An unusual complication of malar augmentation.

The purpose of this report is to describe an unusual complication of aesthetic alloplastic malar augmentation and to provide a brief review of the literature regarding this complication, its treatment, and its prevention. We review the case of a single patient who presented with a delayed malar pneumatocele after undergoing bilateral malar augmentation using rigid titanium screw fixation complicated by an anterior maxillary sinus wall defect. Although an effective and efficient method, rigid screw fixation is not without potential complications as evidenced by the currently reported implant-associated malar pneumatocele. Care should be taken to avoid damage to the maxillary sinus wall during fixation and, if encountered, the procedure should be aborted, the defect repaired, or a nonporous implant placed with postoperative counselling given to the patient.

Adult outpatient tracheostomy care: practices and perspectives.

OBJECTIVES: To determine the attitudes, opinions, and current practice of adult outpatient tracheostomy care from the surgeon and primary care physician's perspective. STUDY DESIGN: Multidisciplinary physician survey. RESULTS: Found 53.4% (667 of 1250) and 28.9% (404 of 1400) of otolaryngologists and internists responded, respectively; 47% of otolaryngologists lack standardized tracheostomy discharge protocols. General ward nurses most commonly (33%) provide discharge education. A total of 64% of otolaryngologists felt primarily responsible for tracheostomy care and follow-up; 48% expect the primary physician to provide some or all tracheostomy care. Ninety-seven percent of internists received little or no residency training in tracheostomy care, which was significantly associated with decreased comfort (P<0.0001) and willingness (P<0.0001) to care for these patients. CONCLUSIONS: Tracheostomy care is a concerted effort between the patient, surgeon, primary physician, and interdisciplinary team. Otolaryngologists should strive to standardize tracheostomy discharge, education, and follow-up practices. SIGNIFICANCE: Disparities are highlighted between disciplines in their comfort, willingness, and knowledge of outpatient tracheostomy care.

Use of the palatal flap for closure of an oronasal fistula.

Palatal obturators are frequently used in the initial treatment of postoperative palatal fistulae to address the associated problems experienced with speech and swallowing. Many reconstructive surgical techniques for palatal defects have been reported. Although palatal-based flaps are less frequently reported, they can offer a relatively simple reconstructive option with minimal morbidity in patients with acquired palatal defects. We present a case report of a patient requiring reconstruction of a midline oronasal fistula after resection of a palatal malignancy and review the literature concerning this technique.