Point-of-Care Pregnancy Testing in Outpatient Sedation Anesthesia: Experience from an Urban Hospital-Based Oral and Maxillofacial Surgery Clinic.

PURPOSE: Pre-surgical point-of-care (POC) pregnancy testing in women of child-bearing age has become routine practice in hospitals across the United States. Its application in the ambulatory care setting is less ubiquitous. The authors herein present its application in their outpatient oral and maxillofacial surgery clinic, as implemented prior to procedures under intravenous sedation. METHODS: This study was implemented as a retrospective, single-center review of clinical records. The authors examined data from Bellevue Hospital Center's oral and maxillofacial surgery clinic for women of child-bearing age undergoing outpatient procedures performed under intravenous sedation during a 22 month time period. The review focused on POC urine human gonadotropin (hCG) results. A basic statistical analysis was performed on the data. Additionally, an examination of the associated costs of this testing was performed. RESULTS: The study included women between 12 and 50 years of age, of which there were 176. Five of the subjects (2.8%) were found to have an elevated hCG suggestive of pregnancy. The average age of those found to be pregnant was 22. All patients were originally scheduled for extraction of third molars. The cost of a single POC hCG test at the authors' institution was $2.00. The cost to identify a single pregnancy within the study period was found to be $70.40. CONCLUSION: In the authors' experience, POC hCG testing for women of childbearing age is easily integrated into a standardized pre-sedation workflow. Although the medications utilized for outpatient sedation procedures are generally considered safe for both mothers and developing fetuses, implementation of POC hCG testing allows for providers and patients to make more fully informed decisions regarding how to proceed with elective cases in the case of a previously undiagnosed pregnancy. Determination of pregnancy status prior to a procedure may prompt referral for appropriate prenatal care, while limiting surgeons' exposure to medicolegal liability. This study contributes to a small body of extant reports from ambulatory surgery centers and outpatient clinics offering IV sedation, offering providers a context in which to consider their own implementation of routine hCG testing.

What Are the Predictors of Craniomaxillofacial Injuries From Hoverboard Accidents?

PURPOSE: A hoverboard, or self-balancing scooter, is a battery-powered vehicle with 2 wheels connected by a longboard that requires handsfree operation. The purpose of the present study was to characterize the emergency department visits for hoverboard-related craniomaxillofacial trauma and determine predictors of injuries and hospital admission. MATERIALS AND METHODS: We performed a retrospective cohort study of the National Electronic Injury Surveillance System from 2015 to 2018. The database was searched using the codes for battery-powered vehicles and craniomaxillofacial body parts (ie, head, face, mouth, eyeball, ear). Entries with the term "hoverboard" in their narrative were included. The predictors were gender, age, body part, year, season, setting, and helmet wear. The outcomes were injury diagnoses (ie, dental injury, facial fracture, soft tissue injury, intracranial injury) and hospital admission. Associations between the predictors and outcomes were evaluated using χ2 and t tests. RESULTS: The final sample included 440 patients, of whom 51% were male and 74% were pediatric (age, ≤18 years). Pediatric and male patients were both less likely to wear helmets (P < .01). The injuries had most commonly occurred in the winter (38%) and in a home setting (77%). Facial fractures were more likely in adults (P = .03) and in the summer (P = .04). The overall admission rate was 4.3%. The admission rates were greater for those with facial fractures (P = .02) and intracranial injuries (P = .03) but lower for those with soft tissue injuries (P < .01). Street injuries resulted in a greater admission rate compared with home injuries (P = .01). CONCLUSIONS: Craniomaxillofacial injuries from hoverboard accidents have resulted in emergency department visits and hospital admissions since the vehicle's introduction to the consumer market in 2015. Most cases occurred in the winter, which might reflect increased sales and novice riders during the holiday season. Injuries to adults, in the summer or outdoors, appear to be more severe. Intracranial injuries were the most frequent diagnosis; thus, helmet wear is recommended.

Current Status of Instagram Utilization by Oral and Maxillofacial Surgery Residency Programs: A Comparison With Related Dental and Surgical Specialties.

PURPOSE: The utility of social media in oral and maxillofacial surgery (OMS) residency programs has never been investigated, despite the increasing popularity of such platforms in academic medicine. As a specialty that strives for constant innovation, it is important for OMS programs to participate in the emerging concept of incorporating social media into medical and surgical education. Therefore, this study aimed to evaluate the use of Instagram in OMS residency programs in the United States. METHODS: A cross-sectional study of Instagram search data was performed. The Instagram accounts of OMS residency programs were searched, and their metrics were retrieved from June 1 to June 5, 2020. Factors correlated with the total number of followers were identified. The use of Instagram in OMS residency programs was compared with that in other related dental and surgical residency programs. RESULTS: Only 17 (18.7%) of 91 OMS residency programs had an Instagram account. The number of programs with Instagram accounts exhibited linear growth (R2 = 0.98) since December 2018. The median number of followers was 326 (range, 94 to 2,152), and the median number of posts was 9 (range, 2 to 40). The number of Instagram followers was positively correlated with the number of accounts followed, the number of total posts, and the number of educational posts, and it was negatively correlated with the Instagram engagement rate. Instagram presence did not differ among residency programs for orthodontics (18.2%), periodontics (5.5%), and OMS (P = .067). However, Instagram presence in OMS residency programs was significantly lower than that in plastic surgery (74.7%; P < .001) and otolaryngology residency programs (35.0%; P = .011). CONCLUSIONS: Instagram use in OMS residency programs is growing but is significantly lower than that in related surgical fields. This may represent a missed opportunity for promoting collaboration and efficiently delivering useful information to trainees.

Are Motorized Scooters Associated With More Severe Craniomaxillofacial Injuries?

PURPOSE: The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. MATERIALS AND METHODS: This is a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in this study if they involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. RESULTS: A total of 11,916 records were included in the present study, of which 9.5% involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooter injuries had more than triple the admission rate compared to nonmotorized injuries (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double the odds of hospital admission (odds ratio, 2.03; P < .01). CONCLUSIONS: Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters may pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.

Outcomes of Clinical Trials on Osteonecrosis of the Jaw.

OBJECTIVE: The purpose of this study was to provide a cross-sectional view of all registered clinical trials enrolling patients with osteonecrosis of the jaw (ONJ). The primary aim was to report predictors of trial completion and publication of results. MATERIALS AND METHODS: This is a cross-sectional study of ONJ trials registered with ClinicalTrials.gov. For each included entry, trial characteristics and endpoints were recorded. Predictors were enrollment size, etiology, study type, intervention type, sponsor, funding, study locations, number of centers, and specialty of the principal investigator. Outcomes were trial status, publication on PubMed, journal of publication, and length of time between endpoints. Associations between predictors and outcomes were evaluated using chi-square tests and t-tests. RESULTS: The final sample included 26 trials. Overall, 50% of trials were completed and 69% of completed trials were published. Three out of four terminated trials were suspended due to lack of funding. The median enrollment for completed trials was 149 participants with a mean length of five years. All trials included medication-related osteonecrosis of the jaw (MRONJ) patients and 26% also included osteoradionecrosis of the jaw (ORNJ) patients. The majority of trials were observational (65%), conducted internationally (62%), and involved multiple centers (54%). Published trials had a mean time of 5.9 years between trial start and publication, which was comparable to trial length (p=0.90) and appeared in either dental (44%) or cancer (56%) journals. Completion and publication rates were not significantly increased by industry sponsorship/funding, larger enrollment sizes, or multi-center involvement. Oral and maxillofacial surgery was the most represented dental specialty of principal investigators (56%). CONCLUSIONS: The majority of completed ONJ trials had their results published in a timely manner. Evidence-based investigation of ONJ is a multi-disciplinary and international effort. Among all specialists, oral and maxillofacial surgeons led the most ONJ trials.

The recognition, physiology, and treatment of medication-induced methemoglobinemia: a case report.

Dapsone is a leprostatic agent commonly prescribed for the management of leprosy, malaria, and the immunosuppression-induced infections of Pneumocystis carinii and Toxoplasma gondii. In susceptible patients, methemoglobinemia, a potentially life-threatening event, can occur. We report a case of dapsone-induced methemoglobinemia which was observed during general anesthesia for the management of a fractured mandible. The pathophysiology, diagnosis, and management of dapsone-induced methemoglobinemia will be discussed.

Eating disorders in the female patient: pathophysiology and treatment strategies.

Eating disorders are common in girls and women. Two common eating disorders--anorexia nervosa and bulimia nervosa--have significant medical complications. Oral and maxillofacial surgeons must be cognizant of the signs, symptoms, and medical consequences of these disorders. The increased incidence of these diseases has implications in the surgical management the oral and maxillofacial surgery patient. A review of the literature and guidelines in the perioperative management of these surgical patients are presented in this article.

Pediatric Benign Soft Tissue Oral and Maxillofacial Pathology.

Despite the many types of oral pathologic lesions found in infants and children, the most commonly encountered are benign soft tissue lesions. The clinical features, diagnostic criteria, and treatment algorithms of pathologies in the age group from birth to 18 years of age are summarized based on their prevalence in each given age distribution. Treatment modalities include both medical and surgical management.

Management of the aging forehead: a review.

Aging in the upper third of the face manifests as rhytids and ptosis of the frontal, glabellar, and brow regions. Frown lines may occur even in younger individuals as a result of habitual or dynamic forehead muscular hyperactivity. Multiple treatment options have been advocated to address forehead rhytids and brow ptosis. This article reviews 3 of the more commonly used treatment options: collagen, botulinum toxin, and surgical forehead lifting. Additionally, an algorithm is proposed as a guideline for selecting the most appropriate option for a given condition.

Diagnosis and management of pediatric salivary gland infections.

The incidence of salivary gland infections in the pediatric population is low but not infrequently seen in pediatric oral and maxillofacial surgery practices and hospital environs. With an ever increasing armamentarium of diagnostic tools and medical and surgical therapies, these patients can be managed successfully with minimum morbidity and decreased incidence of recurrences.

Mandibular fracture as a complication of inferior alveolar nerve transposition and placement of endosseous implants: a case report.

Placement of endosseous implants and inferior alveolar nerve transposition is a treatment option for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. Complications associated with these procedures include infection, prolonged neurosensory disturbances, and/or pathologic fracture. This report presents the surgical management of a patient with a mandible fracture after inferior alveolar nerve transposition with concurrent placement of two endosseous implants.