E-Cigarette Burns and Explosions: What are the Patterns of Oromaxillofacial Injury?

PURPOSE: With the recent increase in popularity of electronic cigarette use in the United States, its harmful effects are not only limited to smoke inhalation, but also to the possibility of e-cigarette device malfunction. The purpose of this review is to characterize oromaxillofacial trauma secondary to electronic cigarette device explosion. METHODS: For this systematic review, PubMed and Embase were searched in October 2019 using the following search terms: e-cigarette burns, e-cigarette injury, and e-cigarette explosions, which yielded 400 studies. Basic science research, animal studies, non-English studies, and reports of non-oromaxillofacial injuries were excluded. Study subject demographics, mechanism of trauma, injury type, treatment, and sequelae were recorded and analyzed. RESULTS: Of all studies, 20 studies met inclusion criteria, including 14 case reports and 6 case series, with a total of 21 study subjects. For cases that reported sex, 100% were male (20) with a mean age of 29.5 years. Most common lacerations and/or burns involved the lips (10/21), tongue (8/21), soft palate and/or hard palate (4/21), and nose (5/21). Thirteen subjects underwent surgeries including oral-maxillofacial surgery or dental implants (7/13), bone graft repair (3/13), open reduction and internal fixation for preservation of sinus outflow tracts (2/13), foreign body removal from the cervical spine (1/13), and iridectomy (1/13). Reported complications included bone loss secondary to traumatic fracture, tinnitus and hearing loss, lip paralysis secondary to persistent edema, major depressive disorder/ post-traumatic stress disorder, persistent sinusitis, photophobia, and bilateral axillary and hand contractures. CONCLUSIONS: Electronic cigarette device malfunction and explosion carries great risk for acute oromaxillofacial trauma that may be disfiguring. With the increasing popularity of electronic cigarette use, clinicians and patients should be advised regarding dangers of electronic cigarette use.

Gender, racial, and ethnic representation of cardiology fellows in the United States, 2014-2020: An underwhelming pace of diversification worsened by the COVID-19 pandemic.

INTRODUCTION: Cardiologists serve a diverse population of patients, yet the lack of diversity within the cardiology workforce has continued to persist and does not represent the composition of the patient population in the United States. Although medical schools and internal medicine residency programs have witnessed major improvements in diversity, the field of cardiology has not emulated these patterns. METHODS: Gender, race, and ethnicity data from the graduate medical education supplements published annually in the Journal of the American Medical Association from 2014 through 2020 were analyzed. The effect of the COVID-19 pandemic on the recruitment of female trainees in cardiology was also investigated. RESULTS AND DISCUSSION: Women represented 24.6% of cardiology trainees in the year 2020, which is a minor increase from 21.2% in 2014. The percentage of Hispanic trainees has slightly decreased from 6.90% in 2014 to 6.26% in 2020, while the percentage of Black trainees has only increased from 5.45% in 2014 to 5.50% in 2020. The data demonstrate a clear disparity and a desperate need for diversification of the cardiology trainee workforce. The COVID-19 pandemic may also exacerbate this lack of diversity in upcoming years due to the reemergence of inequities in social responsibilities between male and female trainees. IMPLICATIONS: Strong action must be taken on an institutional level to shift the culture in cardiology to one that is more appealing to women and underrepresented minorities in order to better serve an increasingly diverse population.

The underrepresentation of women and ethnic minorities in anesthesiology.

PURPOSE: Diversity is crucial in the medical field, where patients have a significantly wide range of ethnic and racial backgrounds. With the increase in diversity in medical school and the growing list of subspecialties in medicine, we would expect to see a rise in diversity in the field of anesthesiology. The purpose of this study is to analyze the representation of gender and underrepresented minorities in anesthesiology residency programs from 2013 through 2019. METHODS: To study the ethnic, racial and gender diversity in residents in the field of anesthesiology, data was analyzed from the self-reported data collected in the Journal of the American Medical Association annual report on Graduate Medical Education over the academic period from 2013 through 2019. RESULTS: In 2013, female trainees made up 36.0% and Black trainees encompassed 5.9% whereas in 2019, female trainees comprised a mere 33.0% of total anesthesiology residents while Black trainees decreased to 5.5%. CONCLUSION: This study illustrates the disparity in the demographic composition of anesthesiology trainees and emphasizes the importance of having a more diverse workforce in the field of anesthesiology.

The Representation of Women and Ethnic Minorities among Integrated Plastic Surgery Trainees: A Persistent Need for Diversification.

BACKGROUND: Diversity in the workplace is crucial. As the United States population continues to diversify, the composition of graduate medical trainees (GMTs) among various medical specialties is not diversifying at nearly the same rate. This study aims to identify gender and ethnic minority disparities present in medicine, specifically among GMTs in the field of plastic surgery. PURPOSE: The field of plastic surgery is vast, with the patient population ranging from newborns to elders of all different races, religions, and ethnicities. However, the representation of women and minorities among the current plastic surgery trainees is not equivalent to the population they serve. METHODS: Data from the Graduate Medical Education (GME) census published in the Journal of the American Medical Association (JAMA) was analyzed to compare trends of female and underrepresented ethnic minorities over the academic period from 2015 through 2019. Data regarding all GMTs and specifically those in the integrated plastic surgery (IPS) program was collected. RESULTS: Over the five-year study period, females were consistently underrepresented in plastic surgery when compared to the total number of female medical trainees. Currently, females represent 42.7% of GMTs in IPS, a small increase from 40.9% in 2015. Furthermore, Whites and Asians encompassed 87.7% (65.6% and 22.1%, respectively) of plastic surgery GMTs in 2019-2020. In the same academic year, Blacks and Hispanics together made up only 9.1% (2.5% and 6.6%, respectively) of GMTs in plastic surgery. CONCLUSION: This study portrays the importance of highlighting gender and ethnic minority disparities in the field of plastic surgery, thereby promoting initiatives for change in the coming future.

The Superior Laryngeal Nerve and Its Vulnerability in Surgeries of the Neck.

Anatomical considerations of the superior laryngeal nerve (SLN), a branch of the vagus, provides information to minimize the potential for iatrogenic intraoperative injury, thereby preventing motor and sensory dysfunctions of the larynx. The present study aims to assess the variation of the SLN and its relationship to the superior thyroid artery (STA) and superior laryngeal artery (SLA). The study was done on 35 formalin-fixed cadavers at Oakland University in 2018-2019. In our study, we found that out of 21 cadavers, 52.4% of the external laryngeal branches (ebSLN) are related posteromedial to the STA, while 47.6% are related anteromedial to it. Out of 14 cadavers, 64.3% of the internal laryngeal branches (ibSLN) are related superoposterior to the SLA, while 35.7% are inferoposterior to it. In most cases, the SLA crosses above the ebSLN while traveling to pierce the thyrohyoid membrane to reach the larynx. The data demonstrate that both the ebSLN and ibSLN display variation in their relationship with the STA and the SLA, respectively. Awareness of these variable relationships is critical for identification and isolation of these structures in order to prevent consequences of nerve injury, primarily a reduction in the highest attainable frequency of the voice and aspiration pneumonia.

Aneurysmal Bone Cysts of the Craniofacial Origin: A Systematic Review.

OBJECTIVE: Aneurysmal bone cysts (ABCs) are blood-filled, locally destructive, benign bone tumors. Our objective was to conduct a systematic review outlining patient demographics, clinical characteristics, management, and outcomes of those with ABCs of the craniofacial bones. DATA SOURCES: Using PubMed, Cochrane, and Embase databases, 116 studies were included. REVIEW METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted. Data including patient demographics, clinical characteristics, treatment strategies, and patient outcomes were collected. RESULTS: A total of 127 patients from 116 studies were identified. Age ranged from 8 months to 90 years, with a mean age of 19.0 years. The most commonly affected craniofacial locations were the mandible (n = 31, 24.4%), temporal bone (n = 21, 16.5%), and occipital bone (n = 14, 11.0%). The most common presenting symptoms included a nontender mass (n = 51, 40.2%), a tender mass (n = 31, 24.4%), and generalized headache (n = 30, 23.6%). Imaging modalities included computed tomography (CT) and magnetic resonance imaging (MRI) (n = 77, 60.6%), CT alone (n = 31, 24.4%), and MRI alone (n = 8, 6.2%). All patients underwent surgical resection, with 1 patient requiring adjuvant radiation in addition to surgery. In total, 121 patients were disease-free and symptom-free without evidence of recurrence (17.4-month mean follow-up, 5.4 months average time to first recurrence). CONCLUSION: The current literature's characterization of ABCs in craniofacial bones is limited to case reports and case series. Given the rarity of these tumors, head and neck surgeons may rely on systematic reviews such as the present analysis to guide management.

Primary Parotid Tumor Thrombosis: Immunohistologic Features and Awareness of Metastatic Potential.

Tumor thrombosis is a poor prognostic feature and an exceptionally rare occurrence in salivary gland malignancies. We present a case of primary parotid myoepithelial carcinoma (MC) with tumor thrombosis in the external jugular vein (EJV). An 82-year-old man presented with a right-sided facial mass. MRI with and without gadolinium demonstrated a mass of the right parotid gland with a filling defect of the right EJV. The patient underwent right parotidectomy and selective neck dissection. Tumor thrombosis was found intraoperatively within the EJV. Final pathology demonstrated a poorly differentiated MC. Adjuvant radiation therapy without concurrent systemic therapy was administered. Three months later, restaging positron emission tomography (PET) with CT revealed numerous bilateral pulmonary nodules with biopsy, demonstrating poorly differentiated MC without locoregional relapse. Given that primary parotid tumor thrombosis is associated with a poor prognosis, the use of early systemic therapy should be investigated.