Key Points 1. A general rule for determining the size of the endotracheal tube (ET) in children is 4 + (age in years/4) for a cuffed tube and 3.5 + (age in years/4) for an uncuffed tube. It is generally safer to choose a smaller ET tube if the two tube sizes are debated. 2. Tracheostomy does not prevent chronic aspiration. 3. Inspiratory stridor with muffled…
Key Points 1. Understand the embryology and anatomy of the recurrent and superior laryngeal nerves (RLN and SLN). Unilateral or bilateral injury to one or both of these nerves can lead to a range of dysfunctions in voice, swallowing, and the ability to cough. 2. A comprehensive history focusing on recent surgeries, intubations, or viral illnesses is critical in determining the etiology of vocal fold paralysis.…
Key Points 1. Phonomicrosurgery is usually reserved for patients who have attempted and failed nonsurgical management, except in cases of very large or suspicious appearing vocal fold lesions. 2. Videolaryngostroboscopy should be performed during the evaluation of a vocal fold lesion to assess mucosal vibratory properties and glottic closure. 3. Many vocal fold lesions caused by excessive phonotrauma recur if the underlying vocal behavior is not…
Key Points 1. As many as 15 million people suffer from some level of dysphagia during their lifetime, with 1 million receiving a new diagnosis of dysphagia every year. 2. More than 60,000 Americans die from complications associated with dysphagia, most commonly aspiration pneumonia. Aspiration pneumonia is one of the leading causes of death among the elderly. 3. The average cost of managing a patient with…
Key Point 1 The American College of Chest Physicians (ACCP) current guidelines define acute and chronic cough and outline treatment recommendations for these disorders. Pearl 1. There are no targeted treatments for unexplained or neuropathic chronic cough but limited clinical trial data support benefit from treatment with neuromodulators and speech-language therapy. Questions Definitions 1 How does the definition of chronic cough differ from acute cough and…
Key Points 1. Most voice disorders have more than one etiologic factor, and medical, surgical, and behavioral therapies may be warranted individually or in combination at any time. 2. Treatment outcomes for voice disorders are driven by patient perception of limitations related to voice. Treatment goals will be different for each patient depending on their personal voice needs. 3. A multidisciplinary team for treating voice disorders…
Key Points 1. Acute laryngitis is often associated with a viral upper respiratory tract infection and resolves within 1 to 2 weeks without antibiotic therapy. 2. Laryngopharyngeal reflux (LPR) is an inflammatory condition of the upper aerodigestive tract caused by the backflow of gastroduodenal contents into the larynx and pharynx. Pepsin, bile salts, and other gastroduodenal proteins directly induce mucosal modifications associated with LPR, while vagally mediated…
Key Points 1. Laryngoscopy is integral to otolaryngology and is required for both diagnosis and treatment in the clinic and the operating theater. 2. Rigid bronchoscopy is not only diagnostic but also therapeutic and can be the key tool in an airway emergency. 3. Communication with the anesthesiologist is of utmost importance during laryngoscopy and bronchoscopy to prevent complications. 4. The narrowest part of the pediatric…
Key Points 1. Three unpaired cartilages (thyroid, cricoid, and epiglottis) and three sets of paired cartilages (arytenoid, corniculate, and cuneiform) constitute the laryngeal framework. 2. Extrinsic laryngeal muscles reposition the laryngeal framework craniocaudally and anteroposteriorly, especially during swallowing while the intrinsic muscles alter true vocal fold position and tension during phonation and respiration. 3. The true vocal folds are covered in squamous epithelium that overlies a…
Key Points 1. Panfacial fractures require a comprehensive timing and treatment plan for each fracture. 2. Muscle pull can affect a fracture and must be considered to prevent complications. 3. Failure to diagnose and repair a medial canthal tendon injury can lead to functional and cosmetic complications that are difficult to repair secondarily. 4. The quickest way to decompress the eye is by lateral canthotomy with…
Key Points 1. Manipulation of the traumatically injured airway during intubation attempts may lead to critical decompensation, which requires an immediate, emergent surgical airway. 2. Chest radiography in a trauma patient allows for rapid assessment of airway deviation, subcutaneous emphysema, pneumothorax, hemothorax, rib fractures, or mediastinal widening, which may be indicative of great vessel injury. 3. Any neck injury resulting from direct force that causes significant…
Key Points 1. Every reconstructive plan should be tailored to the individual patient, taking into consideration not only the unique defect but also other perioperative and patient factors. 2. The ideal plan for one patient may not work for another. 3. Before surgery, always consider patient comorbidities (heart/lung disease, perioperative risk) and optimize patients for healing (diabetes control, thyroid-stimulating hormone [TSH], nutrition [albumin/pre-albumin], cessation of nicotine…
Key Points 1. Apply the concept of the “reconstructive ladder” when assessing the complexity of the required reconstructive method. The more problematic the wound, the more complex the reconstruction. 2. Cutaneous flaps are classified according to their blood supply, configuration, location, or method of transfer. 3. Orienting a skin excision, wound closure, or local flap parallel to relaxed skin tension lines (RSTLs) will camouflage the resulting…
Key Points 1. The patient with facial nerve paralysis necessitates a thorough workup to delineate timing, mechanism, location, and extent of the injury. 2. Ophthalmologic care, whether medical and/or surgical, is crucial in the management of lagophthalmos due to facial nerve paralysis and should be instituted as early as possible. 3. Facial reanimation procedures are classified as static or dynamic, depending on whether facial movement may…
Key Points 1. Of the botulinum toxins available, Botox® has the longest record of safety and efficacy as well as the most FDA-approved indications. However, due to similar mechanism of action and widespread off-label use, Dysport®, Xeomin®, and Jeuveau® may also be used for cosmetic purposes. 2. Hyaluronic acid–based fillers are the most commonly used facial fillers. 3. Major adverse reactions to injection with facial fillers are…
Key Points 1. Facelift is a cosmetic procedure that involves elevating the tissues of the lower face and neck into a more youthful position. 2. There are several possible complications from facelift, including hematoma, nerve injury, skin necrosis, and contour irregularities. 3. Numerous facelift techniques have been described, each with their own risks and benefits. Pearls 1. The most common complication from facelift surgery is hematoma.…
Key Points 1. Skin resurfacing modalities and methods of action Chemical peels: caustic injury Dermabrasion: mechanical injury Laser: thermal injury 2. Different types of chemical peels Superficial chemical peels (epidermis): TCA 10% to 30%, Jessner’s solution, glycolic acid 40% to 70%, and salicylic acid 5% to 15% Medium chemical peels (superficial dermis): TCA 35% to 40%, combination of 35% TCA with other agents and phenol 88%…
Key Points 1. Detailed knowledge of eyelid and orbital anatomy is crucial for any physician working in the periocular area. 2. There are a variety of surgical approaches to the orbit. The best choice depends on the size and location of the pathologic process. 3. Rejuvenation of the periocular area is best accomplished using a combination of neuromodulators, fillers, and surgical procedures. 4. The Asian eyelid…
Key Points 1. A thorough understanding of the anatomy and physiology of the nose is paramount to performing successful rhinoplasty surgery. 2. Nasal tip support mechanisms must be respected, preserved, and/or addressed in rhinoplasty. 3. Preoperative goals, expected outcomes, and potential complications must be discussed at length between the surgeon and patient. Pearls 1. Major nasal tip support mechanisms are (1) the size, strength, and resiliency…
Key Points 1. Symmetry and proportion are important to facial harmony. The individual subunits must balance each other to achieve an aesthetically pleasing result. 2. Ideal relationships have been established based on the relationship of soft tissue landmarks to each other. However, variations exist for different ethnicities. 3. When analyzing the nose, it is important to evaluate its relationship to the rest of the face in…