Arch Otolaryngol
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Comparative Study
Analysis of efficiency of common otolaryngology operations: comparison of operating room vs short procedure room in a pediatric tertiary hospital.
To compare the operative times of routine otolaryngologic procedures performed with 2 different operating room staffing models: the traditional model with 2 staff, a scrub nurse and a circulator, and the short procedure room (SPR) setting, with a circulator only. ⋯ Despite fewer assisting staff, the SPR setting showed a statistically significant reduction in total operative procedure times for TA and BMT, and results were similar for adenoidectomy. Reducing operating room personnel costs is possible in addition to achieving modest gains in efficiency.
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Comparative Study
The role of airway fluoroscopy in the evaluation of stridor in children.
To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor. ⋯ Airway fluoroscopy is a quick, noninvasive, and dynamic study of the entire airway that provides important additional information to the history review and physical examination and is a valuable adjunct to flexible fiberoptic laryngoscopy. It was far superior to plain films and may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway.
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The best treatment for advanced head and neck cancer remains unclear. Proponents of various therapeutic regimens continue to debate this issue with inconclusive and frequently biased data and with carefully selected patients in controlled trials to support their approach. To assess the outcome of patients in a real-world situation, we reviewed a prospectively maintained database of patients with head and neck cancer. ⋯ The data demonstrate the value of analyzing a consecutive series of patients with advanced head and neck cancer. By including patients with comorbidities and those who are noncompliant, we determined a realistic expectation of patient outcomes. By including all patients, the data dramatically show the impact of age, comorbidity, and advanced stage on survival. The survival of patients who underwent elective radiation therapy in combination with neck dissection was similar to that of patients treated with primary tumor surgery. This was particularly true for oropharyngeal tumors. The site and stage-specific data are useful in counseling patients with advanced head and neck cancer regarding treatment choices.
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Iatrogenic facial nerve paralysis is a devastating surgical complication that occasionally results in litigation. ⋯ Surgeons must emphasize and document the likelihood and consequences of this devastating complication to all patients undergoing surgery in this area. Risk management goals include a thorough and timely examination and careful and thoughtful surgical approaches. However, patient rapport and bedside manner may be the only protection the surgeon has from litigation arising from this complication.