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Chapter 11: Outcomes and Controversies
G. Richard Holt, MD, MSE, MPH, MABE
I. Outcomes
A. Factors Affecting the Clinical Outcome
The clinical outcome for an individual patient after treatment for
injuries to the face, head, and neck will depend upon a number of
factors:
y y Extent of facial, head, and neck injuries.
y y Preexisting comorbidities (diabetes, hypertension, pulmonary and
vascular disorders).
y y Extent of other bodily injuries (central nervous system, spinal cord,
cardiopulmonary, ocular).
y y Timing of diagnosis.
y y Timing of treatment.
y y Availability of appropriate diagnostic services.
y y Experience, current knowledge, and competence of surgeon.
y y Patient compliance and accountability.
B. Main Factors under surgeon Control
Not all of the above factors are under the direct control of the surgeon,
especially where resources are limited and where the community has a
high level of endemic noncommunicable diseases. The main factors
under surgeon control are the extent of knowledge, experience, and
competency of the surgeon. Patient outcomes after trauma care have a
strong correlation with these factors. Therefore, throughout their career,
otolaryngologists–head and neck surgeons must maintain interest in,
and the practice of, modern trauma surgery.
C. Case Management and Coordination
Case management and coordination are important in the care of
patients with serious face, head, and neck traumatic injuries or those
with multiple body trauma. The more severely injured patients may
require one or more of the following rehabilitative and restorative
services:
y
y Physical rehabilitation.
y
y Cognitive retraining.
y
y Speech and swallowing therapy.
y
y Clinic and surgical procedure appointments.
y
y Medication compliance.