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KEY POINTS

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  1. Patients with obstructive sleep apnea require evaluation to determine the specific anatomic site(s) of involvement. Long-term cardiovascular problems are a significant concern in these patients.

  2. Repair of traumatic soft tissue injuries requires precise ­re-alignment of anatomic landmarks such as the grey line and vermilion border.

  3. The key principle in the surgical repair of facial fractures is immobilization, which may require plates, screws, wires, and/or intermaxillary fixation.

  4. Concurrent abuse of tobacco and alcohol are synergistic in increasing the risk of developing head and neck cancer

  5. Monomodality therapy (surgery or radiation) is used for early stage (I/II) head and neck cancer, whereas combination ­surgery and chemoradiation is utilized with advanced stage (III/IV) malignancies.

  6. Infectious conditions of the head and neck may present with life-threatening sequelae such as loss of airway or intracranial extension.

  7. Disorders of the head and neck can cause significant cosmetic and functional impairment. The practitioner must be empathetic to the effect of these morbidities on quality of life.

  8. Hoarseness, odynophagia, referred otalgia, nonhealing oral ulceration and/or cervical lymphadenopathy present for >2 weeks duration require consideration for subspecialty consultation for evaluation.

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A COMPLEX REGION

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The head and neck constitute a complex anatomic region where different pathologies may affect an individual’s ability to see, smell, hear, speak, obtain nutrition and hydration, or breathe. The use of a multidisciplinary approach to many of the disorders in this region is essential in an attempt to achieve the best functional results with care. This chapter reviews many of the common diagnoses encountered in the field of otolaryngology–head and neck surgery—and aims to provide an overview that clinicians can use as a foundation for understanding of this region. As is the case with every field of surgery, care for patients with disorders of the head and neck is constantly changing as issues of quality of life and the economics of medicine continue to evolve.

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BENIGN CONDITIONS OF THE HEAD AND NECK

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Ear Infections

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Infections may involve the external, middle, and/or internal ear. In each of these scenarios, the infection may follow an acute or chronic course and may be associated with both otologic and intracranial complications. Otitis externa typically refers to infection of the skin of the external auditory canal.1 Acute otitis externa is commonly known as swimmer’s ear, because moisture that persists within the canal after swimming often initiates the process and leads to skin maceration and itching. Typically, the patient subsequently traumatizes the canal skin by scratching (i.e., with a cotton swab or fingernail), thus eroding the normally protective skin/cerumen barrier. Because the environment within the external ear canal is already dark, warm, and humid, it then becomes susceptible to rapid microbial proliferation and tissue cellulitis. The most common organism responsible is Pseudomonas aeruginosa, although other bacteria and fungi may also be implicated. Symptoms and signs of otitis externa include itching during the ...

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