JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Jun 2014
Case ReportsA Case of Trigeminocardiac Reflex During Infrastructure Maxillectomy.
The trigeminocardiac reflex refers to the sudden development of bradycardia or even asystole with arterial hypotension from manipulation of any sensory branches of the trigeminal nerve. Although it has only rarely been associated with morbidity and tends to be self-limited with removal of the stimulus, it is an important phenomenon for head and neck surgeons to recognize and respond to. ⋯ The trigeminocardiac reflex can be provoked by a number of head and neck and skull base procedures including parotidectomy and posterior maxillectomy. Surgeons and anesthesiologists should be wary of inciting the reflex during manipulation of trigeminal branches. Careful dissection for prevention and early intervention with stimulus removal and anticholinergic use as needed are paramount to ensure good outcomes.
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JAMA Otolaryngol Head Neck Surg · Nov 2014
Observational StudyLong-term outcome of airway stenosis in granulomatosis with polyangiitis (Wegener granulomatosis): an observational study.
Airway stenosis occurs in patients with granulomatosis with polyangiitis (GPA or Wegener granulomatosis). It produces significant morbidity and contributes to mortality. ⋯ The frequency and distribution of airway stenoses in 44 patients with GPA has been described. In the 39 patients who required intervention, multiple procedures were required, but 97% then achieved a prolonged period of airway patency. The procedures and adjuvant treatments were found to be safe. Our experience with a variety of techniques in this rare presentation has permitted design of a structured approach and an algorithm to manage and evaluate airway stenosis in GPA.
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JAMA Otolaryngol Head Neck Surg · Aug 2014
A longitudinal study of emotional intelligence training for otolaryngology residents and faculty.
Emotions underlie and influence physician communications and relationships with patients and colleagues. Training programs to enhance emotional attunement, or emotional intelligence (EI), for physicians and assess training effects are scarce. ⋯ Emotional intelligence training positively influences patient satisfaction and may enhance medical education and health care outcome.
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JAMA Otolaryngol Head Neck Surg · Dec 2014
Epidemiology and treatment of lacrimal gland tumors: a population-based cohort analysis.
Primary tumors of the lacrimal gland are rare and are associated with substantial morbidity and mortality. The literature regarding these tumors is limited to case series and case reports. ⋯ Our study demonstrates that ACC is the most common malignant epithelial neoplasm of the lacrimal gland. Determinants of survival for tumors of the lacrimal gland include age at diagnosis and surgical therapy. Radiation therapy is associated with improved DSS in SCC but not in ACC.
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JAMA Otolaryngol Head Neck Surg · Oct 2013
Predictors of persistent sleep apnea after surgery in children younger than 3 years.
Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied. ⋯ To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.