HSC Section 3 - Trauma, Critical Care and Sleep Medicine

TABLE OF CONTENTS Selected Recent Materials - Reproduced in this Study Guide

2020 SECTION 3: TRAUMA, CRITICAL CARE, AND SLEEP MEDICINE

ADDITIONAL REFERENCE MATERIAL...................................................................................i - iv

I. TRAUMA A. Contemporary management of mandible, midface, and frontal fractures

Kao R, Rabbani CC, Patel JM, et al. Management of mandible fracture in 150 children across 7 years in a US tertiary care hospital. JAMA Facial Plast Surg . 2019 Jun 6. doi: 10.1001/jamafacial.2019.0312. [Epub ahead of print]. EBM level 4........................................................................................................1-5 Summary : This is a retrospective cohort study of 150 patients with 310 total mandible fractures; 109 patients (72.7%) had 2 or more mandible fractures. The mean (SD) patient age was 12.8 (4.6) years. There were 78 condylar or subcondylar fractures (60 patients), 75 ramus or angle fractures (69 patients), 69 body fractures (62 patients), 78 symphyseal or parasymphyseal fractures (76 patients), and 10 coronoid fractures (10 patients). Thirty-eight (25%) of patients were treated with observation and a soft diet. Children 12 years and older were more likely to receive open reduction internal fixation (ORIF) ( p   = 0.02). Of the 112 patients treated with surgery, 63 (56.2%) were treated with maxillomandibular fixation (MMF), 24 (21.4%) received ORIF, and 20 (17.9%) received both MMF and ORIF. Thirteen patients experienced complications, for a total complication rate of 8.7%. Conservative management, using MMF and a soft diet, was favored for most operative pediatric mandible fractures. ORIF with titanium plating was less commonly used. Outcomes were favorable despite a lack of consistent follow up. Summary : This is an evidence-based review to understand the epidemiology, preoperative evaluation, perioperative management, and surgical outcomes of mandible fractures. The objective of this series is to present a review of the literature so that the practicing physician can remain up-to-date on key evidence-based guidelines to enhance management and improve outcomes. B. Management of laryngeal and tracheal injuries Panagiotopoulos N, Patrini D, Barnard M, et al. Conservative versus surgical management of iatrogenic tracheal rupture. Med Prin Pract . 2017; 26(3):218-220. EBM level 2.............................................15-17 Summary : This article reviews management strategies for iatrogenic tracheal rupture. This type of tracheal injury, which is usually the result of orotracheal intubation, requires prompt diagnosis and management, as it is a potentially life-threatening condition. Pickrell BB, Hollier LH Jr. Evidence-based medicine: mandible fractures. Plast Reconstr Surg . 2017; 140(1):192e-200e. EBM level 3............................................................................................................6-14

Parida PK, Kalaiarasi R, Alexander A. Management of laryngotracheal trauma: a five-year single institution experience. Iran J Otorhinolaryngol . 2018; 30(100):283-290. EBM level 4..................18-25

Summary : This review of 253 patients with neck injury highlights the presenting symptoms and physical findings of patients with acute laryngotracheal injury. This report emphasizes the importance of CT imaging in the management of this patient population.