Trends in mandibular fractures in the USA: A 20-year retrospective analysis.

BACKGROUND/AIM: The mandible is one of the most fractured bones in the maxillofacial region. This study analyzes trends in mandibular fracture patterns, demographics, and mechanisms since the early 2000s. MATERIAL AND METHODS: Mandibular fractures were reviewed from the 2007, 2011, and 2017 National Trauma Data Bank including 13,142, 17,057, and 20,391 patients by year, respectively. This database contains hundreds of thousands of patients annually and represents the largest trauma registry in the United States. Variables included number of fractures, sex, age, injury mechanism, and fracture location. Mechanism of injury included assault, motor vehicle crash, fall, motorcycle, bicycle, pedestrian, and firearm. Anatomic locations based on ICD-9/10 codes included symphysis, ramus, condyle, condylar process, body, angle, and coronoid process. Frequencies were compared using Chi-square tests of homogeneity with effect sizes estimated using Cramer's V. RESULTS: Mandibular fractures represent 2%-2.5% of all traumas reported in the database from 2001 to 2017. The proportion of patients sustaining a single reported mandibular fracture decreased from 82% in 2007 to 63% in 2017. Males consistently experienced 78%-80% of fractures. Eighteen to 54-year-olds experienced the largest percentages of fractures throughout the 21st century, while median age of fracture shifted from 28 to 32 between 2007 and 2017. The most common fracture mechanisms were assault (42% [2001-2005]-37% [2017]), motor vehicle crash (31%-22%) followed by falls (15%-20%). From 2001-2005 to 2017, a decrease was observed in assaults (-5%) and motor vehicle crash (-9%) and an increase in falls (+5%), particularly among elderly females. The mandibular body, condyle, angle, and symphysis represent approximately two-thirds of all fractures without a consistent temporal trend among them. CONCLUSIONS: The temporal trends observed can be linked to shifting age demographics nationally that may aid clinicians in diagnosis and inform public safety policies aimed at reducing these injuries, particularly among the growing elderly population.

The Role of Nasal Sill Correction in Secondary Cleft Rhinoplasty.

BACKGROUND: Evaluating outcomes after cleft rhinoplasty can be challenging because of the lack of objective measures that would lead to a more desirable outcome. METHODS: This study is a 10-year retrospective review of 30 consecutive patients who underwent secondary unilateral cleft rhinoplasty performed by a single surgeon. Subjective ratings were made using the Unilateral Cleft Lip Surgical Outcomes Evaluation (UCL SOE), which rates 4 components (nose, cupid's bow, lateral lip, and free vermillion) with a score of 0 to 2. Multiple anthropometric measurements (nostril height ratio, width ratio, medial » height ratio, sill ratio, nostril area ratio, columellar angle, tip projection ratio, and nasolabial angle) were taken using a free National Institutes of Health program, ImageJ. Standardized photographs were compared at T0 (preoperatively), T1 (<6 weeks postoperatively), and T2 (>6 weeks postoperatively). RESULTS: There were 30 patients who met our inclusion criteria: 10 males (66.7%) and 20 females (66.7%). Of these patients, 26 (86.7%) had a complete cleft lip and 4 (13.3%) had an incomplete cleft lip. The patients' average age at time of surgery was 16.2 years with a mean follow-up of 17.9 months. Subjective scores in both nasal and overall UCL SOE ratings improved from T0 to T1, 0.7 to 1.2 (P ≤ 0.001) and 3.6 to 4.7 (P ≤ 0.001), respectively. Visual analog scores in nasal and overall UCL SOE ratings improved between T0 and T2, 0.7 to 0.9 (P = 0.023) and 3.6 to 4.8 (P = 0.002), respectively. Of all the objective measures, nasal sill ratio and cleft height to width ratio correlated with improved subjective ratings across multiple time points. CONCLUSIONS: Our study shows that objective measures such as nasal sill and nostril shape (cleft height to width ratio) correlate with improved subjective visual analog scale using the UCL SOE. The nasal sill is an often overlooked, yet essential, part of creating an aesthetically pleasing nose during cleft rhinoplasty.

Intraoperative Frozen Section Analysis for the Excision of Nonmelanoma Skin Cancer: A Single-Center Experience.

Surgical resection of nonmelanoma skin cancer (NMSC) may be performed via Mohs micrographic surgery (MMS) or standard surgical excision with complete margin analysis. Whereas MMS may necessitate delayed reconstruction surgery, intraoperative frozen section analysis (IFSA) may be used to ensure clear surgical margins before proceeding with reconstruction. To achieve curative resection while optimizing aesthetic outcomes, surgeons may use surgical excision guided by IFSA to forego extensive or delayed reconstruction. Patients undergoing wide local excision for NMSC using IFSA from October 2008 to November 2016 were evaluated. Analysis included IFSA versus permanent section outcomes, the number of required excisions, and the recurrence rate. Our analysis contained 145 patients involving 162 lesions. IFSA demonstrated that 73.4 per cent of margins were negative after one excision and 26.5 per cent were re-excised until achieving negative margins. Analysis revealed one false-positive case (0.62%) and four false-negative cases (2.47%). Nine patients had local recurrence (5.56%). Frozen section sensitivity was 88.99 per cent and specificity 99.20 per cent. The positive predictive value was 96.97 per cent, and negative predictive value was 96.90 per cent. Mean follow-up time was 39 months. Both resection and recurrence data of excised NMSC lesions at our institution suggest that surgical excision using IFSA is a safe and effective alternative to MMS.

The external gate of the human and Drosophila serotonin transporters requires a basic/acidic amino acid pair for 3,4-methylenedioxymethamphetamine (MDMA) translocation and the induction of substrate efflux.

The substituted amphetamine, 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy), is a widely used drug of abuse that induces non-exocytotic release of serotonin, dopamine, and norepinephrine through their cognate transporters as well as blocking the reuptake of neurotransmitter by the same transporters. The resulting dramatic increase in volume transmission and signal duration of neurotransmitters leads to psychotropic, stimulant, and entactogenic effects. The mechanism by which amphetamines drive reverse transport of the monoamines remains largely enigmatic, however, promising outcomes for the therapeutic utility of MDMA for post-traumatic stress disorder and the long-time use of the dopaminergic and noradrenergic-directed amphetamines in treatment of attention-deficit hyperactivity disorder and narcolepsy increases the importance of understanding this phenomenon. Previously, we identified functional differences between the human and Drosophila melanogaster serotonin transporters (hSERT and dSERT, respectively) revealing that MDMA is an effective substrate for hSERT but not dSERT even though serotonin is a potent substrate for both transporters. Chimeric dSERT/hSERT transporters revealed that the molecular components necessary for recognition of MDMA as a substrate was linked to regions of the protein flanking transmembrane domains (TM) V through IX. Here, we performed species-scanning mutagenesis of hSERT, dSERT and C. elegans SERT (ceSERT) along with biochemical and electrophysiological analysis and identified a single amino acid in TM10 (Glu394, hSERT; Asn484, dSERT, Asp517, ceSERT) that is primarily responsible for the differences in MDMA recognition. Our findings reveal that an acidic residue is necessary at this position for MDMA recognition as a substrate and serotonin releaser.