Is Weekend Presentation Associated With Odontogenic Infection Severity?

PURPOSE: Many dental infections that otherwise could be treated in-office are directly referred to emergency departments (ED) outside of normal business hours. This study sought to determine if odontogenic infections presenting to EDs were less severe on the weekends. MATERIALS AND METHODS: This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of an oral soft tissue infection were included in the study sample. The primary study predictor was day of presentation. The study outcome was inpatient admission from the ED. A multivariate regression model was created for ED admission rate to identify independent predictors. RESULTS: A total of 6,560 records were included in the final sample. Overall, 34.8% of encounters occurred on the weekend, and these patients were more likely to have private insurance and reside in higher income locations. The unadjusted ED admission rate (9.4 vs 13.4%, P < .01) was lower for patients evaluated on the weekend. The multiple regression model confirmed that weekend presentation was associated with a significantly lower odds of admission (OR = 0.69, P < .01). CONCLUSIONS: Weekend odontogenic infections were less severe than those presenting on the weekdays. Off-hour dental emergencies remain a potential source of ED waste and should be scrutinized in any reforms seeking to reduce unnecessary emergency room encounters.

The Past Decade in Courts, What Oral-Maxillofacial Surgery Should Know About Facial Cosmetic Surgery.

PURPOSE: The primary objective of this study was to examine medical malpractice in facial cosmetic surgery procedures to characterize factors that determine legal liability and help make the oral-maxillofacial surgeon (OMS) more comfortable with treating this patient population. METHODS: The Thomson Reuters Westlaw Edge is a subscription-based legal database that contains decisional law and other data from a variety of state and federal court records. The database was queried for medical malpractice cases involving facial surgical cosmetic procedures from 2010 to 2020. RESULTS: A total of 763 malpractice cases were identified through the search. After removing duplicates, 758 malpractice cases were hand reviewed based on inclusion/exclusion criteria. A total of 55 cases met criteria for inclusion. Verdict decisions and settlements occurred in the years of 2010 to 2019. Of those 55 cases, the highest concentration of cases occurred in New York (14), California (10) and Pennsylvania (6). Seventy-four percent of the verdicts were in favor of the defendant, 4% of cases settled and 22% of cases were decided in favor of the plaintiff. The minimum award of damages was $8,597.71 with the maximum of $4,150,000.00 (mean: $72,1915.69 ± $1,131,245.94). The provider's primary specialty was most often plastic and reconstructive surgery (84%), followed by ophthalmology (7%), dermatology (3%) and ENT (4%). CONCLUSION: While it is comforting to know that 74% of malpractice cases in the last decade were found in favor of the surgeon, it is important to realize how devastating the litigation experience can be for a medical practitioner. The best defense to a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal.

Complications and Litigation Associated With Injectable Facial Fillers: A Cross-Sectional Study.

PURPOSE: Soft-tissue injectable fillers are a popular treatment option for patients seeking minimally invasive facial rejuvenation. The use of soft-tissue fillers has increased significantly in the past 10 years. In 2017 alone, clinicians administered nearly 2.7 million soft-tissue fillers, up from 1.3 million in 2007. Although injectable fillers have a relatively high safety profile compared with more invasive rejuvenation procedures, serious adverse events, including intra-arterial injections, necrosis, and visual symptoms such as blindness, have been documented. Complications from injectable fillers have also been a source of litigation, which has been shown to be associated with a perceived lack of informed consent. We sought to document the reported complication rates associated with injectable facial fillers from a national database and to report on the available cases of malpractice litigation. MATERIALS AND METHODS: The US Food and Drug Administration's Manufacturer and User Facility Device Experience database was used to collect the reported complications from 2013 to 2017 for the following injectable fillers: Artefill, Bellafill, Belotero, Juvederm, Radiesse, Restylane, Sculptra, and Kybella. Complications were organized by filler type, injection location, and complication type. The Thomson Reuters Westlaw Edge database was used to collect the reported jury verdicts and settlements from 2008 to 2017 for injectable facial fillers. RESULTS: A total of 2813 adverse events were analyzed. The most common locations for complications were the cheek (915 [32.5%]), lips (503 [17.9%]), and nasolabial fold (412 [14.6%]). The commonly reported adverse events were swelling (1,691 [60.1%]), nodule (948 [33.7%]), and pain (636 [22.6%]). Severe complications included intra-arterial injections resulting in necrosis and visual symptoms (eg, blurred vision and blindness). Forehead and dorsal nasal injections were significantly associated with intra-arterial complications resulting in necrosis and visual symptoms (P < .01). Injections with Radiesse were significantly associated with intra-arterial injections resulting in necrosis and visual symptoms (P < .01). A total of 11 malpractice cases were analyzed. The median award in the cases resolved by a verdict in favor of the plaintiff or settlement was $600,000. In 10 of the 11 cases, a lack of informed consent had been alleged. CONCLUSIONS: The complications associated with injectable facial fillers varied greatly, depending on factors involved with their application. The most common adverse effects were swelling, nodule formation, and pain. Serious complications stemming from intra-arterial injections included necrosis and visual disturbances, including blindness. These complications have been raised in legal cases, in which the lack of informed consent was frequently alleged. The present analysis has documented some of the potential risks involved with injectable facial fillers and demonstrated the need for a thorough informed consent process before their administration.

Masticatory efficiency of implant-supported mandibular overdentures retained with attachments compared with conventional dentures: an in vitro digital colorimetric image analysis.

Despite the patient-reported advantages of implants in improving quality of life, satisfaction, and mastication, objective evaluations of the masticatory function and performance of implant-supported dentures are not well represented in the literature. The aim of the present study was to compare the masticatory efficiency of patients with conventional dentures with that of patients with mandibular overdentures retained by implants with 2 Locator attachments. A randomized clinical trial including 20 edentulous patients was conducted. The participants were randomly recruited into 2 groups, a group of 10 patients wearing conventional prostheses in both the maxilla and mandible, and a group of 10 patients wearing a conventional maxillary prosthesis opposite an implant-supported overdenture. To be included in the study, the patients had to have a well-formed ridge (Class I according to the Atwood classification). Their masticatory efficiency, assessed a minimum of 6 months after they received the denture, was evaluated through a color-mixing test using 2 colors of a commercially available chewing gum and ViewGum software, which calculated the variance of hue in the masticated specimens. The masticatory efficiency of the 2 groups was compared using repeated-measures analysis of variance (α = 0.05), which revealed no statistically significant difference between the implant-supported overdenture and conventional denture groups (P > 0.05). Within the limits of this study, the results suggest that a mandibular implant overdenture has no advantage over a conventional complete denture with regard to masticatory efficiency or food comminution in patients who have a well-formed mandibular ridge.

Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions.

Pemetrexed (Alimta®) is a novel anti-folate antimetabolite agent that is used in combination with cisplatin for the treatment of patients with unresectable malignant pleural mesothelioma and as a single agent or in combination with cisplatin for patients with locally advanced or metastatic non-small-cell-lung-cancer. Cutaneous adverse reactions are common side effects of pemetrexed for which the manufacturer recommends 3-day premedication with dexamethasone 4 mg by mouth twice daily-(the day before, the day of, and the day after treatment). Patients' adherence to this premedication regimen is of concern. We report 14 cases of metastatic non-small-cell-lung-cancer patients who were premedicated with a single dose of dexamethasone 20 mg prior to pemetrexed or pemetrexed-based chemotherapy. None of these patients reported a grade 3 or above skin reactions over the course of their treatments. These findings suggest that a single dose of dexamethasone 20 mg may be an alternative premedication regimen in patients with metastatic non small cell lung cancer receiving pemetrexed or pemetrexed-based chemotherapy.

An Overview of Vascular Adverse Events Associated With Facial Soft Tissue Fillers: Recognition, Prevention, and Treatment.

Minimally invasive facial cosmetic surgery procedures have seen an exponential increase in numbers over the past decade. The most commonly performed procedures are neuromodulator and soft tissue filler procedures. Although soft tissue fillers have a high safety and predictability profile, these procedures recently have been associated with serious and dire adverse events. This article will discuss some of the vascular complications associated with facial soft tissue fillers. Management and prevention of these adverse events also will be discussed.

Maxillary sinus augmentation with autogenous tibial bone graft as an in-office procedure.

This retrospective study evaluates the efficacy of maxillary sinus grafting using autologous tibial bone in an outpatient setting. Twenty-seven patients undergoing lateral proximal tibial bone graft with subsequent sinus lifts were involved in this study. All surgeries were performed by the same surgeon in a private practice setting. A total of 28 tibial bone grafts and sinus lifts were performed on 27 patients. All subjects had minimal morbidity without any major complications. At the 1-year follow-up all implants that were placed into the grafted sites maintained stability, and no implants were lost. Two patients complained of hypertrophic scars at the site of bone harvesting (7.4%). One patient complained of leg pain for 10 weeks after the procedure, which resolved completely (2.7%). Overall complication rate was 10.1%. We conclude that the surgical harvesting of proximal tibial bone is associated with a low incidence of overall complications, mild postoperative pain, relative ease of harvest, minimal operative time, immediate ambulation, and rapid recovery, which make it an ideal office procedure when a significant amount of corticocancellous bone is required for maxillary sinus grafting.

Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions.

OBJECTIVE: In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management. METHODS: This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions. RESULTS: The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05). CONCLUSION: There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.

Grafting in Modern Rhinoplasty.

Rhinoplasty is considered one of the most technically difficult surgical procedures because of the limited access and requirement for three-dimensional visual perception and manipulation. Grafting is an essential part of primary and secondary rhinoplasties and forms the foundation for a successful functional and aesthetic outcome. Septal cartilage is the most commonly used grafting material, although many reliable alternatives exist. No randomized clinical trials have been conducted comparing graft materials and techniques for specific indications. In this review, the authors discuss the most common grafting materials and configurations used in the modern rhinoplasty.

Polyethylene glycol antiglobulin tube versus gel microcolumn: influence on the incidence of delayed hemolytic transfusion reactions and delayed serologic transfusion reactions.

BACKGROUND: Our institution has reported on delayed hemolytic transfusion reaction (DHTR) and delayed serologic transfusion reaction (DSTR) incidence changes. From January 1993 to June 2003, a polyethylene glycol (PEG) tube-based technique was used for red blood cell (RBC) antibody screen. In June 2003, a gel microcolumn technique was implemented. Impact of this on antibody detection and DHTR and DSTR incidence was investigated. STUDY DESIGN AND METHODS: Positive antibody screen frequency and antibody specificity from January 2002 to March 2003 and July 2003 to September 2004 were compared. Overall incidence of DHTR and DSTR as well as the number and identity of the RBC antibodies implicated from August 1999 through June 2003 (PEG) and July 2003 through July 2007 (gel) were compared. The mean length of hospital stay (LOS) and number of RBC units transfused per patient were compared. RESULTS: Equivalent numbers of antibody screens were performed with equivalent numbers of positive screens. Significant differences were not seen in the detection of clinically significant antibodies but significantly fewer clinically insignificant antibodies were detected with gel. Ninety-six DHTRs and DSTRs were diagnosed. The LOS and number of transfused RBC units were not statistically different. A significantly higher incidence of DHTRs and DSTRs was seen with PEG compared to the gel. CONCLUSION: The gel microcolumn method is similar to the PEG in detecting clinically significant antibodies but detects fewer clinically insignificant antibodies. The implementation of gel resulted in a lower incidence of DHTRs and DSTRs compared to PEG.

Squamous cell carcinoma arising within a maxillary odontogenic keratocyst: A rare occurrence.

Squamous cell carcinoma (SCC) arising within the lining of an odontogenic keratocyst (OKC) is a rare occurrence. Although potentially locally destructive, OKC is a benign odontogenic process that typically presents with clinical and radiographic features characteristic of a benign intraosseous neoplasm. We present the clinical and radiographic features of a maxillary mass that demonstrated SCC arising from the lining of an OKC. Although the initial clinical and radiographic presentation suggested an infection or malignant neoplasm, biopsies revealed an infiltrative well-differentiated SCC contiguous with and arising from the focus of a pre-existing OKC. The patient subsequently underwent a type II hemi-maxillectomy with neoadjuvant chemoradiation. This report discusses the clinical and radiographic features associated with intraosseous malignancies, especially those arising from an otherwise benign odontogenic lesion. While the majority of OKCs are benign, the current report illustrates the potential for carcinomatous transformation within the lining of an OKC.