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Eric J Dierks

Publications and source records attributed to Eric J Dierks.

At least 19 recordsLinked to original sources
PubMed2006

Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma.

PURPOSE: Laryngeal fractures can occur in association with maxillofacial injuries and may lead to life-threatening airway obstruction. Because of a low incidence and a paucity of peer-reviewed information, there is no universally accepted treatment protocol and few clinicians have extensive experience with complex laryngo-tracheal trauma. The purpose of this retrospective analysis is to validate a treatment protocol for the management of laryngo-tracheal injuries occurring in severely injured patients by assessing the outcome of a consecutive series of patients who were treated by the same surgeons over a 12-year period. PATIENTS AND METHODS: All patients with laryngeal fractures admitted to the trauma service at Legacy Emanuel Hospital and Health Center (LEHHC; Portland, OR) from 1992 to 2004 were managed by the same surgeons, using a standard protocol based on the stability of the airway, and were retrospectively identified using the LEHHC Trauma Registry. Using information from the Trauma Registry and individual physician chart notes, a database was created for the purpose of assessing outcome. The following data were collected: age, gender, mechanism of injury, number of associated injuries and the Injury Severity Score, Glasgow Coma Scale on admission, initial hematocrit, airway management techniques, length of hospital stay, LEHHC laryngeal injury classification, treatment modality, disposition, and any available follow-up. Descriptive statistics were used to describe demographics, treatment, and outcome. Outcome measures were defined as complications, airway patency, speech, and deglutition. RESULTS: A total of 16,465 patients were identified from the Trauma Registry as having sustained head, neck, or facial injuries, of which 37 patients were diagnosed with laryngeal fractures. Complete patient records were available for 27 patients (mean age, 35.5 +/- 15.3 years; range, 8 to 80 years; 23 males, 4 females) who were classified according to the LEHHC laryngeal injury classification scheme. Most patients sustained injuries as the result of blunt trauma (n = 23; 85.1%) and almost all of them had concomitant maxillofacial injuries (n = 26; 96.3%). Twenty patients (74.1%) required advanced airway intervention (tracheostomy, 14; endotracheal intubation, 5; emergent cricothyrotomy, 1), of which 13 patients underwent neck exploration. Eight of these patients required open reduction and internal fixation with titanium plates and screws, and 2 patients required the addition of an endolaryngeal stent. There was a general trend toward poorer outcome with increased LEHHC laryngeal injury classification. However, all patients were successfully decannulated, maintained patent airways, and ate a normal diet. Hoarseness was common in patients who underwent surgical exploration; however, long-term perioperative complications were rare and included infection requiring hardware removal (n = 1), unilateral vocal cord paralysis (n = 1), and subjective dysphagia. CONCLUSION: Fractures of the larynx are uncommon injuries that are frequently associated with maxillofacial trauma and are potentially associated with significant morbidity. Management of laryngo-tracheal injuries using a protocol based on airway status as described in this report results in airway patency, functional vocal quality, and normal deglutition for almost all patients.

Adolescent↗
PubMed2006

Application of a facial injury severity scale in craniomaxillofacial trauma.

PURPOSE: To establish a Facial Injury Severity Scale (FISS) that correlates with patient outcome and provides a practical tool for communication between clinicians and healthcare personnel for management of facial trauma. PATIENTS AND METHODS: All patients presenting to the Emergency Department (ED) at Legacy Emanuel Hospital (Level One Trauma Center) in Portland, Oregon between 01/1993 and 6/2003 with facial fractures with or without concomitant non-facial injuries where identified retrospectively. The diagnosis and treatment of all facial fractures were conducted by the Oral and Maxillofacial Surgery (OMFS) service. The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). The hospital operating room charges (ORC) for the treatment of each patient's facial fractures were also obtained. We designed the FISS to be a numeric value composed of the sum of the individual fractures and fracture patterns in a patient. Not all fractures of the face are weighted equally in the FISS because not all fracture patterns are equal in severity. Individual fracture points within the scale were optimized to result in the highest correlation. RESULTS: A total of 1,115 patient admissions to the ED with blunt or penetrating maxillofacial injuries were identified and reviewed. Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD +/- 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15). The FISS scores were calculated for each patient (average FISS: 4.4, SD +/- 2.7; range, 1 to 13). Hospital ORC for the treatment of each patient's maxillofacial injuries were obtained from the hospital financial services (average ORC: 4,135 dollars, SD +/- 2,832 dollars; range, 845 dollars to 18,974 dollars). A significant correlation was identified between the FISS and the ORC (R value = .82). The length of stay was significantly associated with the FISS (t = 4.7, 245 degrees of freedom, P = .000004). Although the association was statistically significant, FISS is not a very good predictor of length of stay. The correlation between the predicted and observed values was 0.38. There were 3 deaths among the 247 entries. Those 3 deaths had higher than average FISS scores, but the difference between the scores of survivors and non-survivors was not significant (P = .08). The number of deaths was small and a larger study would be required to resolve this question. CONCLUSIONS: We introduce a FISS that is easily calculated and reliably predicts the severity of maxillofacial injuries as measured by the operating room charges required to treat the facial injury. The scale is also an indicator of hospital length of stay. We anticipate this to be a valuable tool for assessment and management of maxillofacial trauma.

Decision Support Techniques↗
PubMed2005

Facial soft tissue injuries as an aid to ordering a combination head and facial computed tomography in trauma patients.

PURPOSE: While the trauma computed tomography (CT) head scan is frequently ordered during resuscitation of multiply injured patients, determining when also to order facial CT in these situations can be difficult. Consequently, facial fractures are commonly missed on initial imaging evaluation. In acute trauma situations, facial soft tissue injury markers are often used to aid in this decision. A study was undertaken to identify exactly which facial soft tissue injuries correlate with facial fractures and which did not. The aim of our research was to compare the facial soft tissue injury patterns of patients receiving a combination head and facial CT who had facial fractures versus those who had no facial fractures. PATIENTS AND METHODS: A retrospective trauma registry review was performed for a 5-year period at Legacy Emanuel Hospital, a level 1 trauma center. The trauma team saw a total of 9,871 trauma patients and 49.9% required head CT as part of their initial evaluation. A total of 777 (15.7%) patients had a combination head and facial CT in which 477 (61.4%) had a facial fracture and 300 (38.6%) had no facial fracture. Statistical significance was established using Bonferroni corrected P values less than .05. RESULTS: Lacerations occurring in areas of the lips, nose, and intraorally, as well as wounds leading to periorbital contusion and subconjunctival hemorrhage, were significantly prevalent in the fracture group. Conversely, scalp lacerations and scalp contusions were significantly higher in the nonfracture group. Other injuries such as lacerations of the tongue, chin, forehead, cheek, ear, eyelid, and eyebrow were indistinguishable between both groups. CONCLUSIONS: Our data demonstrate that there are certain facial soft tissue injury zones that correlate with facial fractures in trauma patients who obtain head CT. We would like to propose that the acronym LIPS-N (Lip laceration, Intraoral laceration, Periorbital contusion, Subconjunctival hemorrhage, and Nasal laceration) be used in conjunction with a physical examination when assessing if a trauma patient who is getting head CT should also get facial CT.

Abbreviations as Topic↗
PubMed2005

Management and outcome of patients with malignant salivary gland tumors.

PURPOSE: Refined imaging technology, the use of external beam radiation, neutron beam therapy, and chemotherapy, has altered management strategies for patients with salivary gland malignancies during the past 2 decades. Although treatment remains primarily surgical, optimal therapeutic regimens have yet to be fully realized. The purpose of this investigation is to report our experience with the management of patients with a variety of malignant salivary gland neoplasms that were treated with various combinations of surgery, radiation, and chemotherapy and to review treatment outcome in an effort to identify predictors of survival and locoregional control. MATERIALS AND METHODS: The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between 1992 and 2002 were retrospectively reviewed. Variables were collected and outcome measures were defined in terms of overall survival, disease-free survival, and locoregional control. Descriptive statistics were compiled and statistically evaluated. Survival was described using the Kaplan-Meier method. Prognostic factors were assessed using the Cox proportional hazards model. Clinical and reconstructive factors were reviewed. RESULTS: Eighty-five patients (35 males and 50 females) ranging in age from 16 to 89 years (mean, 58.6 years) met the criteria for inclusion in the study. The majority of tumors were located in the parotid gland (n = 42), with a significant minority located in the minor salivary glands (n = 29), followed by the submandibular gland (n = 8) and the sublingual gland (n = 6). Mucoepidermoid carcinoma was the most common neoplasm (n = 40). More than half of the patients presented in early-stage disease (stage I = 36, stage II = 17, stage III = 8, stage IV = 25). All patients were treated with surgery as the primary modality. Neck dissection was performed in 29% of patients, and more than half (56%) were treated with adjuvant external beam radiation therapy to a dose of 50 to 70 Gy. Patients were, in general, immediately reconstructed at the time of ablation using composite free tissue transfer when appropriate, local/regional rotational flaps, or maxillary obturators. The disease-free survival rate and locoregional control rate at 5 years were 77% and 86%, respectively. Stage (P = .0017), grade (P = .00044), cervical lymph node metastasis (P = .03), and age (P = .01) proved to make a statistically significant contribution when describing outcome. Neither site (P = .5), the presence of positive margins (P = .3), nor perineural invasion (P = .7) had a significant impact on survival. CONCLUSIONS: The treatment of salivary gland malignancies remains primarily surgical, although adjunctive radiotherapy may play an important role in those patients with advanced-stage disease. This study confirms the contributions of stage, grade, age, and cervical metastasis for describing survival. The benefits of combined modality therapy awaits prospective clinical trials.

Adolescent↗
PubMed2005

Comparison of the severity of bilateral Le Fort injuries in isolated midface trauma.

PURPOSE: The Le Fort classification pattern established in 1901 by the French surgeon Rene Le Fort is commonly used in describing midface fractures. This frequently used classification system is based on predictable patterns of midface fractures initially described for blunt trauma. The purpose of this study was to compare the profile and outcome of patients with isolated bilateral Le Fort I, II, and III fractures. PATIENTS AND METHODS: All patients presenting to the emergency department (ED) at Legacy Emanuel Hospital (Level I trauma center) in Portland, OR, between December 1990 and December 2003 with isolated bilateral Le Fort I, II, or III fractures with or without concomitant nonfacial injuries were identified retrospectively using the Hospital Trauma Registry. Patients were classified into study groups I (n = 22), II (n = 22), or III (n = 23) corresponding to the Le Fort classification, respectively. RESULTS: Sixty-seven patients had a diagnosis of isolated bilateral Le Fort I, II, or III fracture. The average Injury Severity Score (ISS) and hospital length of stay were 18.8 +/- 8.9 and 9.5 +/- 11.9 days, respectively. Blood alcohol was detected in 19 patients. Sixty-four injuries (95.5%) were secondary to blunt trauma, and the remaining 3 (4.5%), penetrating injuries. More than half of the patients (n = 35, 52.2%) were admitted to the intensive care unit (ICU), 18 patients (26.8%) were transferred to the hospital trauma ward from the ED, and 14 patients (20.9%) were taken directly to the operating room. Fifteen (22.4%) patients required a tracheostomy secondary to their maxillofacial injuries. A statistically significant difference in the ISS was detected between patients with Le Fort I versus those with II or III injuries ( P < .0001). Patients with Le Fort II or III fractures had a significantly higher probability of ICU admission or immediate operative intervention. Ten patients (43.5%) with Le Fort III injuries required tracheostomy versus 3 patients (13.6%) with Le Fort I, and 2 patients (9.1%) with Le Fort II injuries. This was statistically significant. None of the patients with Le Fort I injuries had a negative outcome (death); however, 1 patient with Le Fort II injuries (4.5%) and 2 with Le Fort III injuries (8.7%) had a negative outcome. No statistically significant differences or emerging trends were observed among the 3 groups for age, gender, length of stay, number of operations, and number of associated injuries. CONCLUSIONS: Patients with higher Le Fort injuries are characterized by an overall greater severity of injuries as measured by the ISS and the more frequent need for a surgical airway. Patients with Le Fort III injuries have a higher chance of requiring neurosurgical intervention or of experiencing vision-threatening ocular trauma. Immediate operative intervention and/or ICU care is more frequently indicated in these patients.

Adolescent↗
PubMed2004

Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma.

PURPOSE: The management of persistent, post-traumatic cerebrospinal fluid (CSF) rhinorrhea and otorrhea remains a surgical challenge. Repair of CSF leaks has evolved from that of an intracranial approach to one that is primarily extracranial and endoscopic. The purpose of this retrospective analysis is to determine the incidence of persistent CSF rhinorrhea and otorrhea and assess the clinical outcomes of patients presenting to a level 1 trauma center with posttraumatic CSF leaks who were managed by both surgical and nonsurgical means. PATIENTS AND METHODS: The records of all patients with basilar skull fractures and/or severe facial trauma presenting to a major level 1 trauma center from 1991 to 2001 were reviewed. Patients diagnosed with CSF otorrhea or rhinorrhea, who had not undergone an intracranial procedure, elevation of depressed skull fractures, or received a ventriculostomy, were identified and their demographics recorded. For purposes of statistical comparison, patients were divided into 2 groups: "leak" and "no leak." All patients in the leak group were initially observed for a period of 7 to 10 days. Persistent CSF leaks were managed by CSF diversion via lumber drainage for 5 to 7 days. Extracranial repair was performed only if lumbar drainage failed to resolve the leak. RESULTS: Seven hundred thirty-five patients were identified who met the criteria for inclusion in the study. Thirty-four patients (incidence, 4.6%) were identified with CSF leak presenting as otorrhea (n = 25 [75.8%]) or rhinorrhea (n = 9 [26.5%]), which was diagnosed by clinical, laboratory, or radiographic examination (average age, 28.2 years; age range, 2 to 80 years; 23 males and 11 females). All patients in this study experienced successful resolution of CSF otorrhea or rhinorrhea by using a variable combination of observation, CSF diversion, and extracranial repair. There were no complications or cases of meningitis. Twenty-eight patients (84.6%) experienced uncomplicated resolution of the leak without treatment in 2 to 10 days. Persistent CSF leak, defined by drainage greater than 7 days after injury, was identified in 6 patients (incidence, 0.8%), all except 1 who underwent CSF diversion via a lumbar drain for a period of 5 to 10 days. Two of these patients were treated successfully; the remaining 4 patients required surgical procedures. CONCLUSIONS: Post-traumatic CSF leaks are uncommon and will usually resolve without surgical intervention. Successful management in refractory cases often involves a combination of observation, CSF diversion, and/or extracranial and intracranial procedures.

Accidental Falls↗
PubMed2004

Patterns of maxillofacial injuries related to interaction with horses.

PURPOSE: Studies of trauma patients have described patterns of injuries sustained from unfortunate encounters with large animals. However, the patterns of maxillofacial injuries have yet to be reported. The goal of this investigation was to describe and report on maxillofacial injuries that are associated with interaction with horses. PATIENTS AND METHODS: Charts were selected from the trauma registry by E-code at a level 1 trauma center in Portland, OR. A retrospective review was performed on charts collected from the previous 5 years (1998-2002). Data were collected according to patient, pattern of injuries, and mechanism of injury. RESULTS: The 62 patients who were identified consisted of 15 males (24%) and 47 females (76%) and ranged in age from 1 to 83 years (average age, 32 years; most frequent age, 12 years). Most of the accidents occurred in the spring months and involved a horse known to the patient. The most common mechanism was falling from the horse. However, being kicked was correlated with a more serious injury (P =.048). The most frequent injury was abrasion/contusion (24 [39%]), second were lacerations (20 [32%]), and third were fractures (18 [29%]). Fifty (81%) were not wearing helmets. Forty-six (74%) of the patients had other associated injuries. CONCLUSIONS: In patients with facial injuries related to horses, younger females were the most frequently involved. Facial injuries were often associated with other types of injuries. Nearly a third of the facial injuries sustained were fractures. The percentage of riders without a helmet was high. However, in our patient population, wearing a helmet does not seem to add any protection to the face, and almost all of the accidents involved a horse known to the patient. More education aimed at horse owners regarding the use of helmets, proper handling and riding skills, and supervising young riders is encouraged to prevent further injuries.

Accidents↗
PubMed2004

Facial computed tomography use in trauma patients who require a head computed tomogram.

PURPOSE: Head-injured patients admitted to a trauma center may or may not have associated facial fractures. Most head-injured patients undergo head computed tomography (CT) scan early in their evaluation. The question of adding a facial CT at the time of the head CT can be unclear. The aims of our study are 1) to analyze how the facial CT is used in conjunction with the head CT in facial fracture trauma patients, 2) to recognize unique identifiers that would aid the surgeon's decision-making process to order a facial CT in continuity with a head CT, and 3) to examine what is characteristic of head trauma patients who receive a facial CT separately, at some point after the head CT. Materials and methods Data were retrospectively reviewed for a 5-year period at a level I trauma center in which all patients who present with craniomaxillofacial trauma are managed by the oral and maxillofacial surgery (OMFS) service. Included patients must have obtained a head CT during initial resuscitation and be diagnosed with a facial fracture during the same hospital stay. These patients were divided into 3 groups: those who had a 1) head CT only, 2) head CT and facial CT at the same time, and 3) head CT with the facial CT performed at a later time. RESULTS: A total of 9,871 patients were admitted to the trauma service during a 5-year period and 4,926 patients (49.9%) had head CT performed. Of this group, 12% had facial fractures, and the most common associated injury in this group was facial lacerations and concussions. The nasal fracture followed by the orbital fracture was the most common fracture type. Eighty-four percent of the time, the facial CT was used to help diagnose facial fractures in this patient population. The 3 different groups showed unique trends. CONCLUSION: Six points were identified in our study that can augment the physical examination in patients who require head CT. The following points can help prompt the clinician to order a combination head and facial CT: 1) 12% of trauma patients who require a head CT will have a facial fracture, whereas half of these patients will have multiple facial fractures. 2) Orbital fractures are commonly missed in this group and often require a secondary scan such as coronal views for accurate diagnosis. 3) Facial lacerations correlate with ordering a combination head and facial CT. 4) The most common facial fracture identified among patients receiving a trauma head CT is the nasal fracture. 5) The use of the facial CT in more severely injured patients tended to be delayed and was related to increased hospital and intensive care unit days. 6) Only 16% of facial fracture patients who had received an initial trauma head CT did not require further facial CT scanning.

Adult↗
PubMed2004

Tobacco smoking history and presentation of oral squamous cell carcinoma.

PURPOSE: The association between tobacco smoking and oral squamous cell carcinoma is well established. However, few studies have evaluated the smoking history based on a smoking versus never-smoking history or analyzed the relationship between smoking history and site and stage of presentation. The purpose of this study was to examine the relationship between smoking versus never-smoking history and the stage and site of presentation of oral squamous cell carcinoma. PATIENTS AND METHODS: The design of this study was a retrospective review of all patients presented at the Legacy Emanuel Hospital Head and Neck Tumor Board in Portland, Oregon, with a biopsy-proven oral squamous cell carcinoma between 1998 and 2000. Data collected included age, gender, smoking history (smoker versus never smoker), pack-years of tobacco, site, and stage (T, N, and group stage) at presentation. RESULTS: A total of 67 patients were reviewed; 33% of patients were never smokers and 67% of patients had a history of smoking with an average of 49.4 pack-years. The floor of mouth and gingiva were the most commonly affected sites. There was a statistically significant difference between site of presentation and a history of smoking (P =.0007). The 2 sites that showed a significant association with smoking were posterolateral tongue and floor of mouth. CONCLUSIONS: The findings of this study demonstrate that approximately one third of patients with oral squamous cell carcinoma will report that they have never smoked. There was a strong association between a history of smoking and carcinoma involving the posterolateral tongue and floor of mouth.

Adult↗
PubMed2003

Is detection of oral and oropharyngeal squamous cancer by a dental health care provider associated with a lower stage at diagnosis?

PURPOSE: Stage at diagnosis is the most important prognostic indictor for oral and oropharyngeal squamous cell cancers (SCCs). Unfortunately, approximately 50% of these cancers are identified late (stage III or IV). We set out to examinationine the detection patterns of oral and oropharyngeal SCCs and to determine whether detection of these cancers by various health care providers was associated with a lower stage. PATIENTS AND METHODS: Data were gathered on 51 patients with newly diagnosed oral or oropharyngeal SCC through patient interview and chart audit. In addition to demographic data, specific inquiry was made regarding the circumstances surrounding the identification of the lesion. The main outcome measure was tumor stage grouping based on detection source. RESULTS: Health care providers detecting oral and oropharyngeal SCCs during non-symptom-driven (screening) examinations were dentists, hygienists, oral and maxillofacial surgeons, and, in 1 case, a denturist. All lesions detected by physicians occurred during a symptom-driven examination. Lesions detected during a non-symptom-driven examination were of a statistically significant lower average clinical and pathologic stage (1.7 and 1.6, respectively) than lesions detected during a symptom-directed examination (2.6 and 2.5, respectively). Additionally, a dental office is the most likely source of detection of a lesion during a screening examination (Fisher exact test, P =.0006). Overall, patients referred from a dental office were of significantly lower stage than those referred from a medical office. Finally, patients who initially saw a regional specialist (dentist, oral and maxillofacial surgeon, or otolaryngologist) with symptoms related to their lesion were more likely to have appropriate treatment initiated than those who initially sought care from their primary care provider. CONCLUSION: Overall, detection of oral and oropharyngeal SCCs during a non-symptom-driven examination is associated with a lower stage at diagnosis, and this is most likely to occur in a dental office. A regional specialist was more likely than a primary care provider to detect an oral or oropharyngeal SCC and initiate the appropriate treatment during the first visit for symptoms related to the lesion.

Adult↗
PubMed2003

Referral patterns for the treatment of facial trauma in teaching hospitals in the United States.

PURPOSE: The management of facial trauma is considered an integral part of the training of several specialties, including general plastic surgery, otolaryngology, and oral and maxillofacial surgery. Referral patterns of patients who have sustained facial trauma to these various specialty services, however, vary at different institutions according to physician preferences and protocols. The purpose of this project was to examine the referral patterns of facial trauma in the United States at teaching hospitals. MATERIALS AND METHODS: A questionnaire survey of physician-chiefs of emergency or trauma services at teaching hospitals was carried out. Scenarios involving a variety of facial injury patterns were presented, and a hypothetical referral was requested. In addition, questions regarding preferences and opinions regarding the various services were included. RESULTS: Most teaching hospitals had a formal protocol for the referral of patients with facial injuries. With the exception of mandible fractures, referral patterns for patients with facial injuries were relatively even across the 3 specialties. Interestingly, only 56% of respondents would seek the same referral for themselves or relatives in the same way as they would refer a patient based on their in-house protocol. In regard to timeliness, efficiency, and perceived competency in the handling of facial trauma, oral and maxillofacial surgery had statistically significant higher scores than otolarygology and plastic surgery, which were not statistically distinguishable between each other. CONCLUSIONS: All 3 specialties appear to be involved in the management of facial trauma at teaching institutions in the United States; therefore, it seems unlikely that any one specialty will be singled out as the sole provider of these services at all institutions.

Chi-Square Distribution↗
PubMed2002

Surgeons of oral cancer and leaders of a young specialty: the role of 3 oral and maxillofacial surgeons.

The treatment of oral and related cancer has evolved greatly since the early part of the 20th century. Today, some oral and maxillofacial surgeons include oral cancer surgery as a normal part of their practice. This article will discuss 3 pioneers, Elmer C. Hume, Fred Henny, and Claude La Dow, who shared a career-long commitment to oral cancer surgery, trained future leaders of the specialty, and retained their professional identity within dentistry and oral surgery. Their lives and contributions are profiled within the context of the political climate of oral surgery at the time. Oral cancer surgery within the discipline of oral and maxillofacial surgery declined later in the 20th century as this activity increased among head and neck surgeons based in general surgery and later, otolaryngology. Simultaneously, the interest of American oral surgeons was drawn toward orthognathic surgery and the landmark presentation by Hugo Obwegeser at Walter Reed Army Medical Center in June 1966 signaled the beginning of a shift in the focus of the specialty. The close of the 20th century has witnessed a renaissance of interest in oral cancer surgery within American oral and maxillofacial surgery.

History, 20th Century↗