Resident Manual of Trauma to the Face, Head and Neck

Chapter 11: Outcomes and Controversies

y y Assistance with insurance coverage (Medicaid). y y Dental and ophthalmology services.

It is the surgeon’s responsibility to ensure the continuity of care and access for the patient to the full range of rehabilitative services that the

patient may need to achieve the best ultimate outcome. D. Clinical Indicators and Best Practices

A number of clinical indicators and best practices in face, head, and neck trauma care are based on current evidence, expert opinion, and consensus experience. It is important that surgeons maintain system- atic records of their patients’ outcomes, so they may understand and compare the outcomes with expected national standards. Quality improvement is the salutary and expected result of such outcome studies. To review general quality and patient safety information for surgeons, visit the Academy’s Web site (http://www.entnet.org/ Practice/quality.cfm). II. Controversies As with all fields of surgery, there are controversies and differences of opinions in trauma care of the face, head, and neck. In addition to variations in training and experience, there are philosophical differences in how surgeons approach soft tissue and osseous trauma repair and reconstruction. Additionally, resource allocation and cost factors may affect particular protocols for trauma care. Some controversies or differences of opinion bear disclosure for consideration. A. Closed versus Open Reduction of Nasal Fractures 1. Local Anesthesia versus Deeper Anesthesia PRO local anesthesia —Mild to moderately displaced supratip or lateral nasal fractures may be adequately reduced in a clinical setting utilizing topical and local anesthesia. CON local anesthesia —Lateral nasal fractures cannot be adequately reduced without deeper anesthesia, and operative reduction will produce better end results. 2. Outpatient versus Inpatient Closed Reduction PRO outpatient —Outpatient closed reduction of nasal fractures will be less expensive and more cost-effective. CON outpatient —Because of the likelihood that closed reduction will not achieve a satisfactory result and will require a second, operative

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Resident Manual of Trauma to the Face, Head, and Neck