The Burden of Head and Neck Cancer in the United States, 1990 - 2017.

PURPOSE: Head and neck cancers (HNC) are among the most common malignancies in the United States and are a significant cause of morbidity and mortality. Traditional risk factors for HNC include tobacco, alcohol, and Human Papilloma Virus (HPV) infection. Geographic location has also been shown to play a role, whether directly or indirectly. The purpose of this study was to describe the incidence, mortality and geographic variability of HNC within the United States between 1990 and 2017. MATERIALS AND METHODS: The Global Burden of Diseases Study 2017, which models incidence and mortality, was used to obtain incidence and mortality data for "lip and oral cavity cancer", "nasopharynx cancer", "other pharynx cancer" (tonsil, oropharynx, and hypopharynx) and "larynx cancer" for the United States between 1990 and 2017. RESULTS: The overall incidence rate of HNC increased (annual percent change (APC) = 0.23. 95% CI: 0.1-0.3) from 1990 through 2017 while overall mortality decreased (APC = -0.37. 95% CI: -0.4 to -0.3). The anatomic sub-site which saw the largest increase in incidence was "other pharynx" (APC=1.07. 95% CI: 0.9-1.2). In 2017, those in the West had the lowest incidence while those in the South had the highest (15.7 and 20.8 per 100,000 individuals, respectively). CONCLUSIONS: The incidence of HNC in the United States increased between 1990 and 2017. This was driven by larger increases in those sites more prone to HPV-related HNC. While there exists geographic variability in the burden of this disease, additional studies are needed to further understand the impact of patient-specific factors.

What Is the Effect of COVID-19 Social Distancing on Oral and Maxillofacial Trauma Related to Domestic Violence?

PURPOSE: To understand the impact of social distancing policies on the incidence and severity of oral and maxillofacial trauma (OMT) secondary to interpersonal violence (IPV) and domestic violence (DV). METHODS: The authors designed a retrospective cohort study enrolling subjects who presented to an urban Level 1 trauma center in Seattle, WA, for the evaluation and management of OMT between January 1 and December 31 in the years 2018 through 2020. The primary predictor variable was evaluation of OMT during periods with (2020: investigational group) or without (2018 or 2019: control group) social distancing policies in place. The primary outcome variables were the mechanism and severity of injury, defined as IPV, DV or neither, the abbreviated injury scale (AIS) and the injury severity score (ISS). Descriptive, univariate and bivariate analyses were performed with statistical significance at P < .05. RESULTS: Eight hundred twenty-eight subjects; 737 (89%) IPV and 91(11%) IPV due to DV. The incidence of OMT secondary to IPV or DV was unchanged (P = .81, P = .57 respectively). There was a nonsignificant increase in ISS for IPV (P = .07) and no change for DV (P = .46). AIS scores were unchanged for IPV (P = .36). For DV, AIS scores were lower in 2020 when compared to 2019 (P = .04) but unchanged from 2018 (P = .58). At least half of the DV victims were male (50% in 2018, 59% in 2019, and 53% in 2020). Of these, 65% were under 18, and represented the pediatric majority (62%). A nonsignificant increase in non-white subjects presenting with DV in 2020 (P = .15) was seen. CONCLUSIONS: The COVID-19 pandemic did not change the number or severity of OMT cases secondary to IPV or DV in this region of Washington. Pediatric males were more likely to be victims of DV.

What Is the Effect of COVID-19-Related Social Distancing on Oral and Maxillofacial Trauma?

PURPOSE: The purpose of this study was to understand the impact of social distancing policies enacted during the COVID-19 pandemic on the epidemiology of oral and maxillofacial fractures at an urban, Level I trauma center in the United States. MATERIALS AND METHODS: The investigators designed a retrospective cohort study and enrolled a sample of 883 subjects who presented for evaluation of oral and maxillofacial fractures (OMF) between March 1 and June 30 in the years 2018 through 2020. The primary predictor variable was the evaluation of OMF during a period with social distancing policies (2020 - experimental group) or without social distancing policies in place (2018 or 2019 - control group). The primary outcome variables were the facial fracture diagnosis, the abbreviated injury scale (AIS), injury severity score (ISS), and the mechanism of injury. Appropriate univariate and bivariate statistics were computed, and the level of significance was set at P < .05 for all tests. RESULTS: The number of subjects presenting with OMF was lower during the period of social distancing (n = 235 in 2020) than during the periods without (2018: n = 330; 2019: n = 318). During the period of social distancing, there were more individuals who presented secondary to assault, whereas fewer individuals presented secondary to falls (P = .05). On average, those who presented in 2020 had more severe oral and maxillofacial injuries (mean AIS = 3.2 ± 1.2 in 2020 vs 3.0 ± 1.1 in 2019 and 3.0 ± 1.1 in 2018. P = .03) and more overall injuries (mean ISS = 20.7 ± 13.1 in 2020 vs 19.2 ± 12.5 in 2019; 17.8 ± 12.8 in 2018. P = .03). CONCLUSIONS: The investigators found that during the period of social distancing through the COVID-19 pandemic, the number of OMF cases decreased but that the severity of oral and maxillofacial and overall injuries was higher.

Early Effects of COVID-19 on Oral and Maxillofacial Surgery Residency Training-Results From a National Survey.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has had an immense impact on the healthcare industry. Oral and maxillofacial surgery (OMS) clinical practice uniquely exposes providers to COVID-19. The purpose of the present study was to understand the effect of the COVID-19 pandemic on OMS residency training programs (OMSRTPs): 1) training and education; 2) availability and use of personal protective equipment (PPE); 3) experience with, and use of, screening and viral testing; 4) resident experience; and 5) program director (PD) experience and observations of the immediate and future effects on OMSRTPs. MATERIALS AND METHODS: OMS residents and PDs in OMSRTPs in the United States were invited to participate in the present cross-sectional study from April 1, 2020 to May 1, 2020. A 51-question survey was used to evaluate the effects of COVID-19 on OMSRTPs and to assess the 5 specific aims of the present study. RESULTS: A total of 160 residents and 13 PDs participated in the survey, representing 83% of US states or territories with OMSRTPs. Almost all residents (96.5%) reported modifications to their training program, and 14% had been reassigned to off-service clinical rotations (eg, medicine, intensive care unit). The use of an N95 respirator mask plus standard PPE precautions during aerosol-generating procedures varied by procedure location, with 36.8% reporting limited access to these respirators. Widespread screening practices were in use, with 83.6% using laboratory-based viral testing. Residents scheduled to graduate in 2022 were most concerned with the completion of the graduation requirements and with decreased operative experience. Most residents (94.2%) had moved to web-based didactics, and a plurality (47%) had found increased value in the didactics. CONCLUSIONS: Sweeping alterations to OMS clinical practice have occurred for those in OMSRTPs during the COVID-19 pandemic. Although the overall OMSRTP response has been favorable, residents' concerns regarding the ubiquitous availability of appropriate PPE, operative experience, and completion of graduation requirements requires further deliberation.

Metastatic renal cell carcinoma to the mandible: a case report with clinical and histologic findings.

Metastatic disease to the oral cavity is rare. Patients with metastasis to the oral cavity may present with swelling, pain, and paresthesia and require evaluation by providers trained in managing pathoses of the oral cavity and surrounding structures. This report describes the case of a 78-year-old man with painful enlargement of the right posterior mandible that caused paresthesia. An open biopsy procedure resulted in significant blood loss and the need for percutaneous needle biopsy. Immunohistochemical analysis was used to make the diagnosis of metastatic clear cell renal cell carcinoma in this patient, whose primary malignancy was previously unknown. Composite resection of the metastatic lesion and reconstruction were performed with the use of virtual surgical planning, an osteomyocutaneous free tissue transfer, and a custom reconstruction plate. This case highlights the importance of dental professionals in the diagnosis and management of lesions of the head and neck and adds to the literature on metastatic lesions to the region.

Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria.

BACKGROUND: Interest in facial masculinization surgery is expected to increase as gender-affirming surgery becomes more widely accepted and available. The purpose of this study is to summarize the current literature describing operative techniques in facial masculinization surgery and provide an algorithmic approach to treating this patient population. METHODS: PubMed, EMBASE, and Medline databases were queried for literature on operative techniques and outcomes of facial masculinization surgery in transgender and cisgender patients, published through July 2018. Data on patient demographics, follow-up, operative techniques, complications, and outcomes were collected. RESULTS: Fifteen of the 24 identified studies met inclusion criteria. Two studies discussed the outcomes of 7 subjects (6 trans-male and 1 cis-male) who underwent facial masculinization procedures. No objective outcomes were reported in either study; however, subjects were generally satisfied and there were no complications. The remaining studies reviewed operative techniques utilized in the cisgender population. CONCLUSION: A summary of considerations for each facial anatomic subunit and respective operative techniques for facial masculinization is presented. Current facial masculinization procedures in cisgender patients may be considered in the transgender patient population with favorable outcomes. However, further research is needed on techniques and objective outcome measures of facial masculinization procedures in the transgender population.

How does the close surgical margin impact recurrence and survival when treating oral squamous cell carcinoma?

PURPOSE: The surgical margin is the main prognostic factor over which the surgeon has control during resection of oral squamous cell carcinoma (OSCC). This study examined the association between surgical excision margins of patients with OSCC and outcomes of disease-free and overall survival. MATERIALS AND METHODS: The authors implemented a retrospective cohort study. The sample was composed of patients with OSCC having resection as their initial treatment. The predictor variable was the pathologic surgical margin, defined as clear (>5 mm), close (1 to 5 mm), or involved (<1 mm). The outcome variables were disease-free (absence of locoregional recurrence) and overall survival. Data were analyzed using Kaplan-Meier survival curves and Cox regression hazard model. RESULTS: The sample was composed of 54 patients with a mean age of 60.5 years (range, 19 to 85 yr) and 26% were women. The 2- and 5-year overall survival rates were 59 and 50%, respectively. The clear surgical margin group showed higher disease-free survival rates than patients with close and involved margins (5-yr probability, 0.78 vs 0.43 and 0.29; P = .014) and a trend toward increased overall survival at 2 and 5 years (P = .093). CONCLUSION: The results suggest that the presence of a close surgical margin (1 to 5 mm) is an adverse risk feature comparable to an involved margin and therefore is associated with decreased disease-free and overall survival. Future studies are needed to replicate these findings before they can be used as a basis for clinical recommendations.

Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study.

BACKGROUND: No data exist on the prospective outcomes of facial feminization surgery. This study set out to determine the effects of facial feminization surgery on quality-of-life outcomes for gender-diverse patients. METHODS: A prospective, international, multicenter, cohort study with adult gender-diverse patients with gender dysphoria was undertaken. Facial feminization outcome score was calculated preoperatively and postoperatively (1-week to 1-month and >6 months). Photogrammetric cephalometries were measured at the same time points. Self-perceived preoperative masculinity and femininity were recorded. Externally rated gender appearance (scale of 1 to 5, with 1 being most feminine) and general aesthetics (scale of 1 to 10, with 10 being very good) for 10 facial feminization surgery patients were compared with those of five cisgender controls. Univariate linear regression analyses were used to predict outcomes from facial feminization surgery. RESULTS: Sixty-six consecutive patients were enrolled. Patients noted that their brows, jaws, and chins were the most masculine aspects of their faces (54.5 percent, 33.3 percent, and 30.3 percent, respectively). Median facial feminization outcome score increased from 47.2 preoperatively to 80.6 at 6 months or more postoperatively (p < 0.0001). Mean satisfaction was excellent (3.0 at both 1-month and ≥6-month follow-up; p = 0.46). Cephalometric values were significantly more feminine after surgery. Gender appearance was feminine to very feminine (1.83 ± 0.96) and general aesthetics were good (6.09 ± 2.01) but different from those of cisgender women controls (1.25 ± 0.49 and 7.63 ± 1.82, respectively; p < 0.001 for each). CONCLUSION: Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at 1 month and stable at more than 6 months. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

U.S. Oral and Maxillofacial Residents' Experience with Transgender People and Perceptions of Gender-Affirmation Education: A National Survey.

With a growing number of individuals seeking gender-affirming surgery, there is a greater need for providers, including oral and maxillofacial surgeons, experienced in the surgical care of transgender people. The aim of this study was to evaluate oral and maxillofacial surgery (OMS) residents' exposure to the care of transgender people and their perceived importance of education in gender-affirming surgery. All 1,174 OMS residents in accredited U.S. training programs were invited to participate in this cross-sectional study between July 1, 2017, and January 30, 2018. The predictor variables were residents' gender, program region, program type, and level of training. The outcome variables were frequency of exposure to the care of transgender people, aspects of care covered, perceived importance of such training, and perceived need for fellowship opportunities in gender-affirming surgery. Results were analyzed for 87 respondents, for a 7.4% response rate. Among the respondents, 81.6% were male; 64.4% were training in combined MD degree-OMS certificate programs; and 31% reported having had exposure to the care of transgender people during their residency. On a scale from 1=neutral to 3=very important, the respondents' mean reported importance of receiving training in gender-affirming surgery was 1.37±0.94. Also, 37.9% reported that fellowship training should be offered in gender-affirming surgery, specifically facial feminization/masculinization. These results showed that the OMS residents had had limited exposure to the care of transgender people, but they perceived that such exposure should be an important component of their training. Further research is needed to collect results from a larger sample and to better understand the role of oral and maxillofacial surgeons in gender-affirmation surgery.

What is the role of nutrition counseling in the management of isolated mandible fractures?

OBJECTIVE: Providing perioperative nutrition counseling may improve operative outcomes. It is unclear, however, whether this benefit translates to oral and maxillofacial surgery patients. The purpose of this study was to measure the effect of nutrition counseling on operative outcomes and patient satisfaction in those undergoing surgery for mandible fractures. STUDY DESIGN: The investigators implemented a retrospective cohort study. The predictor variable was perioperative nutrition counseling by a registered dietitian (RD). The main outcome variables were weight change, postoperative complications, and results of a survey that evaluated the perioperative experience. RESULTS: Statistical analyses were conducted on a sample of 200 patients (mean age: 34 ± 14 years; 87% males). Overall, there was no difference in percent weight change between those who received nutrition counseling and those who did not (P = .46). Those who received nutrition counseling had fewer postoperative complications (3% vs 11%; adjusted P = .038). Patients who received nutrition counseling from an RD were more satisfied with the nutrition advice they received (P = .0375). CONCLUSIONS: The results suggest that perioperative nutrition counseling by an RD in the management of isolated mandible fractures has no effect on weight change but is associated with decreased postoperative complications and increased patient satisfaction with the nutrition advice they receive.