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Resident Manual of Trauma to the Face, Head, and Neck

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Chapter 11: Outcomes and Controversies

Assistance with insurance coverage (Medicaid).

Dental and ophthalmology services.

It is the surgeon’s responsibility to ensure the continuity of care and

access for the patient to the full range of rehabilitative services that the

patient may need to achieve the best ultimate outcome.

D. Clinical Indicators and Best Practices

A number of clinical indicators and best practices in face, head, and

neck trauma care are based on current evidence, expert opinion, and

consensus experience. It is important that surgeons maintain system-

atic records of their patients’ outcomes, so they may understand and

compare the outcomes with expected national standards. Quality

improvement is the salutary and expected result of such outcome

studies. To review general quality and patient safety information for

surgeons, visit the Academy’s Web site

Practice/quality.cfm).

II. Controversies

As with all fields of surgery, there are controversies and differences of

opinions in trauma care of the face, head, and neck. In addition to

variations in training and experience, there are philosophical differences

in how surgeons approach soft tissue and osseous trauma repair and

reconstruction. Additionally, resource allocation and cost factors may

affect particular protocols for trauma care. Some controversies or

differences of opinion bear disclosure for consideration.

A. Closed versus Open Reduction of Nasal Fractures

1. Local Anesthesia versus Deeper Anesthesia

PRO local anesthesia

—Mild to moderately displaced supratip or lateral

nasal fractures may be adequately reduced in a clinical setting utilizing

topical and local anesthesia.

CON local anesthesia

—Lateral nasal fractures cannot be adequately

reduced without deeper anesthesia, and operative reduction will

produce better end results.

2. Outpatient versus Inpatient Closed Reduction

PRO outpatient

—Outpatient closed reduction of nasal fractures will be

less expensive and more cost-effective.

CON outpatient

—Because of the likelihood that closed reduction will not

achieve a satisfactory result and will require a second, operative