Major complications of laryngoscopy and tracheal intubation are rare. However, mucosal trauma during airway management can lead to the introduction of oropharyngeal bacterial flora into the deep neck spaces, with the potential for fatal complications. This report describes the development of a paratracheal abscess in a healthy 62-year-old man following an outpatient herniorrhaphy. The patient was treated with intravenous antibiotics and underwent ultrasound-guided needle aspiration of the abscess. He was later re-admitted to the hospital with re-accumulation of the abscess, which was successfully treated by open surgical drainage. Though deep neck space infection following laryngoscopy is more common in patients with significant comorbidities and when tracheal intubation has been difficult, this case highlights the need for careful airway management in all patients.

Objective Patient care delivered by residents is an educational opportunity to foster autonomy. These services, however, may not be billed without direct faculty supervision. This quality improvement project analyzes descriptive data, procedures, and billing from an academic otolaryngology–head and neck surgery department’s inpatient consult service. Methods This prospective cohort study collected descriptive and billing data on all consults over 30 consecutive days. Data collected described bedside procedures and operative interventions. Encounters were Current Procedural Terminology coded and equivalent work relative value unit (wRVU) calculated. Codes submitted for billing were reviewed to identify opportunities for inpatient billing improvement. Results Ninety-eight new consults were included, and 105 bedside procedures were performed. Flexible laryngoscopy (n = 27), I&D (incision and drainage; n = 11), and suturing (n = 11) were the most performed bedside procedures. Operative intervention was required in 15 encounters. The inpatient consult team provided the equivalent of 391.39 wRVU. Seventy-three percent of operative compared to 3% of bedside procedures were submitted for billing. Discussion The productivity of our team approximated 61.8% of a full-time general otolaryngologist but with decreased billing submissions. Balance between resident autonomy, education, quality patient care, and the ability to capture service revenue is complex. Strategies other institutions have used to capture missed billing opportunities have included a hospitalist model, mid-level providers, and resident billing. Implications for Practice This study characterizes an academic inpatient consult service. Results describe a case for improving the structure of the inpatient consult service, caution that studies collecting data via department billing may underrepresent services, and suggest alternative service structures to overcome identified billing limitations.

Purpose: There is a recent trend towards rapid discharge after endoscopic endonasal transsphenoidal surgery (EETS). We aimed to identify factors related to in-hospital complications and 30-day readmissions to help inform postoperative care practices. Methods: This is a retrospective analysis of patients that underwent EETS for resection of a tumor. Primary outcomes included complications and 30-day readmission. Results: Transient diabetes insipidus occurred in 37% of patients with a complication. Complication was associated with bedrest, occurring in 15.4% of patients without no bedrest, in 24.5% of patients with bedrest of 2-3 days, and in 54.6% of patients with >3 days of bedrest (p=0.02). The median length of stay was 6 days and 4 days in patients with and without a complication, respectively (p<0.0001). Readmission within 30 days occurred in 9.5% of cases, most commonly due to hyponatremia. 30-day readmission was associated with American Society of Anesthesiologists (ASA) class, where 12.5%, 5.9%, and 37.5% patients with ASA class 2, 3, and 4 were readmitted in 30 days, respectively (p=0.02). A maximum tumor diameter (TDmax) of 20-29 mm was associated with readmission, occurring in 20.9% of those patients (p=0.01). EOR was not associated with postoperative complication or with 30-day readmission. Conclusion: In-hospital complication was associated with increased duration of postoperative bedrest, although no causative relationship can be established based on this data. Preoperative anticoagulation usage, increasing ASA class, and TDmax 20-29 mm may help predict 30-day readmission after EETS. EOR was not associated with complications or 30-day readmission.

Objective: Present a case of chondroblastoma of the temporal bone presenting as a facial nerve paralysis and explain the use of a 3-D acrylic model in surgical resection planning. Study Design: Case presentation. Methods: Benign chondroblastomas of the temporal bone are extremely rare. Approximately 1% of all chondroblastomas affect the skull base, with about 34 cases reported in the literature. Most patients are older (average age 43.8 years) and present with otologic symptoms such as tinnitus, hearing loss, otalgia, vertigo and ear fullness. Temporal bone chondroblastomas tend to be more aggressive requiring more extensive resection. We report the first case reported in the literature of chondroblastoma of the temporal bone presenting with facial nerve paralysis. A 3-D acrylic model of the temporal bone and skull base was used preoperatively to plan the surgical approach for resection and also reconstruction of the skull base defect. The tumor was subsequently completely excised via a Fisch Type B infratemporal fossa approach. Reconstruction was achieved using an iliac crest free flap. At one year postoperatively, the patient is free of disease with full facial nerve function. Results: Successful resection of chondroblastoma of the temporal bone and reconstruction with an iliac crest free flap with the aid of a 3-D acrylic model. Conclusions: Chondroblastomas of the temporal bone are extremely rare. Surgical resection and reconstruction can be challenging. 1) The use of 3-D models can be very beneficial when planning the surgical resection of temporal bone/skull base tumors. 2) Iliac crest free flap is a very suitable option to consider when planning post-resection reconstruction.