Does a Submental Airway Compared to a Tracheostomy Reduce Length of Stay in Craniomaxillofacial Trauma?

BACKGROUND: Patients with craniomaxillofacial trauma (CMT) are at increased risk of airway compromise and may necessitate airway stabilization via a tracheostomy (TO) or cricothyroidotomy. The submental airway (SMA) is an alternative airway and can avoid complications related to TO. PURPOSE: The purpose of this study was to compare the SMA to the TO with respect to hospital length of stay (LOS) and number of days with an advanced airway, termed airway days (ADs). STUDY DESIGN, SETTING, SAMPLE: This single-center retrospective cohort study included subjects with isolated CMT who required operative treatment with either a TO or SMA at Harborview Medical Center. Subjects were excluded if they required a TO for reasons other than treating their CMT. PREDICTOR VARIABLE: The predictor variable was airway type. MAIN OUTCOME VARIABLE: Primary outcome variables were LOS and ADs measured as number of days between admission and discharge dates, and days between establishment of airway and extubation or decannulation dates, respectively. COVARIATES: Covariates included age, sex, American Society of Anesthesiology classification, weight, body mass index, substance use, hospital status, facial injury severity scale scores, and airway placement location. ANALYSES: Bivariate analysis using independent t test, Mann-Whitney U test, and multiple linear regression analyses were used. P value of <.05 was considered significant. RESULTS: Of the 14 subjects identified, 6 underwent a TO and 8 a SMA. The mean LOS in the TO group was 20.3 ± 15.8 days versus 3.9 ± 4.7 days in the SMA group (P = .02). Mean AD in the TO group was 13.2 ± 8.4 versus 0.6 ± 0.7 in the SMA group (P = .01). The TO group had a higher number of operations at 2.0 ± 0.6 versus 1.1 ± 0.4 with a SMA (P = .02). After linear regression analysis adjusting for sex, age, weight, and facial injury severity scale, there were no statistically significant differences between the groups. CONCLUSIONS AND RELEVANCE: Compared to, SMA has a 5-fold decrease in LOS and 22-fold decrease in ADs on bivariate analysis. An SMA is a viable airway management option for operative treatment of isolated CMT. Further studies are warranted with a larger sample size.

Evolution of COVID-19 Guidelines for University of Washington Oral and Maxillofacial Surgery Patient Care.

The emergence of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 (SC2) virus, in late December 2019 has placed an overwhelming strain on healthcare institutions nationwide. The modern healthcare system has never managed a pandemic of this magnitude, the ramifications of which will undoubtedly lead to lasting changes in policy and protocol development for viral testing guidelines, personal protective equipment (PPE), surgical scheduling, and residency education and training. The State of Washington had the first reported case and death related to COVID-19 in the United States. Oral and maxillofacial surgeons have a unique risk of exposure to SC2 and developing COVID-19 because of our proximity of working in and around the oropharynx and nasopharynx. The present report has summarized the evolution of COVID-19 guidelines in 4 key areas: 1) preoperative SC2 testing; 2) PPE stewardship; 3) surgical scheduling guidelines; and 4) resident education and training for oral and maxillofacial surgery at the University of Washington, Seattle, Washington.

Mandibular Fractures: Diagnosis and Management.

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.