Interest in global surgery rotations among oral and maxillofacial surgical residents in the United States.

PURPOSE: This study sought to assess interest in global surgery rotations among current United States (US)-based oral and maxillofacial surgery (OMS) residents. METHODS: An anonymous 23-question survey was distributed to 633 current OMS residents in the US to examine resident interest in global surgery rotations during residency. The primary outcome variable was resident interest in participating in global OMS rotations during residency training, whereas the primary predictor variable was the presence of residency faculty involved in global OMS work. Descriptive statistics were calculated for all study variables and univariate/multivariate logistic regression analyses were conducted to identify predictors of interest in global OMS rotations. RESULTS: A total of 120 residents with an average age of 30.4 ± 3.2 years responded to the survey. At present, 22 (18.5%) residents stated that their residency programs offer some sort of global OMS rotation and 21 (95.5%) of these claimed they were willing to participate in global OMS rotations at their residency program. Out of the residents who stated their program did not offer a global OMS rotation, 86 (87.8%) respondents stated they would be interested in adding a dedicated global OMS rotation to their residency curriculum. The presence of OMS residency faculty involved in global OMS work (p = 0.030) and a resident's willingness to dedicate vacation time to participate in a global surgery rotation (p = 0.005) were associated with increased interest in a global surgery rotation. CONCLUSION: The majority of respondents would welcome a dedicated global OMS rotation during their residency training.

Training satisfaction versus dissatisfaction among chief residents in oral and maxillofacial surgery--a pilot survey.

PURPOSE: To survey chief residents in accredited oral and maxillofacial surgery (OMS) training programs to assess their satisfaction with their surgical training and analyze their career plans after residency. MATERIALS AND METHODS: A 19-question anonymous survey was electronically mailed to 212 individuals identified as graduating chief residents in accredited OMS training programs. RESULTS: Ninety-four individuals (44%) completed the survey. Of these 85 were men (90.4%) and 9 were women (9.6%). Average age was 32 years. Forty-seven respondents (50%) completed the 4-year traditional OMS programs, 37 respondents (39.4%) completed the 6-year MD integrated programs, 9 respondents (9.6%) completed the 4-year MD option programs, and 1 listed "other" as a program type. Fifty-two individuals (55.3%) planned a full-time private practice career, 5 (5.3%) planned a full-time academic career, 3 (3.2%) planned a military career, 27 (28.7%) planned a combined private practice and academic career, and 7 (7.4%) planned to complete a fellowship after residency. Seventy-nine of all respondents (84%) were satisfied with their OMS training program, whereas 15 (16%) were not. CONCLUSION: Most participants of this survey were satisfied with their training program and OMS as a career. However, it is important to note that less than half (44%) of chief residents who received this survey completed it. This short survey is a pilot survey; a more involved evaluation of OMS resident satisfaction is planned, further assessing satisfaction and burnout during residency.

Dental student perceptions of oral and maxillofacial surgery as a specialty.

PURPOSE: The specialty of oral and maxillofacial surgery (OMS) encompasses the diagnosis and surgical management of a variety of pathologic, functional, and esthetic conditions of the oral and maxillofacial region. Despite the specialty's prominent role in the field of dentistry, a lack of complete understanding still remains among dental and medical health professionals as to the exact scope and expertise of the oral and maxillofacial surgeon. The present study aimed to analyze a population of dental students' perceptions of OMS as a specialty with respect to treatment rendered, referral patterns, and a general opinion of the specialty as a whole. MATERIALS AND METHODS: A survey consisting of 10 multiple-choice questions was compiled and distributed to dental students through an on-line polling service (SurveyMonkey). A total of 5 dental student classes at a single dental school were polled using school-based electronic mail, including the graduating seniors. All answers were kept confidential, and no individual students were identified. The students were not able to retake the survey once completed. The final tallies of the survey results were compiled and submitted for statistical analysis. RESULTS: Statistically significant associations between the year of dental education and student perceptions of OMS were determined. As dental students progress through their undergraduate studies, their perceptions change with regard to the referral of dental implants. Periodontists were found to have statistically significantly greater rates of referral than oral and maxillofacial surgeons from dental students in the fourth year and recent graduates compared with younger dental students from the first, second, and third years for placement of dental implants. Statistically insignificant in terms of a changing dental student perception was the finding that third molar removal was within the domain of the oral and maxillofacial surgeon, as well as the management of cleft lip and palate deformities and mandibular fracture repair. Almost all the dental classes believed that the specialty of OMS was both medical and dental in nature and that it is a very important dental specialty. CONCLUSIONS: Dental student perceptions of OMS change throughout their undergraduate training. The reasons for such a change are multivariate and might include factors such as the amount of didactic training and clinical exposure. It is vital to both recognize and address this change at an undergraduate level of training in an effort to increase educated referrals to a surgeon who might provide the best treatment options for the patient. A stronger understanding of the dental students' perception of OMS provides an opportunity for the oral and maxillofacial academic faculty to better educate students and, ultimately, strengthen our specialty.

Survey of residents who have participated in humanitarian medical missions.

PURPOSE: To survey physicians who participated in humanitarian missions as residents to assess the value of this experience on residency training and future career choices. MATERIALS AND METHODS: An anonymous 26-question survey was electronically mailed to 45 individuals identified as having participated in a cleft lip/palate mission during residency. The survey was created and distributed, and the data were collected using the online survey engine Survey Monkey. RESULTS: Thirty-nine individuals (86.7%) completed the survey. Of these, 27 were men (69.2%) and 12 were women (30.8%). Thirty-two (82.1%) were oral and maxillofacial surgeons, 4 (10.3) were plastic and reconstructive surgeons, 1 (2.6%) was an otolaryngologist, and 2 (5.1%) were pediatric dentists. Twenty-five respondents (64.1%) stated that, before their first mission, they had not operated on a primary cleft lip; 21 (53.8%) noted that they had not operated on a primary cleft palate before their first mission. Thirty-six (92.3%) noted that their mission experience improved their ability to repair facial clefts. Thirty-seven (94.9%) believed their mission experience improved their overall surgical skill. All respondents (n = 39, 100%) believed their mission experience improved their overall ability to evaluate patients with cleft. Thirty-six (92.3%) believed their experience in humanitarian missions made them more culturally sensitive/competent health care providers. Thirty-eight respondents (97.4%) believed these missions made them more socially aware of the differences in access/availability of health care globally. Thirty-eight (97.4%) believed that participation in a humanitarian mission was a high point of their residency. Thirty-seven (94.9%) planned to participate in humanitarian medical missions during their career after residency. CONCLUSION: All respondents believed that participation in a humanitarian mission during residency was a positive part of their training. In addition, these missions allowed the residents to develop as surgeons and improve their awareness of global health care and cultural competence. Given these important educational aspects, participation in a humanitarian mission should be considered a required part of residency training.

Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions.

OBJECTIVE: In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management. METHODS: This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions. RESULTS: The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05). CONCLUSION: There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.

Survey of faculty educator development award recipients.

PURPOSE: Since 2002, the American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation have annually awarded the Faculty Educator Development Award (FEDA) to select junior full-time oral and maxillofacial surgery faculty. To date, 33 individuals have received this award. The purpose of this study was to evaluate the FEDA's impact on the recipients' career and assess the FEDA's strengths and weaknesses from the perspective of the recipients. MATERIALS AND METHODS: A complete list of FEDA recipients was obtained from the American Association of Oral and Maxillofacial Surgeons, to whom a 19-question survey was electronically mailed for completion. RESULTS: Twenty-two of the 33 surveys were completed and returned. Strengths of the FEDA included encouraging faculty recruitment and retention and financial support. Weaknesses included unknown selection criteria for the FEDA, unknown FEDA selection committee, and that the financial component of the award was available for only 3 of the 6 years of the FEDA requirement. CONCLUSION: Although there are some weaknesses in the FEDA, it is the only award of its kind available to the specialty of oral and maxillofacial surgery. As such, consideration should be given to expanding the number of awards given and increasing the amount of the award. In addition, academic oral and maxillofacial surgery needs to improve its recruitment and retention of junior surgical faculty to ensure the continued viability of the specialty and training programs. Suggestions for improvement are discussed.

Resuming Dental and Craniomaxillofacial Surgical Missions During the COVID-19 Pandemic: Guidelines and Recommendations.

STUDY DESIGN: Descriptive review article. OBJECTIVE: The purpose of this article is to provide guidelines and recommendations for how to safely resume dental and craniomaxillofacial STSMs. The following considerations will be discussed: the need for extensive collaboration between organizations and local leadership, the importance of COVID-19 testing, use and management of personal protective equipment, team selection and training, social distancing protocols, and criteria for patient and case selection. METHODS: A literature review was completed, identifying resources and current data regarding the safe resumption clinical activities during the COVID-19 pandemic. RESULTS: At this time, there are no protocols developed regarding the safe resumption of STSMs. Primary resources, including the CDC, WHO, and FDA should be closely monitored so that developed protocols from these recommendations reflect the latest information. CONCLUSION: This paper outlines general considerations and recommendations for dentists, oral health specialists, and craniomaxillofacial surgeons seeking to safely resume STSMs. These recommendations are designed to minimize the risk of exposure to COVID-19 by reinforcing social distancing protocols, reviewing criteria for patient and case selections, encouraging collaboration between organizations and local leadership, and team training. These guidelines should be tailored to fit the needs of each individual mission while keeping the safety as the main objective.

Racial diversity in American oral and maxillofacial surgery.

PURPOSE: Health care disparity in the United States is a significant problem. Part of the solution is to improve the diversity of health care providers. The purpose of this study is to review the racial demographic of American oral and maxillofacial surgery as it compares with the racial demographic of the United States. Additionally, the racial demographic of the American dental and medical professions are reviewed. MATERIALS AND METHODS: Databases from the American Association of Oral and Maxillofacial Surgeons, American Dental Association, and Association of American Medical Colleges were analyzed, specifically reviewing racial demographic data of academic oral and maxillofacial surgery, dentistry, and medicine. RESULTS: Of the 349 full-time faculty, 248 were white (71.1%), 24 black (6.9%), 18 Hispanic (5.1%), 30 Asian (8.6%), and 29 other/unknown (8.3%); there were no full-time faculty of American Indian or Alaska Native descent. Of the 991 oral and maxillofacial surgery residents, whites comprised 701 (70.7%), blacks 43 (4.3%), Hispanics 42 (4.2%), Asians 197 (19.9%), and unknown 8 (0.8%). There are currently no residents of American Indian/Alaska Native origin. A 2006 American Dental Association survey of the distribution of race among the 179,594 professionally active dentists in the United States revealed 86.2% white, 3.4% black, 3.4% Hispanic, 6.9% Asian, and 0.12% American Indian. In 2004, whites comprised 36.7% (344,821) of US physicians, blacks 3.3% (30,598), Hispanics 2.8% (26,094), and Asians 5.7% (53,799); 27.6% (258,950) of US physicians were listed as unknown, and 23.6% (221,633) were listed as international medical graduates without demographic information. CONCLUSIONS: American oral and maxillofacial surgery's racial demographic (just as dentistry and medicine) does not remotely resemble the racial demographic of the United States. To improve health care disparity in this nation, diversifying the health care professional workforce is essential. Oral and maxillofacial surgery, a unique surgical specialty connecting medicine to dentistry, is positioned to make an impact on the oral health care disparity in this nation and as such should make a concerted effort to improve the racial diversity of the specialty.

Travel/Tropical Medicine and Pandemic Considerations for the Global Surgeon.

International travel goes hand in hand with medical delivery to underserved communities. The global health care worker can be exposed to a wide range of infectious diseases during their global experiences. A pretravel risk assessment visit and all appropriate vaccinations and education must be performed. Universal practices of water safety, food safety, and insect avoidance will prevent most travel-related infections and complications. Region-specific vaccinations will further reduce illness risk. An understanding of common travel-related illness signs and symptoms is helpful. Emerging pathogens that can cause a pandemic should be understood to avoid health care worker infection and spread.

Diversity and Cultural Competency in Oral and Maxillofacial Surgery.

Health disparities in the United States have been well documented over the past several decades and continue to affect the American population. As the world becomes more diverse, it is imperative that the health care professional workforce is trained to care for the diversifying patient population, striving to improve health disparities in the United States and worldwide. Improving the diversity within the health care professional workforce likely will aid in emphasizing the importance of cultural competency of health care professionals, with the development of programs aimed at cultural competency training and assessment.

Oral and Maxillofacial Surgery in Low-Income and Middle-Income Countries.

Five billion people worldwide do not have access to safe, affordable surgical and anesthesia care. The burden of inadequate access to safe and affordable surgical care falls heaviest on individuals living in low-income and middle-income countries (LMIC), where 9 out of 10 people do not have access to basic surgical care. Global oral and maxillofacial surgical care is included in the global burden of surgical disease, and increased awareness of the need for global oral and maxillofacial surgery (OMS), with the initiation, support, and funding of research on the need to develop a global OMS capacity-building strategy is imperative.

Developing a Sustainable Program for Volunteer Surgical Care in Low-Income and Middle-Income Countries.

Volunteer medical missions to low-income and middle-income countries have been a popular but unregulated method of providing care to underserved regions of the world as they work to improve surgical capacity. This article addresses various organizational tenets, such as forming a mission statement, selecting a site location, determining funding sources, establishing a team, patient safety, organization, and postoperative care and follow-up.

Answering the Call: How to Establish a Dentoalveolar Surgery Mission in Low- and Middle-Income Countries.

Addressing access to oral health care in many low- to middle-income countries is a complicated issue. Oral and maxillofacial surgeons may help engage with vulnerable populations through carefully planned dentoalveolar mission trips. The process of planning a mission includes selecting a population and identifying their unique needs, designing clinic layouts and workflows, team preparation, collection of supplies, fundraising, and advertising. During the mission, methods for protecting privacy, delivering treatment that is standard of care, and sanitation/sterilization options are reviewed. Ethical considerations include avoiding exploitation of vulnerable populations, offending local hosts, need for data collection, and long-term mission sustainability.

Telemedicine using smartphones for oral and maxillofacial surgery consultation, communication, and treatment planning.

Telemedicine is the specialty of medicine that uses the evolving telecommunications industry combined with medical information technology to provide remote medical services. The use of smartphone telemedicine is an efficient and effective way for remote specialist consultation and should be considered by the oral and maxillofacial surgeon. Smartphones provide fast and clear access to electronically mailed digital images and allows the oral/maxillofacial surgeon free mobility, not restricted by the constraints of a desktop personal computer. This in turn allows for improved efficiency of the specialty consultation and improved triaging, ultimately providing improved care to the maxillofacial patient.

Cleft surgery in rural Bangladesh: reflections and experiences.

PURPOSE: The authors review their experiences during multiple cleft surgical missions to rural Bangladesh from 2006 to 2008. A significant number of patients who underwent primary palatoplasty or cheiloplasty were of adult age or size. Adult primary cleft lip and palate repair is often more challenging than repair at the standard age of fewer than 2 years. This patient population is rarely seen in the United States, but may be treated more often by American surgeons during surgical missions to the developing world. This report discusses the experiences of the authors' treatment of cleft lips and palates in rural Bangladesh. PATIENTS AND METHODS: One hundred forty-six cleft-lip and cleft-palate patients were treated during 3 missions to rural Bangladesh, from 2006 to 2008. Thirty-three (23%) patients were of adult size, and aged 13 to 35 years. One hundred thirteen (77%) patients were aged 12 years or younger. Unilateral cleft lips were repaired with a Millard advancement-rotation technique. Bilateral cleft lips were repaired via the 1-stage procedure advocated by Mulliken and Salyer. Cleft palates were repaired using a 2-finger flap method. RESULTS: Overall, 8 of 146 patients (5.5%) had nonlife-threatening complications (infection or wound dehiscence) requiring subsequent revision surgery. The adult-sized patients had clefts of significantly increased size secondary to patient growth, as well as maxillary expansion transversely and anteriorly. Adult cleft-lip repair required significant soft-tissue dissection to close the cleft adequately, and ensure symmetry to the upper lip and alar bases. However, this procedure sometimes resulted in placement of the lip cicatrix in an anatomically disadvantageous position. In addition, with the increased transverse dimension of the adult cleft palate, tension-free 3-layer closure was difficult. Again, aggressive dissection of the soft tissue was required: the nasal and muscular layers were closed without much tension, but oral closure was often under tension, requiring the assistance of dermal biomaterials to bolster the repair. CONCLUSIONS: Patients in the developing world often have limited access to specialized health care, and may not realize that cleft lips and palates can be repaired. As a result, there is an increased incidence of unrepaired clefts in adult-sized individuals in this part of the globe. The American surgeon may encounter these patients during surgical missions. The surgeon should be prepared to repair adult patients with clefts that are significantly enlarged in all 3 dimensions. Closure will require significant soft-tissue dissection as well as the use of biomaterials as needed to repair wide cleft palates.

Lack of reliable evidence for oral submucous fibrosis treatments.

DATA SOURCES: Searches were made for relevant studies using the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and IndMED (bibliographic database of Indian biomedical journals). There were no language restrictions. STUDY SELECTION: Randomised controlled trials were to be selected if they compared surgery, systemic or topical medicines, or other interventions, to manage the symptoms of oral submucous fibrosis (OSF). DATA EXTRACTION AND SYNTHESIS: Two authors independently assessed trial quality and extracted trial data. Disagreements were resolved by consultation with a third author. Attempts were made to contact study authors where necessary for clarification and for additional information. Because of limited poor quality data, only a descriptive summary of the results of the included trials was carried out. RESULTS: Two trials, involving 87 participants, evaluated either lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with mouth-stretching exercises and heat. There were no reports of toxicity to the interventions but some side-effects, which were mostly gastric irritation to pentoxifylline, were noted. CONCLUSIONS: The lack of reliable evidence for the effectiveness of any specific interventions for the management of OSF is illustrated by the paucity, and poor methodological quality, of trials retrieved for this review.

Surgically assisted palatal expansion with a bone-borne self-retaining palatal expander.

PURPOSE: To evaluate the use of a bone-borne self-retaining palatal expander to treat transverse maxillary hypoplasia in place of conventional tooth-borne expanders in conjunction with surgically assisted palatal expansion. PATIENTS AND METHODS: Ten patients with transverse maxillary hypoplasia underwent surgically assisted palatal expansion with insertion of a bone-borne self-retaining palatal expander from May 2005 to December 2006. RESULTS: All 10 patients had adequate transverse expansion. Nine of 10 patients had symmetric expansion. Twelve months postexpansion, none of the patients had transverse relapse. CONCLUSION: Surgically assisted palatal expansion with a bone-borne self-retaining palatal expander is a viable alternative to more conventional palatal expanders.

Internal Maxillary Artery Preoperative Embolization Using n-Butyl Cyanoacrylate and Pushable Coils for Temporomandibular Joint Ankylosis Surgery.

BACKGROUND: Temporomandibular joint (TMJ) ankylosis causes disability through impaired digestion, mastication, speech, and appearance. Surgical treatment increases range of motion with resultant functional improvement. However, substantial perioperative blood loss can occur (up to 3 L) if the internal maxillary artery (IMAX) is injured as it traverses the ankylotic mass. Achieving hemostasis is difficult because of limited proximal IMAX access and poor visualization. Our aim is to investigate the technical feasibility and preliminary safety of preoperative IMAX embolization in patients undergoing TMJ ankylosis surgery. METHODS: Case series using chart reviews of 2 patients who underwent preoperative embolization before TMJ ankylosis surgery. RESULTS: Both patients were women (28 and 51 years old) who had severely restricted mouth opening. Embolization was performed using general anesthesia with nasal intubation on the same day of TMJ surgery. Both patients underwent bilateral IMAX embolization using pushable coils (Vortex, Boston Scientific) of distal IMAX followed by n-butyl-cyanoacrylate (Trufill, Cordis) embolization from coil mass up to proximal IMAX. There were no complications from the embolization procedures. Both patients had normal neurologic examination results. TMJ surgery occurred with minimal operative blood loss (≤300 mL for each surgery). Maximum postoperative mouth opening was 35 mm and 34 mm, respectively. One patient had a postoperative TMJ wound infection that was managed with antibiotics. CONCLUSIONS: Preoperative IMAX embolization before TMJ ankylosis surgery is technically feasible with encouraging preliminary safety. There were no complications from the embolization procedures and surgeries occurred with low volumes of blood loss.