital mortality, complications, length of hospitalization, and costs. ⋯ HACs are uncommon events in HNCA surgical patients. Because prediction of HACs is poor and the potential for human error crosses demographic, geographic, and structural boundaries, universal innovative measures to reduce the occurrence of HACs are needed.
-
Define surgical outcomes of specific donor sites for free tissue transfer in head and neck reconstruction. ⋯ This review demonstrates that certain subsets of patients are at higher risk for complications after free tissue transfer. Patients undergoing free flap reconstruction for cutaneous defects have substantially shorter hospital stays and are at lower risk of flap complications, whereas reconstruction for radionecrosis and secondary reconstruction tend to have higher overall flap failure rates.