A remaining question is whether time alone can help in some cases. “Instead of just these single-institution studies,” Dr. Francis said, “we need to start performing multicenter comparative studies with sufficient sample sizes to help inform treatment decisions.”
Explore This IssueMay 2018
Does the Frontal Sinus Need to Be Obliterated Following Fracture with Frontal Sinus Outflow?
Alexander Chiu, MD, chair of otolaryngology-head and neck surgery at the University of Kansas in Kansas City and
ENTtoday physician editor, said the approach to this injury involves aesthetics, maintaining normal sinus function, and—most importantly, he said—consideration of short- and long-term complications. “Traditional teachings will tell you that any frontal sinus outflow tract fracture should be acutely treated with a frontal sinus obliteration,” he added.
But is that always the case? Not necessarily, he said. The most relevant literature on the subject, he said, is a systematic review covering seven studies and 350 of 515 patients managed with frontal sinus preservation rather than traditional management. Those managed with preservation had a complication rate that was not statistically different from the others (Craniomaxillofac Trauma Reconstr. 2010;3:141–149).
This is solid evidence that sinus preservation can be a good approach in the right hands, Dr. Chiu said. “You do need to acutely manage frontal sinus outflow tract injuries. The question is whether you need to obliterate and cranialize. The short-term evidence points to the fact that you can follow these patients and treat them endoscopically if they maintain an obstruction—if you have the skill set to treat those patients.”
Is Dexamethasone Effective in Preventing Nausea and Vomiting After Common Otolaryngology Procedures?
Parwane Pagano, MD, assistant professor of anesthesiology at Columbia University Medical Center in New York City, said risk factors for postoperative nausea and vomiting (PONV) include female gender, age younger than 50, the duration of the anesthesia, and the need for opioids. PONV can delay discharge and lead to unplanned hospitalizations after procedures that were planned as outpatient.
Dexamethasone is thought to work for PONV by central nervous system binding, lowering inflammatory mediators, and possibly by killing pain. Hyperglycemia can occur in patients with impaired glucose tolerance, she noted.
In one of the more recent studies, a meta-analysis of seven randomized controlled trials, including 611 patients undergoing thyroidectomy, IV dexamethasone at 5 to 10 mg, given intraoperatively with one other antiemetic drug or antacid, was associated with a lower incidence and decreased severity of PONV (Med Sci Monit. 2014;20:2837-2845). Other studies and analyses have found similar efficacy, Dr. Pagano said.