Misconceptions About Negative Pressure Rooms and Their Impact Aboard USNS Comfort in New York City.

The outbreak of novel coronavirus disease 2019 (COVID-19) has had a momentous impact on the field of otolaryngology due to the high number of aerosol-generating procedures involving the upper aerodigestive tract. These procedures bear significant risk to the provider and clinical environment due to the possibility of viral aerosolization. While significant attention has been appropriately paid to personal protective equipment during this pandemic, an understanding of industrial hygiene is also necessary for the safe delivery of health care to mitigate the risk of exposure to other patients and health care workers. We provide a review of air ventilation practices and their role in reducing pathogen spread. In addition, we share our experiences with effectively treating COVID-19-positive patients aboard the USNS Comfort through proper environment control measures.

Patient compliance following isolated mandibular fracture repair.

OBJECTIVE: Compliance with postoperative care in the maxillofacial trauma population often is considered poor. This lack of follow-up does not seem to be a function of decreased access to care but rather its anticipated lack of utilization. The goal of this study is to identify what factors are associated with increased compliance in postoperative management of mandible fractures. STUDY DESIGN: Retrospective cohort study. METHODS: Using Current Procedural Terminology codes to identify maxillofacial injuries requiring operative repair, a subset of isolated mandibular fractures was identified. Age, gender, race, insurance type, travel distance, mandible fracture location, surgical approach, and complications were used as variables in univariate regression modeling to examine factors associated with compliance to postoperative care. RESULTS: Between 2010 and 2013, 344 isolated mandible fractures were identified. A total of 83.1% of patients made their first postoperative follow-up visit. Demographic data, fracture location, distance to medical center (odds ratio [OR] = 1, P = 0.75), type of repair, use of drains (OR = 1.27, P = 0.61), or nonabsorbable suture (OR = 1.44, P = 0.32) did not appear to be associated with compliance. No association between complications and postoperative compliance was observed (OR = 2.37, P = 0.17). Trends toward improved compliance were observed when evaluating insurance type and use of temporary fixation hardware. The presence of current tobacco use was found to be negatively associated with patient compliance (OR = 0.33, P < 0.01). CONCLUSION: Postoperative compliance after surgical repair is better than what is currently represented in the literature. It appears that postoperative compliance is dependent on patient-related factors more so than what can be modified by the surgeon. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2230-2235, 2017.

Barriers to Repair in Maxillofacial Trauma.

IMPORTANCE: Multiple factors can be associated with the delayed repair of maxillofacial injuries that may be associated with increased morbidity. OBJECTIVE: To assess factors affecting timing of repair and barriers which may exist in the management of maxillofacial trauma. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study at a tertiary care facility used the Current Procedural Terminology coding to identify adult patients undergoing operative repair of maxillofacial injuries between January 2010 and December 2013. Demographic information, presence and severity of concomitant injuries, as well as fracture-specific data including fracture type(s), mechanism of injury, and documented complications were recorded. Identifiable delays for medical, logistical, or other reasons were also documented. Multivariate regression modeling was used to determine factors associated with increased time to repair. A comparative analysis was used to identify association between complications and time to operative repair. MAIN OUTCOMES AND MEASURES: Time to operative repair from date of presentation; association of known operative delay and perioperative complications. RESULTS: Overall, 780 patients were included in the study. Of patients meeting inclusion criteria, mean (SD) age was 36.7 (14.2) years (range, 18-88 years), and 616 patients (79%) were male. Average time to repair was 6.5 days (range, 0-43 days), and 138 patients (17.7%) were observed to have a documented reason for delay for medical reasons (n = 62 [44.9%]), operating room logistical factors (n = 17 [12.3%]), or other reasons (n = 59 patients [42.8%]) either as a function of delayed patient presentation or failure of patients to make scheduled appointments or operations. Injury severity score (ρ = 0.45; P < .001), concurrent injuries (P < .001), decreased Glasgow Coma Scale (P < .001) and inpatient status at time of surgery (P < .001), were associated with increased time to repair. The observed complication rate was 13.6%. There was no statistically significant association between known operative delay and development of complications (χ21 = 2.92; P = .08). CONCLUSIONS AND RELEVANCE: Management of maxillofacial trauma appears to occur in a timely manner. Patient injury severity appears to have the greatest effect on timing of repair. While delays in operative repair may be unavoidable in certain circumstances, streamlining and managing causes of known delay may help improve and expedite patient care. LEVEL OF EVIDENCE: 3.