Airway management after maxillectomy with free flap reconstruction.

BACKGROUND: Maxillectomy defects require complex 3-dimensional reconstructions often best suited to microvascular free tissue transfer. Postoperative airway management during this procedure has little discussion in the literature and is often dictated by surgical dogma. The purpose of this article was to review our experience in order to evaluate the effect of airway management on perioperative outcomes in patients undergoing maxillectomy with free flap reconstruction. METHODS: A retrospective chart review was performed on patients receiving maxillectomy with microvascular reconstruction at 2 institutions between 1999 and 2011. Patient's airways were managed with or without elective tracheotomy at the surgical team's discretion and different perioperative outcomes were measured. The primary outcome was incidence of airway complication including pneumonia and need for further airway intervention. Secondary outcome was measured as factors leading to perioperative performance of the tracheotomy. RESULTS: Seventy-nine of 143 patients received elective tracheotomy perioperatively. The incidence of airway complication was equivalent between groups (10.1% vs 9.4%; p = .89). Patients with cardiopulmonary comorbidities were more likely to receive perioperative tracheotomy (74.1% vs 50.9%; p = .03) without a difference in airway complications. Other patient cofactors did not have an impact on perioperative tracheotomy or airway complication rate. CONCLUSIONS: Elective tracheotomy may safely be avoided in a subset of patients undergoing maxillectomy with microvascular reconstruction. Elective tracheotomy should be considered in patients with cardiopulmonary risk factors.

Social networking and professionalism in otolaryngology residency applicants.

OBJECTIVES/HYPOTHESIS: To assess compliance with Accreditation Council for Graduation Medical Education standards of professionalism among otolaryngology residency applicants with publicly searchable Facebook profiles. STUDY DESIGN: Case series. METHODS: Applicants to an otolaryngology residency program were searched on the Facebook website. Multiple matches were narrowed by available information until the correct individual was identified. Searches were performed in a manner that would not allow access to restricted information, thus showing only what would be accessible publicly. Four reviewers evaluated all profiles and generated a professionalism score. Scores were collated with National Resident Matching Program data and match results to identify significant associations. RESULTS: Of the 234 applicants to our institution, 119 had Facebook profiles. Of these, 85 profiles contained information beyond simple demographics. Eleven percent of applicant profiles contained pictures or text that at least one reviewer felt could be perceived as unprofessional. There were six profiles with content considered to be concerning and one profile that contained clear violations of professional boundaries. Professionalism score did not correlate with whether the applicant matched, was interviewed, or received a place on the rank list. Age, gender, marital status, and Step 1 score did not correlate with a lower professionalism score. Our series included 61% of all otolaryngology applicants. CONCLUSIONS: Publicly available Facebook profiles with questionable content existed for 11% of otolaryngology applicants in this series. This finding did not affect applicants' match outcomes, nor was it predicted by any data available on the applicants' applications.