Elective parotidectomy in the management of advanced auricular malignancies.

OBJECTIVE: The purpose of this study is to determine whether elective parotidectomy is necessary in patients with clinically and radiographically N0 parotid disease with isolated primary auricular nonmelanoma cutaneous malignancies. Auricular malignancies are typically managed by wedge resection or wide local excision. Although small lesions are easily managed by conservative excision, large bulky tumors, those with multifocal involvement, and recalcitrant lesions, often require more extensive resection including total auriculectomy, parotidectomy, and/or neck dissection. STUDY DESIGN: A 10-year retrospective case review from four tertiary university medical centers from 1992 to 2002. METHODS: Information was retrospectively retrieved using a database of patients from the department of pathology. Seventy-one charts were reviewed. Patients with a clinical history of advanced nonmelanoma auricular carcinoma undergoing elective parotidectomy and/or neck dissection with clinically and radiographically N0 nodal disease were evaluated for the presence of occult parotid metastasis. All patients underwent parotidectomy in conjunction with a total auriculectomy for surgical extirpation of their primary auricular carcinoma. Parotid specimens were evaluated for histopathologic evidence of metastatic neoplastic disease. RESULTS: Pathological examination showed no histological evidence of occult parotid metastasis in all 19 patients who underwent elective parotidectomy in the presence of clinically and radiographically N0 nodal disease of the parotid or cervical regions. CONCLUSIONS: Parotidectomy may not be necessary in the surgical management of advanced auricularcarcinoma in the absence of clinically positive parotid disease or external auditory canal involvement.

Day float: an alternative to the night float coverage system for residency programs.

OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) has mandated an 80-hour work week that has resulted in changes to many residency programs. In otolaryngology, most programs have switched to either home call or night float systems. Our department covers all of the maxillofacial trauma and backup airway calls, which has made it difficult to employ a home call system. Instead of a night float coverage system, our program implemented a day float coverage system that allows the residents to participate in a 24-hour call period. After call and sign-out, the residents go home; however, their clinical duties are covered by the day float resident. STUDY DESIGN: A brief review of the literature pertaining to call coverage systems followed by a description of our day float system. Residents who have participated in either night float, day float, or both systems were then surveyed regarding their experiences or perceptions of both systems. METHODS: A nine-question survey was handed out to our otolaryngology residents and their responses were recorded. RESULTS: The averaged responses strongly favored the day float over the night float coverage system regardless of the level of training and the systems in which the residents have participated. CONCLUSIONS: The day float coverage system is favored by residents in our program. It allows for a more attending-like 24-hour period of call, continuity of care, attendance at educational activities, and more time with family. In addition, it eliminates a prolonged period devoid of clinical activities.

Adult supraglottitis subsequent to smoking crack cocaine.

Supraglottitis is one possible complication of smoking crack cocaine. From 1992 through 2001, our institution treated nine patients for thermal supraglottitis secondary to crack cocaine inhalation. In this article, we describe two of these cases, and we briefly review what is known about this entity and the mechanism of injury. We also provide our recommendations for management.