A Snapshot on Oral and Maxillofacial Surgery Resident Scholarly Activity: Can We Do Better?

BACKGROUND: The Commission on Dental Accreditation (CODA) requires oral and maxillofacial surgery (OMS) residents to engage in scholarly activity. Currently, it is unknown how this mandate translates into research output. PURPOSE: The purpose of this study was to quantify the research output of OMS residents. In addition, we sought to identify characteristics associated with resident productivity. STUDY DESIGN: This was a cross-sectional study of all OMS residents during the 2021-2022 academic year. Attempts were made to obtain resident rosters from every CODA-accredited OMS program. Resident names were searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) to identify peer-reviewed publications. Postgraduate year (PGY), program name, and total publication count during residency were recorded for each resident. Academic status and fellowship affiliation of the residency program were also included. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor was PGY level of each resident. MAIN OUTCOME VARIABLE: The main outcome variable was the publication count of each OMS resident during the 2021-2022 academic year. COVARIATES: The covariates were the academic status and the fellowship affiliation of the residency program. A program was determined academic if they were associated with a dental or medical school. A program was determined fellowship associated if they had any CODA approved fellowship. ANALYSES: Simple bivariate comparisons were performed using Wilcoxon signed-rank tests. RESULTS: Complete resident rosters were identified for 87 residency programs. One thousand one hundred thirty two residents were queried and a total of 548 peer-reviewed publications were identified. There was a mean of 6.30 publications per program and 0.43 publications per resident. More than half of all residents had no identifiable publication. PGY5 residents averaged the most publications per resident (1.45) followed by PGY6 (1.04) and PGY4 (0.63). Academic programs had significantly more publications per resident than nonacademic programs (median of 3.00 vs 0.00, P = .02). Programs with a fellowship association also had more publications per resident (median of 5.00 vs 2.00, P < .01). CONCLUSION: Current CODA research requirements do not translate into resident publications. Publication counts appeared to slightly increase with PGY level; however, OMS resident productivity still lags far behind that of other surgical subspecialties.

Enlargement of Inferior Alveolar Nerve Canal and Mental Neuropathy Associated With B-Cell Lymphoma: A Case Report and Literature Review.

Enlargement of an inferior alveolar nerve canal (IANC) on radiographic imaging can indicate the presence of a wide variety of pathologic entities. Oral and maxillofacial surgeons have the unique opportunity to regularly examine panoramic radiographs and must exercise proficient clinical judgment when noting abnormal findings on imaging. While malignant processes associated with IANC enlargement are uncommon, these pathologies do occur and may be associated with significant sequelae, especially when accompanied by a delay in diagnosis and in treatment. The purpose of this case report is to describe a case in which a patient presented with mental nerve neuropathy associated with unilateral IANC enlargement on radiography, which was found to be a B-cell lymphoma on biopsy. More importantly, we aim to remind oral and maxillofacial surgeons of this rare presentation of a malignant process so as to promote prompt recognition and referral for appropriate treatment.

Hygiene Recall in Diabetic and Nondiabetic Patients: A Periodic Prognostic Factor in the Protection Against Peri-Implantitis?

PURPOSE: Diabetes mellitus is associated with an increased risk of poor outcomes with dental implant placement. This study aims to identify if frequency of hygiene visits is a protective factor for the development of peri-implantitis in diabetic patients. METHODS: A retrospective cohort design was conducted on patients presenting for dental implant placement at the Philadelphia Veterans Affairs (VA) Medical Center from 2006 to 2012. The primary predictor variable was hygiene frequency, recorded as either infrequent, annual (7-12 month recall), or biannual (≤6-month recall). The number of months between implant placement and the presence of peri-implantitis was the primary outcome (time-to-peri-implantitis) variable, which was assessed on a subject level and adjusted for clustered, correlated multiple implants on the same subject. Additional variables were greater than or equal to 60 years of age, male gender, smokers, short implant length, diabetes, uncontrolled diabetes, and removable prostheses. Descriptive, univariate, and Cox proportional hazards regression statistics were computed to measure associations with peri-implantitis with P ≤ .05 used to define statistical significance. RESULTS: The study sample was composed of 286 patients. In total, 748 implants were placed. Subjects greater than or equal to 60 years of age were 2 times more likely to develop peri-implantitis (hazards ratio (HR) = 2.015, 95% Cl (0.985-4.119), P = .0549). Subjects receiving implant-supported removable prostheses were 2.3 times more likely to develop peri-implantitis (HR = 2.315, 95% CI (1.006-5.327), P = .0485). With each hygiene visit, patients' risk of developing peri-implantitis decreased 20% (HR = 0.805, 95% Cl (0.394-1.647), P = .5528). In addition, diabetic patients were 49% more likely to develop peri-implantitis (HR = 1.491, 95% CI (0.758-2.936), P = .2475) than nondiabetic patients. CONCLUSIONS: Diabetic patients may be at increased risk for the development of peri-implantitis and an increased frequency of hygiene visits may reduce peri-implant diseases.

Proceedings of the OMS COVID-19 Response Conference.

The coronavirus disease 2019 (COVID-19) pandemic has affected the world in unprecedented ways. It is clear that this pandemic, unlike any public health challenge in recent memory, has the potential to fundamentally alter the delivery of many healthcare services, including the practice of oral and maxillofacial surgery. In response to this global health crisis, the Oral and Maxillofacial Surgery (OMS) COVID-19 Response Conference was held virtually on April 9, 2020, organized by oral and maxillofacial surgeons (OMSs) and administrators from multiple institutions to provide a forum for OMSs to discuss how COVID-19 has affected the specialty. As evidence-based information on COVID-19 continues to emerge, the present report serves as a method to disseminate the current opinions and management strategies from a variety of experts in OMS.

Is Alcohol Consumption Associated With Protection Against Peri-Implantitis? A Retrospective Cohort Analysis.

PURPOSE: Recent studies have pointed to the effects of social factors on the health of dental implants. We investigated whether varying levels of alcohol consumption will influence the health of dental implants and associated peri-implant inflammation. PATIENTS AND METHODS: A retrospective cohort study was performed to evaluate implants placed from 2006 to 2012 at the Philadelphia Veteran's Affairs Medical Center. Alcohol consumption was gathered from the health maintenance records within 3 months of implant placement and served as the predictor variable. Analysis was performed at follow-up visits for the presence of the outcome variable, peri-implantitis, which was assessed at an implant level. A multivariable generalized estimating equation logistic regression model was constructed, and a Wald test was used to analyze the statistical significance of each parameter. The results were interpreted as an odds ratio estimate, including the 95% confidence interval. Descriptive statistics were used to compute and analyze the data, with P < .05 used to define statistical significance. RESULTS: Demographically, our cohort consisted mainly of male patients (92%), with an average age of 60 years at implant placement. The mean interval to peri-implantitis was 30 ± 25 months. Peri-implantitis occurred most frequently within 2 years of implant placement. The incidence of peri-implantitis was greatest among heavy alcohol consumers (42%) and lowest among mild and moderate consumers (12 and 6%, respectively). Compared with no consumption, mild alcohol consumption was associated with a 47% decrease in peri-implantitis (P < .0223) and moderate consumption was associated with a 75% decrease (P < .0250). Heavy consumption was associated with a nearly threefold increase in peri-implantitis (P < .0001). CONCLUSIONS: The results from our retrospective cohort analysis revealed that mild to moderate alcohol consumption is associated with a lower rate of peri-implantitis. However, heavy consumption was associated with an increase in the incidence of peri-implantitis among patients with dental implants.

Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe?

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

Massive Middle Cerebral Artery Infarction After Surgically Assisted Rapid Palatal Expansion: A Case Report.

Dentofacial deformities have a marked impact on a patient's quality of life. Fortunately, these deformities often can be corrected through orthodontic and surgical treatment. In adults, transverse maxillary discrepancies are often corrected by performing a surgically assisted rapid palatal expansion (SARPE) procedure. This procedure is accompanied by many of the same complications involved in performing a Le Fort I osteotomy. Although major complications from maxillary surgery are uncommon, severe hemorrhage and cerebrovascular accidents are real risks accompanied by serious sequelae. The purpose of this case report is to describe a case in which a patient developed a massive middle cerebral artery infarct after a SARPE procedure. The authors discuss the possible etiology and pathogenesis of the complication. They also aim to remind surgeons of this rare complication to ensure prompt recognition and management to prevent delays in care.

Mortality from an aspiration of dental crown during extraction.

An aspiration of a dental crown during a dental extraction requires appropriate and timely diagnosis and management. While foreign body aspiration in dental procedures is relatively uncommon, it constitutes a true medical emergency and is associated with significant morbidity and mortality. We report a case of mortality from a foreign body aspiration and discuss the epidemiology, risk factors, signs and symptoms, management, and prevention of foreign body ingestion and aspiration events.

Ameloblastic Fibro-Odontoma of the Maxilla in a Pierre-Robin Sequence Patient.

INTRODUCTION: Pierre Robin sequence (PRS) is a rare disorder classically observed as a triad of features including micrognathia, glossoptosis, and upper airway obstruction. It is associated with a syndrome in about 60% of cases. While odontogenic tumors are common findings in patients with familial adenomatous polyposis and nevoid basal cell carcinoma syndromes, PRS has not been found to be consistently associated with any tumors of the jaw. CASE REPORT: The current report aims to describe a patient with PRS who presented with an extensive ameloblastic fibro-odontoma (AFO) of the maxilla. CONCLUSION: Continued observation for odontogenic tumors in PRS is necessary.

Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre.

OBJECTIVE: This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. MATERIALS AND METHODS: Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. RESULTS: Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. CONCLUSION: MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. KEY POINTS: • MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy. • MRN has moderate-to-excellent correlation with intra-operative findings. • MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.

Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ?

OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.

Combined Transnasal, Transoral Excision of Odontogenic Cysts Offers Reduced Recurrence Rates and Favorable Sinonasal Outcomes.

Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches.