Resident Manual of Trauma to the Face, Head and Neck

3. Timing of Ingestion................................................................ 226 D. Symptoms...................................................................................... 226 E. Physical Exam.................................................................................227 1. General.......................................................................................227 2. HEENT........................................................................................227 3. Pulmonary.................................................................................227 4. Abdomen...................................................................................227 F. Preoperative Management.........................................................227 1. Limit Fluid Intake.....................................................................227 2. Avoid Neutralizing Agents....................................................227 3. Apply Conservative Measures.............................................227 4. Place Nasogastric Feeding Tubes under Supervision.....227 5. Use Imaging............................................................................. 228 6. Consider Endoscopy.............................................................. 228 G. Postoperative Management...................................................... 230 1. Pharmacologic Therapy........................................................ 230 2. Alimentation............................................................................ 230 3. Further Workup...................................................................... 230 H. Complications............................................................................... 230 1. Esophageal Perforation......................................................... 230 2. Esophageal Strictures............................................................. 231 3. Esophageal Carcinoma ......................................................... 231 IV. Conclusion .......................................................................................... 231 V. References ............................................................................................232 Chapter 11: Outcomes and Controversies ...............................................233 I. Outcomes ..............................................................................................233 A. Factors Affecting the Clinical Outcome..................................233 B. Main Factors under Physician Control.....................................233 C. Case Management and Coordination......................................233 D. Clinical Indicators and Best Practices..................................... 234 II. Controversies ...................................................................................... 234 A. Closed versus Open Reduction of Nasal Fractures............. 234 1. Local Anesthesia versus Deeper Anesthesia.................. 234 2. Outpatient versus Inpatient Closed Reduction.............. 234 B. Immediate Primary versus Delayed Closure of Contaminated Soft Tissue Wounds. ........................................235 1. Risk of Infection.......................................................................235 2. Cost Considerations...............................................................235 3. Use of Metal Alloy or Resorbable Fixation Plates...........235 III. Final Considerations ..........................................................................235 Conclusion .........................................................................................................237 AAO-HNS Committee on Trauma .............................................................. 238

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