The utility of cone-beam computed tomography and multislice computed tomography scan for the evaluation of invasion versus erosion by mandibular squamous cell carcinoma as viewed on medical PACS.

Introduction: The degree of bone involvement in mandibular squamous cell carcinoma has a significant impact on surgical planning. The purpose of this study was to determine the utility of cone-beam computed tomography (CBCT) for the evaluation of invasion by mandibular squamous cell carcinoma. Methods: A retrospective review was conducted to identify subjects treated for oral squamous cell carcinoma (OSCC). All subjects had OSCC adjacent or fixed to the mandible, received preoperative CBCT and multislice computed tomography scan (MSCT), and had resection specimens that included bone. Results: Twenty-one subjects met the inclusion criteria. The sensitivity of CBCT was 100% (95% CI 0.75-1), the specificity was 75% (95% CI 0.35-0.97), the positive predictive value was 87% (95% CI 0.66-0.98), and the calculated test accuracy was 91%. The sensitivity of MSCT was 92% (95% CI 0.64-1), the specificity was 100% (95% CI 0.63-1), and the calculated test accuracy was 95%. Discussion: CBCT provides meaningful data that may be useful in identifying bony involvement in patients with mandibular squamous cell carcinoma. The utility in delineating erosion versus invasion is limited.

Are higher odontogenic infection severity scores associated with difficult intubations?

PURPOSE: This study aimed to determine if there is a relation between odontogenic infection severity score (OISS) and difficult intubation at the time of surgical treatment for severe odontogenic infections (SOI). A secondary goal of this study was to determine the utility of OISS as a predictor of difficult intubations. METHODS: This retrospective cohort study was composed of consecutive patients admitted and surgically treated in the operating room (OR) for SOIs. Patients with an OISS ≥ 5 were designated as Group 1 and < 5 Group 2. RESULTS: There was a statistically significant difference in difficult intubations between the two groups (p = 0.018). Patients with an OISS ≥ 5 were nearly four times more likely to be difficult intubations compared to patients with an OISS < 5 (OR 3.70, 95% CI 1.19-11.45). When OISS ≥ 5 was used to predict difficult intubation, the sensitivity was 69%, the specificity was 63%, the positive predictive value was 23%, and the negative predictive value was 93%. CONCLUSION: OISS ≥ 5 was associated with a higher prevalence of difficult intubations compared to an OISS < 5. OISS may provide clinically relevant data that can be used with established risk factors, laboratory values, and clinical judgment.

Can a Social Media Application be a Valid Educational Tool for Oral and Maxillofacial Surgery Patients?

BACKGROUND: TikTok (ByteDance, Beijing, China) is the fastest growing social media application (SMA) to date and has become a major source of information for medicine. The rising use of media platforms by patients and practitioners alike plays a significant role in the perception of healthcare. PURPOSE: The purpose of this study is to identify the presence and popularity of oral and maxillofacial surgery content on the SMA, to measure whether the information shared is useful for viewers, and whether there are differences in quality of the videos between video content producer groups. STUDY DESIGN, SETTING, AND SAMPLE: A cross-sectional study was used to evaluate oral and maxillofacial surgery content on the SMA. Included videos were published during a 3-month period (November 16, 2021 to February 17, 2022) and mentioned "oral surgery" or "wisdom teeth" in the video description, title, or hashtag. INDEPENDENT VARIABLE: The independent variable was video content producer-content created by health professionals versus laypersons. MAIN OUTCOME VARIABLE: Quality of each video was determined by the information in the video and its usefulness, using the Global Quality Scale (GQS) criteria. COVARIATES: Topic was categorized as educational or anecdotal. Popularity was measured by the number of likes accumulated. ANALYSES: Statistical analysis was performed using 2-sample t-tests. Statistical significance was achieved with a P value < .05 with 95% confidence interval. RESULTS: Of 558 videos searched, 426 videos met study criteria. GQS score was greater in health professional videos (MHP = 3.30) versus layperson videos (ML = 2.05) (P < .05). Most video content producers were laypersons (69%) and videos were mostly anecdotal (87%). Health professional videos had greater popularity than layperson videos (P < .05). Health professionals and laypersons averaged 25,148 likes and 2,109 likes, respectively. All videos combined totaled 3,939,685 likes. CONCLUSION: By analyzing GQS and the popularity of videos, it has shown that health professionals produced higher quality videos along with greater number of likes. With 39% of videos by health professionals being educational, it shows that we are using the SMA to instruct patients. However, there is still room to produce more educational rather than anecdotal videos with the goal to provide accurate information to patients.

A Snapshot on Oral and Maxillofacial Surgery Resident Scholarly Activity: Can We Do Better?

BACKGROUND: The Commission on Dental Accreditation (CODA) requires oral and maxillofacial surgery (OMS) residents to engage in scholarly activity. Currently, it is unknown how this mandate translates into research output. PURPOSE: The purpose of this study was to quantify the research output of OMS residents. In addition, we sought to identify characteristics associated with resident productivity. STUDY DESIGN: This was a cross-sectional study of all OMS residents during the 2021-2022 academic year. Attempts were made to obtain resident rosters from every CODA-accredited OMS program. Resident names were searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) to identify peer-reviewed publications. Postgraduate year (PGY), program name, and total publication count during residency were recorded for each resident. Academic status and fellowship affiliation of the residency program were also included. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor was PGY level of each resident. MAIN OUTCOME VARIABLE: The main outcome variable was the publication count of each OMS resident during the 2021-2022 academic year. COVARIATES: The covariates were the academic status and the fellowship affiliation of the residency program. A program was determined academic if they were associated with a dental or medical school. A program was determined fellowship associated if they had any CODA approved fellowship. ANALYSES: Simple bivariate comparisons were performed using Wilcoxon signed-rank tests. RESULTS: Complete resident rosters were identified for 87 residency programs. One thousand one hundred thirty two residents were queried and a total of 548 peer-reviewed publications were identified. There was a mean of 6.30 publications per program and 0.43 publications per resident. More than half of all residents had no identifiable publication. PGY5 residents averaged the most publications per resident (1.45) followed by PGY6 (1.04) and PGY4 (0.63). Academic programs had significantly more publications per resident than nonacademic programs (median of 3.00 vs 0.00, P = .02). Programs with a fellowship association also had more publications per resident (median of 5.00 vs 2.00, P < .01). CONCLUSION: Current CODA research requirements do not translate into resident publications. Publication counts appeared to slightly increase with PGY level; however, OMS resident productivity still lags far behind that of other surgical subspecialties.

Dentinogenic ghost cell tumor: a case report and review of the literature.

The purpose of this report is to highlight the presentation and review the clinical and histopathological features of DGCT. There have been 130 DCGT diagnoses reported in the literature. DGCT is part of the odontogenic ghost cell tumor family which also includes the calcifying odontogenic cyst (COC) and the ghost cell odontogenic carcinoma (GCOC). In June of 2018, a 48-year-old female presented with a painless, soft tissue growth overlying the right mandibular alveolar ridge. Further workup of the lesion included a panoramic radiograph and maxillofacial computed tomography (CT) which revealed a well-defined, multilocular lytic expansile radiolucency occupying the right mandibular body. An incisional biopsy of the right mandibular gingival mass was performed which revealed an unusual odontogenic neoplasm with mineralization and ghost cells. The patient was subsequently treated with excisional biopsy of the right mandibular lesion via enucleation and curettage. The specimen was sent to pathology and the tumor was found to have an epithelial neoplastic proliferation resembling that of ameloblastoma, accompanied by foci of ghost cells. Since mandibular bone was involved, a diagnosis of a benign central DGCT with extension into the overlying gingiva was rendered. She was successfully treated with excisional biopsy via enucleation and curettage and has no evidence of recurrence at three years post-operatively. DGCT can exhibit locally aggressive behavior and is characterized by ameloblastoma-like epithelial cells and the presence of dentinoid material and ghost cells.

Peripheral intraosseous carcinoma arising from a recurrent odontogenic keratocyst.

Primary intraosseous carcinoma (PIOC) is a distinct clinical and genomic pathology that should be considered when treating aggressive odontogenic cysts refractory to standard treatments. Odontogenic cysts have a very low chance of malignant transformation, with most studies citing an incidence of <0.05%. The pathogenesis of PIOC is multifactorial, with chronic inflammation-induced carcinogenesis being the most cited theory. Early detection is imperative to enhance the patient's prognosis, with the 5-year overall survival rate of PIOC being 38%. This paper presents a case of PIOC and reviews data on its epidemiology, diagnosis, presentation, and treatment.

Does the type of planning in orthognathic surgery influence patient satisfaction?

PURPOSE: To determine if the method of orthognathic surgery planning used-computer aided surgical simulation (CASS) versus analog model surgery-influenced patients' post-operative satisfaction. The authors hypothesized that there was no difference in patient satisfaction based on the type of planning in orthognathic surgery. METHODS: This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a 6-year period. Patients were asked to complete a survey questionnaire that consisted of eight questions, each utilizing a five-point Likert scale. RESULTS: There were 643 patients initially identified with 401 potential subjects meeting the inclusion criteria. Of these 401 patients, the survey was successfully administered to 161. Patients whose orthognathic surgery was planned virtually were not only significantly more likely to be satisfied with their appearance post-operatively, but also more likely to go through with surgery again if they could choose to (p < 0.05). CASS patients were also more likely to identify that their surgery was planned virtually. When stratified by age, younger patients were more likely to have read about CASS. When each survey question was stratified based on the type of surgery that was performed, there were no significant differences. CONCLUSION: Patients whose surgeries were virtually planes were significantly more likely than model surgery patients to be satisfied with their post-operative appearance as well as with their decision to have orthognathic surgery. CASS has proven to be an accurate, time-saving, and potentially cost-saving tool for surgeons. Based on the results of this study, the type of surgical planning method matters for post-operative patient satisfaction with their appearance.

Complications of Severe Odontogenic Infections: A Review.

Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.

Does the use of a "wrap" in three-dimensional surgical planning influence the bony margin status of benign and malignant neoplasms of the oral, head, and neck region? An initial investigation.

PURPOSE: Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade. Surgeons utilize a virtual "wrap" to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins. METHODS: The investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for the pathology of the head and neck, involving the bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics were reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report. RESULTS: The sample was composed of 39 cases, one of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, one had involved bony margin on final histopathology (2.6%; 95% confidence limits, 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had an involved bony margin on final histopathology. CONCLUSION: The results of this preliminary study suggest three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins.

Is a Medical Degree Associated With Faculty Leadership Position Attainment in Oral and Maxillofacial Surgery Residency Programs?

PURPOSE: The decision to obtain double-degree versus single-degree training in oral and maxillofacial surgery (OMS) has been a widely debated topic in the United States over the past several decades. The purpose of this study is to determine if OMS faculty holding leadership positions (ie, program directors and chairs/chiefs) are more likely to be single-degree trained versus double-degree trained. METHODS: The authors designed a cross-sectional observational study to address the research purpose. The primary predictor variable was faculty leadership education (single-degree trained vs double-degree trained). The secondary predictor variable was accredited OMS program type led by the faculty with leadership positions (double-degree, both single-degree and double-degree, single-degree, or military program). The primary outcome variable was faculty leadership position (program director or chair/chief). Sums and percentages were calculated and Chi-squared (χ2) tests were used to compare the faculty leadership education with faculty leadership positions for each group. P values less than .05 were considered statistically significant. RESULTS: The study sample was composed of 198 subjects, of which 99 subjects were identified as program directors and 99 subjects were identified as chairs/chiefs. There was no statistically significant difference between the proportions of program directors and chairs/chiefs who were single-degree trained versus double-degree trained when looking at all accredited OMS programs in the United States (52.5% vs 47.5%, P = .615 and 56.6% vs 43.4%, P = .191, respectively). However, program directors of double-degree programs were statistically significantly more likely to be double-degree trained than single-degree trained (77.1% vs 22.9%, P = .001) and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained than double-degree trained (67.4% vs 32.6%, P = .022 and 65.1% vs 34.9%, P = .047, respectively). CONCLUSION: Overall, no statistically significant difference exists between the proportions of program directors and chairs/chiefs that were single-degree trained versus double-degree trained at accredited OMS programs. However, when stratifying programs by program type, program directors of double-degree programs were statistically significantly more likely to be double-degree trained and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained.

Medication-Related Osteonecrosis of the Jaws in the Pediatric Population.

PURPOSE: Few reports have investigated medication-related osteonecrosis of the jaws (MRONJ) in the pediatric population. The study purpose was to measure the frequency of MRONJ in pediatric patients receiving antiresorptive medications at our institution. MATERIALS AND METHODS: This retrospective case series was granted an exemption by the University of Texas Southwestern Medical Center Institutional Review Board. The primary outcome variable was the presence or absence of MRONJ. Other variables of interest included 1) age at first dose of antiresorptive; 2) sex; 3) antiresorptive medication received; 4) reason for antiresorptive; 5) dental records available; 6) dental extractions that occurred after the start of antiresorptive; 7) exposure to immunosuppressants/chemotherapy; 8) time interval from the last dose of antiresorptive to dental extractions; and 9) longest follow-up after starting antiresorptive. Frequencies and proportions were calculated for categorical data. Medians, means, and standard deviations were calculated for continuous data. RESULTS: The study sample was composed of 122 subjects. We observed 0 cases of MRONJ during the study interval. At the start of antiresorptive treatment, the average age was 8.18 years (range 0.02-17; standard deviation (SD) 5.15). There were 67 males (55%) and 55 females (45%). The reason for antiresorptive treatment was osteogenesis imperfecta in 36 patients, malignancy in 6 patients, and other in 80 patients. Thirty patients received pamidronate, 72 received zoledronate, 17 received a combination, and 3 received only denosumab. A total of 16 patients had exposure to immunosuppressants and/or chemotherapy. The average follow-up time was 4.89 years (median 4 years). Twenty-six patients underwent dental extractions of 74 teeth following antiresorptive treatment. CONCLUSIONS: While there were no reported cases of MRONJ in the present study, it is advisable to monitor pediatric patients who have received antiresorptive treatment closely. When possible, appropriate dental treatment should be completed prior to starting antiresorptive therapy. In the absence of reported MRONJ cases, dental extractions should not be withheld because of previous antiresorptive exposure and antiresorptive medication dosing need not be altered in the pediatric population.

Assessment of pro re nata inpatient opioid consumption following surgical treatment of severe odontogenic infections.

OBJECTIVE: The purpose of this study was to analyze the pro re nata (PRN) opioid consumption of patients with severe odontogenic infections following operating room incision and drainage using odontogenic infection severity scores (SS). STUDY DESIGN: This retrospective study reviewed consecutive charts of patients admitted for severe odontogenic infections from January 2016 to December 2020. Postoperative opioid doses were tabulated. Severity scores (SSs) were assigned based on the risk to the airway and vital structures. Patients with SS ≥5 were designated as group A and patients with SS <5 as group B. The primary predictor variable was SS, and the primary outcome variable was amount of milligram morphine equivalent consumed. RESULTS: A total of 93 patients met the inclusion criteria. Group A included 40 patients, and group B included 53 patients. No statistically significant difference was found between the 2 groups in age, hospital duration, and American Society of Anesthesiologists classification. Group A consumed a significantly greater amount of PRN postoperative inpatient opioid medications (P = .02). CONCLUSIONS: Patients with odontogenic infection SS ≥5 consumed more postoperative PRN opioid analgesic medications. Given that odontogenic infections are largely preventable, it is imperative to prevent progression of odontogenic infections to limit patient exposure to opioid medication.

The Cost of Surgically Treated Severe Odontogenic Infections: A Retrospective Study Using Severity Scores.

PURPOSE: Hospital treatment of odontogenic infections can be costly, and often these infections present with varying degrees of severity that can be quantified with odontogenic infection severity scores (OISSs). The purposes of this study were (1) to measure the association between OISSs and hospital bills and (2) to identify risk factors associated with OISSs. METHODS: This retrospective cohort study assessed subjects from January 1, 2016, to December 31, 2020, with severe odontogenic infections treated in the operating room and admitted to the University of Texas Southwestern Medical Center/Parkland Memorial Hospital for >1 hospital day. OISSs were assigned based on the risk to the airway and vital structures. OISSs ≥ 5 were designated group A and < OISSs 5 group B. The primary predictor variable was OISSs, and the primary outcome variable was the mean billed cost of the stay. Analysis to identify associated variables for OISS ≥ 5 was also conducted. Secondary predictor variables were age, gender, smoking status, HIV diagnosis, diabetes mellitus diagnosis, blood glucose at admission, and white blood cell count (WBC) at admission. The secondary outcome variable was OISS. Comparisons between Group A and Group B were conducted using t-tests. Analysis to identify associated variables for OISS ≥ 5 was conducted using univariate and multivariate analysis. Values of P < .05 were considered statistically significant. RESULTS: There were 144 subjects that met inclusion criteria. There were 65 subjects in Group A and 69 in Group B. Group A had a significantly larger mean billed cost of stay (95% CI 8937.7 to 48,225.74; P = .001). Analysis of secondary predictor variables revealed that male sex (OR 2.07; 95% CI 1.06 to 4.07; P = .03), blood glucose ≥ 100 at presentation (OR 3.05; 95% CI 1.46 to 6.38; P = .002), and WBC of > 11,000/mL at presentation (OR 3.17; 95% CI 1.44 to 6.98; P = .003) resulted in an increased likelihood of OISS ≥ 5. CONCLUSIONS: Patients with OISSs ≥ 5 have higher mean billed costs when compared to patients with OISSs < 5. Male sex, blood glucose ≥ 100, and WBC >11,000/mL at presentation is associated with increased likelihood of OISS >5.

Admission C-reactive protein, WBC count, glucose, and body temperature in severe odontogenic infections: a retrospective study using severity scores.

OBJECTIVE: The purpose of this study was to determine whether various serum marker levels (C-reactive protein [CRP], white blood cell [WBC] count, glucose) or body temperature at admission are associated with severity of odontogenic infections. STUDY DESIGN: This retrospective chart review of patients admitted to the hospital for treatment of severe odontogenic infections (SOIs) over a 5-year period (2016-2020) assigned patients with a severity score (SS) ≥5 to group A and those with an SS <5 to group B. Serum marker levels and temperature at admission were collected, and comparisons between group A and group B were conducted for serum marker levels and body temperature at admission using 2-sample t tests. RESULTS: The mean serum CRP and temperature at admission between the 2 groups was not statistically significant (P > .05). The mean WBC count and serum glucose at admission between the 2 groups was statistically significant (P = .001 and P = .036, respectively). CONCLUSIONS: This study demonstrates that serum glucose and WBC at admission are significantly higher in patients with more SOIs. In addition, serum CRP and body temperature at admission are not adequate prognostic indicators of odontogenic infection severity.