ABSTRACT
In maxillofacial head and neck oncology, tracheostomy is often used to secure the airway, but not without risk. This study compared the existing practice of two units: one where tracheostomy was routinely done with one where overnight intubation was used. From both units we retrospectively analysed 50 consecutive patients who had intraoral resection, neck dissection, and microvascular reconstruction for head and neck cancer. When compared with tracheostomy, overnight intubation resulted in a shorter mean stay in the intensive therapy unit (ITU) (1.4 compared with 3.7 days), a shorter overall hospital stay (12.9 compared with 18.0 days), less time to first oral intake (8.9 compared with 12.8 days), and a lower rate of lower respiratory tract infection (LRTI) (10% compared with 38%). This study supports the discontinuation of routine tracheostomy and the adoption of a more selective practice to improve recovery.
Subject(s)
Airway Management/methods , Head and Neck Neoplasms/surgery , Intubation, Intratracheal/methods , Recovery of Function/physiology , Tracheostomy , Adolescent , Adult , Aged , Aged, 80 and over , Critical Care , Enteral Nutrition , Female , Follow-Up Studies , Free Tissue Flaps/transplantation , Hospitalization , Humans , Length of Stay , Male , Mandible/surgery , Microsurgery/methods , Middle Aged , Neck Dissection/methods , Neoplasm Staging , Postoperative Care , Plastic Surgery Procedures/methods , Respiratory Tract Infections/prevention & control , Retrospective Studies , Young AdultABSTRACT
Facial paralysis can have a profound effect on the patient from both an aesthetic and functional point of view. The symptoms depend on which branch of the nerve has been damaged and the severity of the injury. The purpose of this paper is to review currently available treatments for dynamic reanimation of a damaged facial nerve, and the goals are a symmetrical and coordinated smile. Careful selection of patients and use of the appropriate surgical technique can have excellent results.
