MRRead-A Novel Approach to Training Residents in Magnetic Resonance Image Temporomandibular Joint Interpretation.

PURPOSE: The purpose of our study was to create an online, web-based training module that would instruct a group of participants in the interpretation of a magnetic resonance image (MRI) of the temporomandibular joint (TMJ) scan in a logical, step-wise manner to locate and identify all relevant features of internal derangement. The investigator's hypothesis was that implementing the MRRead TMJ training module would improve the participants' competency in the interpretation of MRI TMJ scans. METHODS: The investigators designed and implemented a single-group prospective cohort study. The study population was composed of oral and maxillofacial surgery interns, residents, and staff. Subjects eligible for study inclusion were oral and maxillofacial surgeons of any level, between 18 and 50 years of age, that completed the MRRead training module to completion. The primary outcome variable was the difference between the pretest and post-test scores of the participants, and the frequency of missing internal derangement findings before and after the course. Secondary outcomes of interest were subjective data gathered from the course, including participant feedback as well as subjective evaluation of the training module and perceived benefit, as well as the learner's self-reported confidence level in interpreting MRI TMJ scans on their own before and after completion of the course. Descriptive and bivariate statistics were used. RESULTS: The study sample consisted of 68 subjects, aged 20 to 47 (M = 29.1) years. When comparing the results of the exams precourse and post course, the overall frequency of missed features of internal derangement decreased from 19.7 to 5.9, and the total score overall increased from 8.5 to 68.6%. Regarding secondary outcomes, the majority of participants indicated that they agree or strongly agree with a number of positive subjective questions asked. In addition, there was a statistically significant increase in the participants' comfort levels in the interpretation of MRI TMJ scans. CONCLUSION: The results of this study confirm the hypothesis that completing the MRRead training module (www.MRRead.ca) improves competency and comfort among participants in the interpretation of MRI TMJ scans and their identification of features of internal derangement correctly.

Does the Transversus Abdominis Plane Block Reduce Morbidity Following Iliac Crest Bone Harvest in Pediatric Patients With Alveolar Clefts?

OBJECTIVE: The purpose of this study is to determine whether a Transversus Abdominis Plane (TAP) block can reduce donor site morbidity among pediatric patients undergoing iliac crest bone grafting for repair of their alveolar cleft. DESIGN: This retrospective cohort study was carried out at the Division of Dentistry at the Montreal Children's Hospital. Medical charts of patients who underwent alveolar cleft bone grafting between January 2011 and January 2021 were reviewed and they were divided into two groups, intraoperative TAP block and intraoperative local anesthesia infiltration (control group). The outcomes measured were patients' post-operative pain at the donor site, in-hospital narcotics requirements and length of stay. RESULTS: A total of 66 patients were included. There were no significant differences in pain scale among the TAP group and control group [1.9 (SD 2.5) and 1.3 (SD 2.1), respectively (p = 0.23)]. The mean length of stay for both groups was 1 day. Interestingly, there was a significant higher proportion of patients who required in-hospital opioids (morphine) in the TAP block group when compared to the control group (p = 0.03). CONCLUSIONS: The results of our study suggest there may be no role for a TAP block in reducing pain and improving opioid stewardship.

CTRead-A Revolutionary Approach to Training Residents in Computed Tomography Facial Bone Interpretation.

PURPOSE: The purpose of our study was to create an online, web-based training module that would instruct a group of residents in the interpretation of a computed tomography (CT) facial bone scan in a logical, stepwise manner to locate and identify all relevant facial fractures. Our hypothesis was that implementing the CTRead facial bones training module would improve residents' competency in the interpretation of CT facial bone scans. MATERIALS AND METHODS: We designed and implemented a prospective quasi-experimental trial. The population for the present study included medical and dental residents. The primary outcome variable was the difference between the pre- and post-test scores of the participants and the frequency of missing fractures before and after the course. The secondary outcomes of interest were subjective data gathered from the course, including participants' feedback and subjective evaluation of the training module and perceived benefit. Another secondary outcome measured was the residents' self-reported confidence level in interpreting the CT facial bone scans on their own before and after completion of the course. Descriptive and bivariate statistics were used. RESULTS: The population sample included 38 residents from North America, aged 25 to 34 years (mean, 28.2 years). When comparing the results from before and after the course, the overall frequency of missed fractures had decreased from 20.7 to 6.4 (P < .001), and the total score overall had increased from 32.7 to 74.7% (P < .001). Regarding the secondary outcomes, most participants indicated that they agreed or strongly agreed with a number of positive subjective queries. In addition, we found a statistically significant increase in the participants' comfort level in the interpretation of CT facial bone scans. CONCLUSIONS: The results of the present study have confirmed the hypothesis that completing the CTRead training module (available at: www.CTRead.ca) improves competency among residents in the interpretation of CT facial bone scans and their correctly identification of facial fractures.

Muscle shape as a predictor of traumatic enophthalmos.

The literature on enophthalmos is reviewed to understand its etiology and its prevention following orbital fractures. Specifically, the importance of muscle shape changes in predicting enophthalmos is discussed. The indications for surgical repair of orbital blowout fractures are well established. However, 7 to 10% of patients still develop enophthalmos despite these criteria. Because late repair of enophthalmos is associated with poor esthetic and functional results, the sensitivity and specificity of the current indications need to be further improved. Increased orbital volumes after fracture together with soft tissue displacement and herniation are the two most important factors causing enophthalmos. The loss of both bone and periorbita as supporting structures is seen on coronal computed tomography scan as changes in shape of the extraocular muscles. In floor fractures, the inferior rectus changes from an ellipse to a more rounded shape. The same is true for the medial rectus in medial wall fractures. It is the degree of rounding measured as a ratio of height to width that has been shown to be predictive of enophthalmos. Therefore, because rounding signifies loss of bone and soft tissue support, it may be a more important indication for surgical intervention than fracture size alone.