Retrospective study of tracheostomy indications and perioperative complications on oral and maxillofacial surgery service.

PURPOSE: Tracheostomy is an extremely common procedure performed by a variety of surgical specialties. The purpose of the present study was to review the intraoperative and perioperative management and complications, present our surgical technique, and discuss the role of our service in providing this care within a large community hospital setting. PATIENTS AND METHODS: The 112 patients in our retrospective study were divided into 3 subsets: those referred by medical specialties, tumor/reconstructive surgery patients, and trauma victims. Cases of percutaneous dilational and intensive care unit bedside tracheostomy were excluded. Intraoperative and immediately postoperative complications were included. Bleeding complications were defined as those necessitating a return to the operating room. The patients were followed up for a 24-hour period postoperatively. RESULTS: The medical referral, tumor/reconstructive, and trauma patients made up 55%, 29%, and 16% of the included patients, respectively. The overall complication rate was 2.7%. CONCLUSIONS: Conventional open tracheostomy in an operating room is associated with a low complication rate. The low incidence of perioperative bleeding can be attributed to the use of electrocautery in the division of the thyroid isthmus. This service provided an exceedingly safe and efficient surgical treatment by focusing on precise surgical protocols in an operating room setting. Intense coordination of consultation response, operating room scheduling, and communication with other services involved in these patients' care is critical to develop and maintain the privilege to provide this treatment. Our report can be used to educate the medical community regarding the role of an oral and maxillofacial surgery service in providing tracheostomy.

Contemporary concepts in the treatment of chronic osteomyelitis.

Although there are relatively standard treatment approaches for chronic osteomyelitis, many avenues of investigation are being pursued to reflect contemporary concerns. The mainstays of care continue to include timely and thorough surgical débridement and culture-directed antibiotics. Sensitive diagnostic screening is essential, and advances in radiology can lead to early confirmation of disease and accurate surveillance. There is potential to greatly reduce overall morbidity, chance of recurrent infection, and treatment courses by using the local delivery systems currently researched by orthopedic surgeons. The challenges posed by multidrug-resistant bacterium may be countered by sound culturing techniques and new antibiotics. The general purpose of this article is to survey the new directions in oral surgery, orthopedics, infectious disease, immunology, and radiology that may have application to the treatment of maxillofacial osteomyelitis.