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.

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.

Oral Hairy Leukoplakia in Patients With No Evidence of Immunosuppression: A Case Series and Review of the Literature.

OBJECTIVES: Oral hairy leukoplakia (OHL) is caused by Epstein-Barr virus (EBV) and is often associated with HIV and other immunosuppressive conditions. It is rare in HIV-negative patients, but has been reported in patients who use immune-modulating medications (e.g., cyclosporine). The objectives of this study were to determine the occurrence of OHL in HIV-negative patients and report Langerhans cell counts in these lesions. STUDY DESIGN: A series of 7 new cases of OHL among HIV-negative patients is described. Langerhans cells were counted using an immunoperoxidase stain for CD1a and light microscopy. RESULTS: The 7 patients were male, ranging in age from 26 to 69 years. Clinically, all lesions were diagnosed as leukoplakia on the lateral border of the tongue. Microscopic examination revealed hyperparakeratosis and candidiasis in some cases, acanthosis and a band-like zone with clearing of cells in the upper spinous layer, which were EBV-positive by in-situ hybridization. There was a significant decrease in Langerhans cell counts in OHL patients. CONCLUSION: OHL can occur in HIV-negative patients.

Participation of Canadian Oral and Maxillofacial Surgeons in Oral, Lip, and Oropharyngeal Cancer Care.

PURPOSE: The purpose of this study was to assess the participation of Canadian oral and maxillofacial surgeons (OMSs) in the various phases of oral, lip, and oropharyngeal cancer care. MATERIALS AND METHODS: A survey was conducted to quantify participation in oral, lip, and oropharyngeal cancer care and assess participation ranging from screening for malignancy to active treatment and rehabilitation of those with late-stage disease. RESULTS: Three hundred ninety-one surgeons were contacted and 206 (52.7%) responded to the online survey. The survey showed 98.1% of respondents were involved with cancer screening and 97.1% were involved in prevention and early intervention (monitoring and treatment) of premalignant lesions. In addition, 95.1% of respondents participated in diagnosis and staging of tumors. Early-stage cancer was managed surgically by 49.5% of respondents, whereas 11.2% of respondents managed late-stage disease. Management of oral rehabilitation was performed by 79.0% of respondents. CONCLUSION: OMSs are an integral part of all phases of oral and oropharyngeal cancer care, including primary surgical oncology, in Canada. Although OMSs in Canada participate widely in integral prevention and survivor rehabilitation programs, few members participate in late-stage disease management and regional multidisciplinary care teams.

Flightless I is a focal adhesion-associated actin-capping protein that regulates cell migration.

The role of adhesion-associated actin-binding proteins in cell migration is not well defined. In mouse fibroblasts we screened for focal adhesion-associated proteins that were isolated with collagen-coated beads and detected by tandem mass spectrometry. We identified flightless I (FliI) as an actin-binding protein in focal adhesion fractions, which was verified by immunoblotting. By confocal microscopy most FliI was distributed throughout the cytosol and in focal adhesions. By sedimentation assays and in vitro binding assays, we found that FliI associates with actin filaments and actin monomers. Assays using purified proteins showed that FliI inhibits actin polymerization and caps but does not sever actin filaments. Cells with FliI knockdown or cells overexpressing FliI migrated more or less rapidly, respectively, than wild-type controls. Compared with controls, cells with FliI knockdown were less adherent than wild-type cells, exhibited reduced numbers of focal adhesions containing activated ß1 integrins and vinculin, and exhibited increased incorporation of actin monomers into nascent filaments at focal adhesions. These data indicate that FliI regulates cell migration through its localization to focal adhesions and its ability to cap actin filaments, which collectively affect focal adhesion maturation.