Overlapping Spots of Photodynamic Therapy for Treatment of Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report.

Introduction: Photodynamic therapy (PDT) has shown substantial benefit in the treatment of choroidal hemangioma (CH) in recent years. This report describes the use of PDT with overlapping spots in a patient with Sturge-Weber syndrome (SWS) and large circumscribed CH. Case Presentation: A 9-year-old girl with SWS and a history of glaucoma in her left eye was referred to a retina clinic for possible macular changes. Examination revealed decreased vision in the left eye, pigmentary changes in the macula, and choroidal thickening in the posterior pole. After being lost to follow-up for 2 years, the patient returned with further vision deterioration with best-corrected visual acuity (BCVA) of 20/150 and new subretinal fluid (SRF). Imaging findings were consistent with a diagnosis of CH and SRF. PDT with verteporfin was initiated on the entire area with multiple overlapping spots, resulting in resolution of SRF and improvement in visual acuity and choroidal contour. At 18-month post-treatment, the patient's BCVA was 20/25 with no recurrence of SRF or increased choroidal thickening. Significant pigmentary changes and subretinal hyper-reflective material were observed in the OCT of the treated area. Conclusion: Multiple overlapping laser spots of PDT can result in longstanding regression of large circumscribed CH in a patient with SWS with excellent final visual acuity. However, significant subretinal changes may also result following this method of treatment.

Does Maxillomandibular Fixation Technique Affect Occlusion Quality in Segmental LeFort I Osteotomy?

BACKGROUND: Segmental maxillary osteotomies require precise occlusal control due to variability in individual segment positioning. The role of maxillomandibular fixation (MMF) technique on occlusal control has not been validated. PURPOSE: The purpose is to measure and compare the accuracy of occlusal positioning among MMF techniques. STUDY DESIGN, SETTING, SAMPLE: This was a double-blinded in vitro study on experiment models to simulate a 3-piece LeFort I osteotomy. The models were constricted posteriorly and expanded using 3 different MMF techniques and compared to the unaltered baseline occlusion. Based on sample size calculation, 32 separate attempts were made for each MMF technique. PREDICTOR VARIABLE: The predictor variable was MMF technique (brackets, MMF screws, and embrasure wires). MAIN OUTCOME VARIABLES: The primary outcome variable was the visual occlusal analysis score, a 1.00 to 4.00 continuous scale measuring the similarity of the achieved occlusion to the planned (control) occlusion assessed by an oral and maxillofacial surgeon and an orthodontist. High visual occlusal analysis score indicated greater occlusal accuracy, with 3.50 defined as the threshold for accuracy. The secondary outcome variable was the linear error of the achieved occlusion at the canine and first molar teeth, with lower error indicating greater accuracy. An a priori accuracy threshold of 0.5 mm was set for this variable. COVARIATES: None. ANALYSES: Kruskal-Wallis test with post hoc testing was used to analyze the difference in the outcome variables of interest. P value < .05 was considered statistically significant. RESULTS: Thirty-two attempts for each technique showed that brackets had higher VAOS than MMF screws and embrasure wires (median differences 1.49 and 0.48, P < .001), and had lower linear occlusal error (median differences 0.35 to 0.99 mm, P < .001). CONCLUSION AND RELEVANCE: MMF technique influences the quality of occlusal control, with greater visual rating scores and lower linear errors seen with brackets than with embrasure wires or MMF screws.

Journey from human hands to robot hands: biological inspiration of anthropomorphic robotic manipulators.

The development of robotic hands that can replicate the complex movements and dexterity of the human hand has been a longstanding challenge for scientists and engineers. A human hand is capable of not only delicate operation but also crushing with power. For performing tasks alongside and in place of humans, an anthropomorphic manipulator design is considered the most advanced implementation, because it is able to follow humans' examples and use tools designed for people. In this article, we explore the journey from human hands to robot hands, tracing the historical advancements and current state-of-the-art in hand manipulator development. We begin by investigating the anatomy and function of the human hand, highlighting the bone-tendon-muscle structure, skin properties, and motion mechanisms. We then delve into the field of robotic hand development, focusing on highly anthropomorphic designs. Finally, we identify the requirements and directions for achieving the next level of robotic hand technology.

Which Factors Affect the Reduction Quality of Open Reduction Internal Fixation of Mandibular Subcondylar Fractures?

BACKGROUND: Open reduction internal fixation (ORIF) of mandibular subcondylar fractures (MSF) involves several variables that could affect decision making. There is insufficient data regarding factors influencing the outcomes of MSF ORIF. PURPOSE: The purpose of this study was to investigate factors associated with quality of bony reduction of MSF and occlusion, after ORIF. STUDY DESIGN, SETTING, AND SAMPLE: We designed a retrospective cohort study of consecutively treated subjects for MSF ORIF, ages 18 to 64 years, by University of Illinois' Department of Oral and Maxillofacial Surgery, between January 1, 2013, and January 26, 2021. PREDICTOR VARIABLE: The primary predictor variable was the vertical level of MSF from the gonial angle. Secondary predictor variables included surgeon, fixation scheme (number and configuration of miniplate), surgical approach, time to surgery, mechanism of injury, vertical fragment overlap, overlying soft tissue thickness, presence of other mandibular fractures, and severity and direction of displacement. MAIN OUTCOME VARIABLES: The primary outcome variable was the mean radiographic reduction score (RRS), rated by 2 blinded observers on a 1 to 5 scale. The secondary outcome variable was presence of postoperative malocclusion as documented in the medical records. COVARIATES: Covariates were age and sex. ANALYSES: Descriptive statistics were computed. To investigate the influence of the predictor variables on reduction quality, multifactorial analysis of variance with post hoc Tukey test was performed. For malocclusion, χ2 test was performed. The level of significance was set at P < .05. RESULTS: Thirty-eight MSF in 37 subjects were included. Mean age was 32.7 years (range 18 to 64), and 83.8% were male. Mean RRS was 4.38 (standard deviation 0.77). Fixation scheme was the only variable that showed significant impact on RRS: single-straight miniplate had lower scores than double-straight (-1.50, P = .011), rhomboid (-1.29, P = .036), and ladder miniplates (-1.38, P = .048). There was 1 incidence of malocclusion (2.7%) which resolved without intervention. CONCLUSIONS AND RELEVANCE: Favorable reduction (anatomic reduction to mild discrepancies) can be achieved without malocclusion using double-straight, or rhomboid-shaped or ladder-shaped miniplates, without influences from patient or injury-related factors. In contrast, single-straight miniplate fixation resulted in moderate discrepancies in reduction, although it did not lead to malocclusion.

Reconstruction of Large Full-Thickness Lower Eyelid Defects With Remnant Eyelid Rotation, Semicircular Skin and Muscle Flap, and Lateral Tarsoconjunctival Flap.

PURPOSE: To describe and assess the results of reconstruction of large, full-thickness defects of the central or medial lower eyelid using a semicircular skin flap, rotation of the remnant lateral eyelid, and a lateral tarsoconjunctival flap. METHODS: The surgical approach is described, and the authors performed a retrospective chart review of consecutive patients between 2017 and 2023 reconstructed with this technique. Outcomes were assessed for size of eyelid defect, vision, subjective symptoms, facial and palpebral aperture symmetry, eyelid position and closure, corneal examination, surgical complications, and need for subsequent surgical intervention. Postoperative appearance was graded on malposition, distortion, asymmetry, contour deformity, and scarring (MDACS). RESULTS: Charts of 45 patients were identified. The average size of the lower eyelid defect was 18 mm (ranging from 12 to 26 mm). Facial and palpebral aperture symmetry were acceptable and all patients had preserved visual acuity and eyelid position and closure. The MDACS cosmetic score was perfect (0) in 15.6% (7/45) of eyelids, good (1-4) in 80.0% (36/45) of eyelids, and mediocre (5-14) in 4.4% (2/45) of eyelids. Second stage reconstruction was not necessary in 32 (71.1%) cases. There were no serious surgical complications, but minor complications included redness of the eyelid margin and pyogenic granulomas. CONCLUSIONS: Medial rotation of the remnant lower eyelid with a lateral semicircular skin and muscle flap over a lateral tarsoconjunctival flap was very effective in this series. Benefits include scarring within the facial skin tension lines, maintained vision throughout the recovery period, no eyelid retraction, and often single stage reconstruction.

Metastatic Epithelioid Sarcoma of the Eyelid in a 47-Year-Old Man: A Case Report.

Epithelioid sarcoma is a rare soft tissue neoplasm of uncertain differentiation that typically affects the distal extremities. Primary orbital epithelioid sarcoma is rare, and no reports exist characterizing metastases of this tumor to the orbit and ocular adnexa. In this article, the authors describe a rare case of eyelid metastasis in a 47-year-old man with epithelioid sarcoma of the right fibula diagnosed 16 months earlier who was otherwise doing well on the adjuvant tazemetostat therapy. In addition, the authors perform a retrospective review of cases of primary orbital epithelioid sarcoma reported in the literature, of which 4 patients responded favorably to surgical excision whereas 2 others eventually died as a direct result of their disease.

What Is the Linear Accuracy of Regional Voxel-Based Registration for Orthognathic Surgery Landmarks?

PURPOSE: While regional voxel-based registration (R-VBR) has been shown to have excellent reproducibility and angular accuracy, there are limited data on the linear accuracy of R-VBR for common orthognathic surgery landmarks, or on whether angular accuracy correlates with linear accuracy. The purpose of this study was to estimate the linear accuracy of R-VBR for several skeletal landmarks commonly used in orthognathic surgical planning, and to measure the correlation between angular and linear discrepancies. MATERIALS AND METHODS: This is a retrospective cross-sectional study of consecutive patients treated at a single center with nonsegmental LeFort I and bilateral sagittal split osteotomy surgery from January 2019 to November 2020. Cone beam computed tomography at the preoperative (T0) and immediate postoperative (T1) stages were analyzed to measure the postoperative positional changes of 11 orthognathic landmarks in 4 regions of interest (ROI) using R-VBR performed twice by two examiners. Pairwise correlation analysis and canonical correlation analysis were performed for the angular discrepancies (primary predictor variable) and the linear discrepancies (primary outcome variable) to measure the correlation between the two. RESULTS: In cone beam computed tomography analysis of 28 eligible subjects (16 males, 12 females; mean age 18.9 years, range 15 to 25), the mean absolute (MA) angular discrepancies ranged from 0.15° to 0.55°, while the corresponding MA linear discrepancies ranged from 0.05 to 0.41 mm. There was a strong correlation between angular and linear discrepancies that was statistically significant (P = .001 to .04, Spearman's rank correlation coefficient 0.38 to 0.87). CONCLUSIONS: For nonsegmental LeFort I osteotomies and bilateral sagittal split osteotomy, R-VBR has excellent linear accuracy within a single voxel size (0.3 mm) for commonly used orthognathic landmarks in the maxillary and distal mandibular ROI. The MA linear discrepancy for the proximal mandibular segment ROI was greater than a single voxel size, with a maximum of 0.41 mm.

Kimura Disease of the Periorbita and Earlobe in a 15-Year-Old Male: A Case Report and Review of the Literature.

PURPOSE: The authors describe a case of Kimura disease (KD) affecting the lacrimal gland, the ipsilateral periorbita, and the contralateral earlobe. The authors also review the literature for characteristics and outcomes of KD affecting the periorbita or earlobe. METHODS: The authors review retrospectively a single chart and abstract data from the English language literature. RESULTS: A 15-year-old Samoan male presented with a left upper eyelid mass and later the contralateral earlobe and ipsilateral periorbita. Surgical resection was partially effective and normal vision and eye motility were maintained. Histopathology was consistent with KD. Thirty-seven cases of periorbital KD were identified in the literature. The average age of patients with periorbital KD was 31.9 years (standard deviation: 17.8 years), with 81.1% (30/37) of patients being male and 69.4% (25/36) Asian. Over half of periorbital KD patients had lacrimal gland involvement (51.3%; 19/37). Fifteen patients were initially treated with surgery; 3 (20%) had recurrence of the disease. Another 15 patients were initially treated with corticosteroids; 12 (80%) had recurrence of the disease. Ophthalmologic data, when reported, demonstrated that, most patients had no visual (77.8%; 14/18 patients) or motility disturbances (82.4%; 14/17 patients) but most had proptosis 71.4% (10/14). Only 4 cases of earlobe involvement in KD were identified, all in women. CONCLUSIONS: In the literature, orbital KD was rare but often affected the lacrimal gland and caused proptosis, commonly in young adult Asian males. Vision and extraocular motility were usually normal. Earlobe involvement was very rare. This unique case of KD that affected the orbit and contralateral earlobe corroborates the prior literature that KD is prone to recurrence but may not adversely affect vision or extraocular motility.

Zygoma and Mandibular Angle Reduction: Contouring Surgery to Correct the Square Face in Asians.

Changing the facial appearance with facial contouring surgery is popular, especially in East Asian countries where a square face is a common chief complaint. Mandibular angle reduction, malar reduction, genioplasty, and chin and body contouring surgery can be performed as independent or ancillary procedures during orthognathic surgery. Many techniques have been developed and different osteotomy designs have been proposed to enhance outcomes and minimize complication risks. Here, we review the surgical techniques and considerations for mandibular angle and malar reduction, the two most commonly performed contouring surgeries in East Asia to correct the square face.

Accuracy of Patient-specific Soft-tissue Prediction Algorithms for Maxillomandibular Surgery in Class III Patients.

Context: Improved esthetics is an important factor for most patients undergoing orthognathic surgery. Thus, a treatment simulation that can provide patients with a realistic view of the esthetic outcome after surgery is important in clinical practice. Aims: To evaluate the accuracy of simulations generated using algorithms specific for patient's type of malocclusion and surgical procedure compared to nonspecific algorithms. Settings and Design: A total of 36 patients (average age 18.41 years) who had undergone maxillary advancement and mandibular setback for Class III malocclusion were included. Subjects and Methods: The presurgical and postsurgical cone-beam computed tomography scans were used to generate the lateral cephalograms and the surgical simulations were created with the patient-specific algorithm (specific for Class III patients) and the nonspecific algorithm (default algorithm not specific for any particular malocclusion or type of surgery) using the treatment simulation feature in Dolphin Imaging software. The accuracy of the simulations was examined by comparing the soft-tissue changes in the surgical simulations with the postsurgical result. Statistical Analysis Used: Statistical analyses were performed with SPSS-software at 0.05 significance level. For the mean difference between the postsurgical and surgical-simulation landmarks, a paired sample t-test (Student's t-test) was performed. Results: Patient-specific algorithms were accurate in vertical prediction of lower lip, B', tip of nose, upper lip, and horizontal prediction of pogonion'. Whereas the nonspecific algorithm was accurate in the horizontal prediction of the lower lip, pogonion', and menton'. Conclusions: Patient-specific and nonspecific algorithms for generating surgical simulations showed different accuracy for vertical and horizontal predictions of the parameters.

Volumetric analysis of spontaneous bone healing after jaw cyst enucleation.

The purpose of this study is to evaluate the degree of spontaneous bone healing after cyst enucleation as well as its contributing factors. Pre- and post-operative computed tomography (CT) scans of consecutive patients who had undergone jaw cyst enucleation were retrospectively analyzed. The outcome variable was healing ratio, which was calculated using the volume of the cyst before surgery and the volume of the defect in the bone after surgery. Predictor variables including duration of observation, pre-operative cyst size, age, gender, and involved jaw were analyzed to determine their influence. Forty-four subjects (30 Male and 14 Female, average 40.7 ± 15.7 years) were included in this study. Healing ratio was significantly lower during the first year (33.5 ± 32.8%) compared to the second (74.5 ± 24.2%) and subsequent years (74.2 ± 17.8%). In 35 patients who had follow-ups of over 1 year, the healing ratio was not affected by the pre-operative cyst size and upper/lower jaw except gender (p = 0.037, female > male) and age (p = 0.021, younger than 30 years > 30 years and older). The residual defect was significant larger in cysts 3 cc or larger (1.64 ± 1.54 cc) compared to smaller cysts (0.43 ± 0.42 cc, p = 0.006). The residual defect volume of large cysts was similar to those of the pre-operative volume of small cysts (1.47 ± 0.72 cc). In conclusion, spontaneous bone healing ratio of post-enucleation defects was about 73.5% after 12 months. Large cysts (> 3 cc) had larger defect, comparable to the volume of small cysts, but with altered contour. Additional treatment such as a bone graft may be considered especially in large cysts.

Do We Need Safety Nets for Outsourced Computer-Aided Orthognathic Planning? A Two-Center Analysis.

PURPOSE: While the accuracy, cost-effectiveness, and time-efficiency of computer-aided orthognathic surgical planning (CAOP) have been studied, little is known about the influence of logistical factors of outsourced CAOP (OS-CAOP) on patient care. The purpose of this study was to investigate the limitations of OS-CAOP and their effect on treatment planning workflow and surgical outcomes. METHODS: A retrospective cross-sectional study was designed involving subjects who had undergone orthognathic surgery using CAOP from 2 academic oral and maxillofacial surgery centers in South Korea (Kyungpook National University, KNU) and the United States (University of Illinois Chicago, UIC) over an 8-year period. The primary predictor variable was use of modifications or alternatives to OS-CAOP. The primary outcome variable was the frequency of planning changes due to reasons that may have affected outcomes. Covariates included age and sex. Descriptive statistics was used, in addition to a chi-square test to analyze differences among categorical variables. RESULTS: Of a total of 642 eligible subjects in both centers, 5.8% used alternatives to OS-CAOP. 78.4% of these were due to reasons that may have affected outcomes (P < .001), representing 4.5% of all cases. The frequency of the need for OS-CAOP alternatives was identical in both centers (5.8%), but the specific reasons varied, with KNU having mostly plan-related changes (38.1% of alternatives), and UIC with more access and education-related reasons (68.8% of alternatives). At KNU, 71.4% of all alternatives were by repeat OS-CAOP, whereas at UIC, all were by in-house CAOP (IH-CAOP). CONCLUSIONS: In 2 major academic oral and maxillofacial surgery centers in South Korea and the United States, a substantial portion of OS-CAOP required pre-surgical modification, or use of alternatives. Most of the changes were for reasons that could potentially impact outcomes, prompting the need to consider establishing a "safety net" plan compatible with individual clinician's practice setting and healthcare system.

Reproducibility of a three-dimensional skeletal-based craniofacial orientation method for virtual surgical planning.

Inadequate craniofacial orientation of computed tomography (CT) scans can have significant implications in all three planes of space. The purpose of this study was to present the reproducibility of a 3-dimensional skeletal-based method of craniofacial orientation for virtual surgical planning. The protocol was defined by landmarks commonly used for cephalometry, and required identification of basion, nasion, right porion, and right orbitale, and navigation in all CT views (coronal, sagittal, and axial) for correction of yaw, roll, and pitch. Reproducibility of the method was assessed using eight CT scans that were randomly selected and anonymised. The observer group consisted of six oral and maxillofacial surgeons with varying levels of experience (resident or faculty) who performed craniofacial orientation according to the proposed method. Results were expected to be below 2° of variation, when overall accuracy as well as the influence of the academic level of the observers and symmetry of the evaluated anatomy, were considered as independent variables. Overall accuracy for all cases and for yaw, roll, and pitch were always below 2° of variation, without influence of level of experience and symmetry. Interobserver assessment was categorised as excellent in all instances, and intraobserver evaluation demonstrated consistency in the orientation of all axes. The proposed craniofacial orientation protocol presented in this study is easy to learn, applicable to computer-aided surgical planning, and can be performed by the non-technical clinician, resulting in excellent reproducibility and consistency.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

PURPOSE: The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population. METHODS: Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20 years), group II (20 to 39 years), group III (40 to 59 years), and group IV (over 60 years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ2 test, and analysis of variance were used for statistical analysis according to age and gender. RESULTS: The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P = .281) and female (P = .442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank. CONCLUSIONS: An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

The role of muscular traction in the occurrence of skeletal relapse after advancement bilateral sagittal split osteotomy (BSSO): A systematic review.

The aim of this systematic review was (i) to determine the role of muscular traction in the occurrence of skeletal relapse after advancement BSSO and (ii) to investigate the effect of advancement BSSO on the perimandibular muscles. This systematic review reports in accordance with the recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic database searches were performed in the databases MEDLINE, Embase and Cochrane Library. Inclusion criteria were as follows: assessment of relapse after advancement BSSO; assessment of morphological and functional change of the muscles after advancement BSSO; and clinical studies on human subjects. Exclusion criteria were as follows: surgery other than advancement BSSO; studies in which muscle activity/traction was not investigated; and case reports with a sample of five cases or fewer, review articles, meta-analyses, letters, congress abstracts or commentaries. Of the initial 1006 unique articles, 11 studies were finally included. In four studies, an intervention involving the musculature was performed with subsequent assessment of skeletal relapse. The changes in the morphological and functional properties of the muscles after BSSO were studied in seven studies. The findings of this review demonstrate that the perimandibular musculature plays a role in skeletal relapse after advancement BSSO and may serve as a target for preventive strategies to reduce this complication. However, further research is necessary to (i) develop a better understanding of the role of each muscle group, (ii) to develop new therapeutic strategies and (iii) to define criteria that allow identification of patients at risk.

What Do We Know Beyond Reliability in Voxel-Based Registration? Validation of the Accuracy of Regional Voxel-Based Registration (R-VBR) Techniques for Orthognathic Surgery Analysis.

PURPOSE: Despite having excellent reproducibility, the accuracy of regional voxel-based registration (R-VBR) techniques used for postoperative orthognathic surgical analysis has not been validated. The purpose of this study was to validate the accuracy of R-VBR. METHODS: Preoperative (T0) and postoperative (T1) cone beam computed tomography (CBCT) of consecutive patients treated at a single center with nonsegmental LeFort I and bilateral sagittal split osteotomy were included. T1 CBCTs were oriented to match that of the standardized T0, and thus were assigned a known rotational transformation matrix in pitch/roll/yaw (P/R/Y), to create T1-prime (T1'). A copy of T1 (cT1) was made and was superimposed to T1' using R-VBR for 4 regions of interest (ROI): maxilla, distal mandible, right proximal mandible, and left proximal mandible, to create cT1'. The transformation matrix for each of the ROI was compared to those of T1' using paired t test and Bland-Altman analysis. RESULTS: Twenty-eight eligible subjects' CBCTs were analyzed. Mean difference between T1' and cT1' ranged from -0.08 to 0.14° (maximum 0.73°), with no statistically significant differences (P = 0.216 to 1). Mean absolute difference ranged from 0.13 to 0.31° (maximum 0.73°). Bland-Altman analysis showed good agreement between T1' and cT1', indicating excellent accuracy. CONCLUSIONS: R-VBR using the maxilla, distal mandible, and the bilateral proximal mandibular segments as ROI has excellent accuracy in terms of rotational measurements.

A triple-blind randomized clinical trial of different associations between dexamethasone and non-steroids anti-inflammatories for preemptive action in third molar extractions.

The aim of this study is to evaluate the preemptive analgesic effects of dexamethasone (DEX) alone or combined with non-steroidal anti-inflammatory drugs (NSAIDs) in third molar surgeries. The subjects were divided into five groups (n = 20 teeth/group); subjects received only 8 mg of dexamethasone 1 h before the surgical procedure (DEX group), or in combination with etodolac (DEX + ETO), ketorolac (DEX + KET), ibuprofen (DEX + IBU), loxoprofen (DEX + LOX). Paracetamol 750 mg was provided as the number of rescue analgesics (NRA). Salivary PGE2 expression was measured preoperatively and at 48 h. Edema and Maximum mouth opening (MMO) were measured postoperatively at 48 h and 7 days. A visual analog scale (VAS) was performed postoperatively at 6, 12, 24, 48, 72 h, and 7 days. Salivary expression of PGE2 showed a decrease only for the DEX group. Edema and MMO and NRA consumption showed no significant differences among the groups (P > 0.05). The VAS showed a significantly lower pain perception at 6 h after the surgery for the DEX + ETO and DEX + KET groups (P < 0.05). The combination of DEX and NSAIDS should be considered for preemptive acute postsurgical pain management in third molar surgery. In some drug associations such as dexamethasone 8 mg + NSAIDS (ETO and KET) in the pre-operative time, only a few rescue analgesics are necessary.

Ophthalmology Provider Ratings and Patient, Disease, and Appointment Factors.

The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.