HSC Section 3 - Trauma, Critical Care and Sleep Medicine

C. Management of penetrating head and neck injuries Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: a guide to evaluation and management. Ann R Coll Surg Engl . 2018; 100(1):6-11. EBM level 4..............................................................................26-31 Summary : This article is a comprehensive review that helps guide clinical management of patients with penetrating trauma to the neck. It presents an evidence-based, algorithmic, practical guide for clinicians to use when assessing and managing penetrating neck injury. D. Orbital trauma Frohwitter G, Wimmer S, Goetz C, et al. Evaluation of a computed-tomography-based assessment scheme in treatment decision-making for isolated orbital floor fractures. J Craniomaxillofac Surg . 2018; 46(9):1550-1554. EBM level 4.................................................................................................32-36 Summary : This is a retrospective study of 106 patients with unilateral isolated orbital floor fractures. Correlations between preoperative ophthalmological examinations and specific CT parameters were performed, looking at CT scans of orbital floor fractures with the aim of facilitating treatment decision- making using four CT-based variables. Findings showed that critical size defects of the orbital floor of ≥ 2 cm are likely to cause clinically significant posterior displacement of the globe, resulting in enophthalmos, and the authors proposed parameters of a readily accessible and easy-to-evaluate scheme to help identify patients in need of surgical intervention. Sharma AN, Tiourin E, Banyard DA, et al. Clinical utility of postoperative computed tomography imaging in orbital floor fracture management. Ann Plast Surg . 2019; 83(1):43-47. EBM level 4...................................................................................................................................................37-41 Summary : A retrospective chart review was conducted for all patients who underwent orbital floor fracture repair at University of California, Irvine, from 2008 to 2017. Demographics, injury characteristics, and presurgical and postsurgical management were retrospectively extracted for 217 cases. Patients who experienced a change of care following postoperative CT (N = 6) were compared with the entire patient cohort. In this patient cohort, postoperative CT imaging and its associated costs did not significantly benefit management of orbital floor fracture repair. Careful clinical physical examination should be emphasized over postoperative CT imaging to reliably determine the necessity for reoperation in orbital floor fracture management. E. Temporal bone trauma O TM. Medical management of acute facial paralysis. Otolaryngol Clin North Am . 2018; 51(6):1051- 1075. EBM level Review....................................................................................................................42-46 Summary : This article provides an expansive differential diagnosis of the causes and medical treatment of acute facial paralysis. The author briefly discusses trauma, but succinctly addresses the clinical practice guideline gap analysis of making the proper diagnosis of Bell’s palsy versus other causes of facial paralysis. The article includes an algorithm for medical therapy. The review article includes CT as an objective endpoint in management.

Sun DQ, Andresen NS, Gantz BJ. Surgical management of acute facial palsy. Otolaryngol Clin North Am . 2018; 51(6):1077-1092. EBM level Review...............................................................................67-82

Summary : This article discusses common causes of facial nerve palsy, including Bell’s palsy and temporal bone fracture, discusses rationale and surgical approaches for Bell’s palsy and trauma, and is a complete review of electrophysiologic testing. The review article includes CT as an objective endpoint in management.