Most junior otolaryngologists treat maxillofacial/neck trauma on a monthly basis. A total of 64% identify trauma as a component of their ideal practice. They report being well to very well trained in all facets of trauma, with the exception of vascular and laryngotracheal injuries; but they desire additional education, such as courses and panels. Universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.

Greater recognition and treatment of depression in individuals with impaired vision is warranted.

We present a case of obstructive sleep apnea (OSA) that required multilevel surgical correction of the airway and literature review and discuss the role supraglottic laryngeal collapse can have in OSA. A 34-year-old man presented to a tertiary otolaryngology clinic for treatment of OSA. He previously had nasal and palate surgeries and a Repose tongue suspension. His residual apnea hypopnea index (AHI) was 67. He had a dysphonia associated with a true vocal cord paralysis following resection of a benign neck mass in childhood. He also complained of inspiratory stridor with exercise and intolerance to continuous positive airway pressure. Physical examination revealed craniofacial hypoplasia, full base of tongue, and residual nasal airway obstruction. On laryngoscopy, the paretic aryepiglottic fold arytenoid complex prolapsed into the laryngeal inlet with each breath. This was more pronounced with greater respiratory effort. Surgical correction required a series of operations including awake tracheostomy, supraglottoplasty, midline glossectomy, genial tubercle advancement, maxillomandibular advancement, and reconstructive rhinoplasty. His final AHI was 1.9. Our patient's supraglottic laryngeal collapse constituted an area of obstruction not typically evaluated in OSA surgery. In conjunction with treating nasal, palatal, and hypopharyngeal subsites, our patient's supraglottoplasty represented a key component of his success. This case illustrates the need to evaluate the entire upper airway in a complicated case of OSA.

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Objective: 1) Define practice patterns and perceptions of young otolaryngologists treating maxillofacial trauma. 2) Identify manners in which the AAO-HNS can meet future maxillofacial trauma needs. Method: A 26-question survey was designed to identify demographic factors, practice patterns, perceptions of facial trauma, and areas for improvement in trauma care. It was distributed anonymously to AAO-HNS members who completed residency from 2005 to 2009 and analyzed using descriptive statistics. Results: A total of 444 of 1378 (32%) otolaryngologists responded. A total of 85% treat maxillofacial trauma (<1 case/month). A total of 64% identify trauma as part of their ideal practice. Sense of duty (54%) and institutional requirement (33%) are the most common reasons for trauma participation. Major deterrents: patient noncompliance (60%) and lifestyle limitations (47%). While insufficient reimbursement is a major deterrent (52%), only 35% would increase their volume if reimbursement improved. Sixteen (3.7%) have had a trauma-related lawsuit. Increased education represents the most common request to the AAO-HNS (59%), followed by focus on improved reimbursement/tort reform (28%). Topics proposed: practice guidelines, pediatric, laryngeal, and midface trauma. Conclusion: Most otolaryngologists treat facial trauma, but do so infrequently. A total of 64% of young otolaryngologists identify trauma as a component of their ideal practice. However, universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.