JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Jul 2016
Assessment of the Predictive Value of the Modified Frailty Index for Clavien-Dindo Grade IV Critical Care Complications in Major Head and Neck Cancer Operations.
Functional status and physiologic deficits independent of age are being recognized for surgical risk stratification. Frailty is expressed as a combination of decreased physiologic reserve and multisystem impairments distinct from normal aging processes. ⋯ The mFI is predictive of postoperative critical care support after surgery for head and neck cancer. Specifically, increases in mFIs were strongly associated with CDIV complications for glossectomy, mandibulectomy, and laryngectomy. Classifying patients by their functional status using the mFI may help predict outcomes after head and neck oncologic surgery.
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JAMA Otolaryngol Head Neck Surg · Mar 2019
ReviewDiagnosis, Classification, and Management of Pediatric Tracheobronchomalacia: A Review.
Tracheobronchomalacia (TBM) describes an increased collapsibility of the trachea and bronchi that is greatest on forced expiration. A broad term, TBM encompasses intrinsic tracheal weakness, some forms of tracheal deformation, and extrinsic compression. Tracheobronchomalacia is the most common congenital tracheal anomaly, affecting 1 in 2100 children. Tracheobronchomalacia is often associated with recurrent and prolonged respiratory tract infections, can lead to chronic lung disease, and can be fatal in its most severe form. Tracheobronchomalacia is often associated with other congenital anomalies and syndromes. ⋯ Tracheobronchomalacia is an entity of relevance to pediatric otolaryngologists and should be considered as being associated with respiratory distress, stridor, cough, recurrent pneumonia, or feeding difficulties, especially in children with syndromes or other congenital anomalies. A multidisciplinary approach to these patients is essential. A classification scheme facilitates discussion of individual patients among health care professionals and guides appropriate management. Novel surgical approaches for the treatment of TBM, including anterior and posterior tracheopexy and aortopexy, may be considered in management of the treatment of children with symptomatic TBM.
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JAMA Otolaryngol Head Neck Surg · Jan 2016
Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-analysis.
Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework. ⋯ Maxillomandibular advancement is an effective treatment for OSA. Most patients with high residual AHI and RDI after other unsuccessful surgical procedures for OSA are likely to benefit from MMA.