The Laryngoscope
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Opioid misuse and diversion is a major concern, with a negative impact on both the individual and society. The objective of this study was to perform an evidence-based systematic review of the efficacy of perioperative analgesic regimens following otologic surgery. ⋯ There is evidence that combination analgesics, such as acetaminophen plus codeine, provide superior pain relief to monotherapy analgesics in the perioperative pain management of otologic surgeries. NSAIDs, α-agonists, and nerve blocks may also be viable single-therapy options. Further prospective randomized controlled trials into perioperative analgesia for patients undergoing otologic surgery may be helpful in establishing a definitive consensus. Laryngoscope, 130:190-199, 2020.
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Medical three-dimensional (3D) printing, the fabrication of handheld models from medical images, has the potential to become an integral part of otolaryngology-head and neck surgery (Oto-HNS) with broad impact across its subspecialties. We review the basic principles of this technology and provide a comprehensive summary of reported clinical applications in the field. ⋯ As technology and training standards evolve and as healthcare moves toward personalized medicine, 3D printing is emerging as a key technology in patient care in Oto-HNS. Treating physicians and surgeons who wish to stay abreast of these developments will benefit from a fundamental understanding of the principles and applications of this technology. Laryngoscope, 129:2045-2052, 2019.
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Meta Analysis
Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta-analysis.
Perioperative antibiotic prophylaxis in patients undergoing surgery for maxillofacial fractures is standard practice. However, the use of postoperative antibiotic prophylaxis remains controversial. This systematic review and meta-analysis sought to evaluate the effect of postoperative antibiotic therapy on the incidence of surgical site infection (SSI) in patients with maxillofacial fractures. ⋯ Our findings, along with the available evidence, does not support the routine use of postoperative antibiotic prophylaxis in patients with maxillofacial fractures. Avoiding the unnecessary use of antibiotic therapy in the postoperative period could have important implications for healthcare costs and patient outcomes. Laryngoscope, 129:82-95, 2019.
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Review
The fragility of statistically significant findings from randomized trials in head and neck surgery.
The Fragility Index (FI) is a novel tool for evaluating the robustness of statistically significant findings in a randomized control trial (RCT). It measures the number of events upon which statistical significance depends. We sought to calculate the FI scores for RCTs in the head and neck cancer literature where surgery was a primary intervention. ⋯ Randomized trials in the head and neck cancer literature where surgery is a primary modality are relatively nonrobust statistically with low FI scores. Laryngoscope, 128:2094-2100, 2018.