Mechanisms of dental injuries in basketball, United States, 2003-2022.

BACKGROUND/AIM: Oral injuries such as oral soft tissue lacerations and contusions can occur in basketball by mechanisms such as running into other players or falling. Given a high enough impact force, dental injuries such as tooth fractures and avulsions can occur. Previous research has studied the different types of oral injuries as well as the mechanisms that cause them. Yet, the mechanisms resulting in dental injuries have remained unexplored. The aims of this study were to investigate the distribution of different oral injuries within each injury mechanism and evaluate which mechanisms were most likely to lead to a dental injury. MATERIALS AND METHODS: This is a retrospective cohort study using the National Electronic Injury Surveillance System (NEISS). Subjects who experienced oral injuries from basketball between January 1, 2003 and December 31, 2022 were included in this study. The independent variable was the injury mechanism. The dependent variable was the dental injury outcome (yes/no). Multivariate logistic regression was used to measure the association between the injury mechanism and the dental injury outcome. A p < .05 was considered statistically significant. RESULTS: This study included 4419 subjects who experienced oral injuries (national estimate, 138,980). Approximately 14.7% of oral injuries were dental injuries. Subjects experiencing collisions with objects such as walls or the basketball hoop (odds ratio (OR), 4.39; p < .001), falls (OR, 3.35; p < .001), or contact with the basketball (OR, 1.77; p = .006) had significantly higher odds of sustaining a dental injury relative to those experiencing contact with another player. CONCLUSIONS: Basketball players experiencing contact to the mouth have high odds of sustaining a dental injury. An understanding of injury mechanisms is important for medical teams to manage these injuries and for coaches to educate athletes on safe and proper playing styles. Furthermore, healthcare providers and basketball staff should encourage athletes to wear mouthguards to reduce the risk of traumatic dental injuries.

THE COMBINATION OF ORAL VALACYCLOVIR WITH TOPICAL CLOBETASOL THERAPY WAS THE MOST EFFECTIVE IN REDUCING THE TIME TO HEAL FROM HERPES LABIALIS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Koe KH, Veettil SK, Maharajan MK, Syeed MS, Nair AB, Gopinath D. comparative efficacy of antiviral agents for prevention and management of herpes labialis: A systematic review and network meta-analysis. J Evid Based Dent Pract. 2023 Mar; 23(1):101778. doi: 10.1016/j.jebdp.2022.101778. Epub 2022 Sep 14. PMID: 36914303. SOURCE OF FUNDING: None. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Trends in Soccer-Related Craniomaxillofacial Injuries, United States 2003-2022.

BACKGROUND: Soccer is one of the most popular sports worldwide. However, it has risks of injury to craniomaxillofacial regions such as the head, neck, and mouth. PURPOSE: The purpose of this study is to determine which demographic and injury characteristics among soccer players with craniomaxillofacial injuries are associated with increased hospitalizations. STUDY DESIGN, SETTING, AND SAMPLE: This is a retrospective cohort study utilizing the National Electronic Injury Surveillance System. Subjects included in this study experienced an injury to a craniomaxillofacial area from soccer between January 1, 2003, and December 31, 2022. PREDICTOR VARIABLE: The predictor variables included demographics (age, sex, race) and injury characteristics (craniomaxillofacial region, diagnosis). MAIN OUTCOME VARIABLE: The primary outcome variable was injury severity defined as hospitalization outcome after injury (yes/no). The secondary outcome variable was the trends in the incidence of soccer craniomaxillofacial injuries over time (2003-2022). COVARIATES: The covariates were the heterogenous set of predictor variables in this study. ANALYSES: Descriptive statistics and univariate analyses were computed. Survey-weighted univariate and multivariate logistic regression were used to measure the association of demographic and injury variables with hospitalization outcome. Statistical significance was defined as P < .05. RESULTS: The study sample included 26,642 subjects (national estimate, 799,393). The national incidence of craniomaxillofacial soccer injuries generally increased between 2003 and 2012 and decreased between 2016 and 2020. Subjects in the ≥30 age group had increased odds of hospitalization compared to those in the 10-19 age group (odds ratio [OR], 2.12; P < .001). Compared to females, males had significantly higher odds of hospitalization (OR, 1.53; P < .001). Head (OR, 8.42; P < .001) and neck (OR, 15.8; P < .001) injuries had increased odds of hospitalization compared to facial injuries. Relative to contusions/abrasions, subjects with fractures (OR, 94.7; P < .001), dental injuries (OR, 41.3; P < .001), and concussions (OR, 5.33; P = .017) were at significantly higher odds of hospitalization. CONCLUSION AND RELEVANCE: Age, sex, craniomaxillofacial region, and diagnosis were significant predictors of hospitalization outcome after craniomaxillofacial soccer injury. Safer playing styles, use of mouthguards, and proper medical management may reduce future risks of craniomaxillofacial injury from soccer.

What are the Soft Tissue Risk Factors for Obstructive Sleep Apnea in Patients with Down's Syndrome?

OBJECTIVE: To determine the risk factors and their respective magnitudes for developing Obstructive Sleep Apnea (OSA) in Down syndrome (DS) patients. DESIGN: Retrospective cohort study. PATIENTS: The 2016 Kids' Inpatient Database (KID) was queried to identify all patients diagnosed with DS. MAIN OUTCOME MEASURES: The primary predictor variables were tonsillar hypertrophy (TH), adenoidal hypertrophy (AH), Hypertrophy of Tonsils & Adenoids (HTA), Laryngeal Stenosis (LS), Hypotonia, Glossoptosis, Congenital Laryngomalacia (CL), and Overweight & Obesity (OO). The primary outcome variable was OSA. RESULTS: The final sample consisted of 18,181 patients with a diagnosis of DS. Relative to patients aged 0-5, patients aged 6-10 (OR 3.5, P < 0.01), 11-5 (OR 3.4, P < 0.01), and 16 & above (OR 3.6, P < 0.01) were each independently associated with increased odds of OSA. Further, TH (OR 23.2, P < 0.01), AH (OR 20.3, P < 0.01), HTA (OR 64.2, P < 0.01), glossoptosis (OR 5.0, P < 0.01), CL (OR 4.3, P < 0.01), and OO (OR 3.7, P < 0.01) were all independent risk factors for OSA. CONCLUSIONS: The presence of hypertrophied tonsils and adenoids together was the strongest risk factor for OSA. DS patients aged six and above were at risk for OSA development relative to younger patients. Patients with DS should be tested for OSA, which otherwise will deteriorate their existing comorbidities.

What Are the Risk Factors of Incurring Maxillofacial Fractures From Unarmed Hand-To-Hand Combat?

PURPOSE: The purpose of our study was to determine the risk factors of incurring maxillofacial fractures among individuals who engage in unarmed hand-to-hand combat. METHODS: The following retrospective cohort study was completed using data from the Nationwide Inpatient Sample. The primary predictor variable was blood alcohol level. The primary outcome variable was maxillofacial fracture. We used SPSS to conduct all statistical analyses. RESULTS: Our final sample consisted of 9,441 patients injured from unarmed hand-to-hand combat. The mean age of the sample was 38.7 years. The most common age group was young adults (42.9%), followed closely by middle-aged adults (41.9%). The number of males was nearly 4 times that of females. The mandible was the most frequently fractured maxillofacial bone. Concerning the mandible per se, the angle (37.1%) was the most frequently fractured site, while the coronoid process (0.2%) was the least frequently fractured site. Relative to females, males were 2.7 times more likely to incur a craniomaxillofacial fracture (P < .5). CONCLUSIONS: Males had an increased risk of maxillofacial fracture relative to females. The mandible, particularly the angle, was the most frequently fractured maxillofacial bone. We speculate this is because hooks are frequently thrown in unarmed hand-to-hand combat.

Open Repair Versus Closed Repair: A Cost-Analysis of the Two Surgical Approaches for the Treatment of Craniosynostoses.

PURPOSE: The purpose of this study was to quantify the hospitalization charges of the 2 general surgical approaches in the treatment of craniosynostosis and determine if there was a significant difference between the 2. Several studies compared them side-by-side according to specific variables, such as success rates, postoperative complications, blood loss, and length of stay, but were limited by small sample sizes. METHODS: This is a retrospective cohort study that was conducted using the Kids' Inpatient Database (KID). All patients diagnosed with craniosynostosis (Q75.0) were identified. The procedures were grouped according to the approach taken, whether it was a traditional, open approach, or a closed, minimally invasive approach. The primary predictor variable was the surgical approach (open vs closed). The outcome variables were the hospital charges (US dollars) and length of stay (days). Statistical analyses were based on the univariate and multivariate linear regression models, and P value less than .05 marked the significance level. RESULTS: Among a sample of 2,585 cases, an open approach was employed in 2,353 cases and a closed approach in 232 cases. Race, payer information, hospital region, admission status (elective vs not elective), patient location, and surgical approach (open vs closed) were all significant predictors (P < .15) of increased hospitalization charges. Relative to white patients, being in the 'other' racial class added $10,987 in hospital charges (P < .05). Relative to the Northeast, being a patient in the West added $33,459 in hospital charges (P < .01). Not being admitted electively added $72,572 (P < .01) relative to elective admissions. Finally, open repair added $59,539 (P < .01) in charges relative to closed repair. CONCLUSIONS: The traditional open approach added nearly $60,000 to the cost of the procedure when compared with the closed, endoscopic approach. The scope and invasiveness of the open approach demand greater surgical services, hospital services, supplies, and equipment, ultimately contributing to this increased cost.

Does Total Parotidectomy Improve Survival Over Partial Parotidectomy in Early-Stage Adenoid Cystic Carcinoma of the Parotid Gland?

PURPOSE: The decision to perform a partial or total parotidectomy in localized high-grade parotid cancer is often a matter of debate in the absence of a deep lobe disease. The purpose of this study was to compare survival between patients submitted to partial and total parotidectomy for early-stage parotid adenoid cystic carcinoma (ACC). PATIENTS AND METHODS: This was a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database from 2004 through 2017. Patients with pT1/2 N0 M0 parotid ACC were included. The primary study predictor was surgical treatment with either total or partial parotidectomy. Other covariates included age, gender, race, T stage, and need for facial nerve resection. Outcomes were disease-specific (DSS) and overall survival (OS). Kaplan-Meier survival probabilities were calculated. Simple and multiple regression models were constructed to identify prognostic varaibles. RESULTS: A total of 300 patients were included in the final sample. Of these 300, 55.7% of tumors were T2, and 59.3% of patients were treated with a total parotidectomy. In the univariate time-to-event analyses, neither total parotidectomy nor facial nerve preservation reduced the risks of disease-specific or overall death. In the multivariate model, after controlling for covariates, only older age (DSS hazard ratio [HR] = 2.59; P < .01, OS HR = 2.72; P < .01) and T2 stage (DSS HR = 2.44; P = .02, OS HR = 2.02; P < .01) independently influenced survival. CONCLUSIONS: For localized parotid ACC, total parotidectomy did not improve survival compared to partial parotidectomy. It might be acceptable to maintain clinically uninvolved parotid gland when circumstances so permit.

Geriatric Craniomaxillofacial Fractures: Where do They Happen and Why?

PURPOSE: The geriatric population is a constantly growing population that is especially vulnerable to trauma. The primary purpose of this study was to determine what factors are associated with increased rates of hospital admission in geriatric patients who sustain craniomaxillofacial fractures secondary to falls. MATERIALS AND METHODS: This is a 5-year retrospective cross-sectional study that was conducted using the NEISS database. There were several, heterogenous predictor variables. The primary outcome variable was admission rate, which was used as a proxy to the severity of injury. Patient and injury characteristics were compared using chi-square and independent-sample t-tests. Binary logistic regression was conducted to determine the risk of hospital admission. RESULTS: The final sample included 2,879 cases in total. The mean age of the study sample was 78.8 years (SD, 8.6 years). Most patients were white (51.6%) females (64.2%) who were injured at their respective homes (58.7%). Relative to injuries that took place at a sports center, injuries that took place at the patient's home (OR, 2.52; P < .05) independently increased the risk for admission. Relative to maxilla fracture, orbital bone fracture (OR, 3.91; P < .05) was an independent risk factor for admission. Relative to lacerations, intracranial injuries (OR, 3.76; P < .01) increased the risk of admission. CONCLUSIONS: Craniomaxillofacial fractures that took place at the patients' home were at increased risk for admission. Orbital bone fractures and intracranial injuries were at increased risk for admission. From our, and other studies findings, screening and fall prevention interventions should be implemented amongst the geriatric population.

Which Sport Is More Dangerous: Ice Hockey or Field Hockey? A Review of the Head and Neck Injuries Associated With the Two Sports.

PURPOSE: Ice hockey and field hockey are contact sports with the potential for injury, especially to the head and neck regions. The purpose of this study is to estimate and compare hospital admission (injury severity) between ice hockey and field hockey of those who presented to the emergency department with head and neck injuries. METHODS: The investigators designed and implemented a 20-year retrospective cohort study using the National Electronic Injury Surveillance System database. We included data related to ice hockey and field hockey injuries from January 2000 to December 2019 in this study. The primary predictor variable was sport played (ice hockey vs field hockey). Secondary predictor variables and covariates were derived from patient and injury characteristics. The primary outcome variable was hospital admission. Logistic regression was used to determine independent risk factors for the outcome variable. RESULTS: Our final sample was composed of 5,472 patients: 4,472 patients suffered head and neck injuries from ice hockey while the remaining 1,000 patients suffered head and neck injuries from field hockey. Players less than 18 years old were associated with 2.07-fold odds of admission (P < .01). Injury to the head (odds ratio [OR] = 14.339; 95% confidence interval [CI], 2.0 to 105.1; P < .01) and neck (OR = 89.260; 95% CI, 11.2 to 712.6; P < .01) were independently associated with an increased odds of admission. Relative to contusions/abrasions, players who suffered a concussion (OR = 141.637; 95% CI, 11.5 to 1,741.5; P < .01), fracture (OR = 155.434; 95% CI, 17.0 to 1,419.2; P < .01), internal organ injury (OR = 186.450; 95% CI, 15.5 to 2,236.8; P < .01), or hematoma (OR = 23.046; 95% CI, 1.2 to 442.5; P < .05) were all independently associated with an increased odds of admission. Ice hockey was not an independent risk factor for admission relative to field hockey. CONCLUSIONS: The findings of this study suggest that ice hockey was more associated with injuries to the head and neck as well as with concussions and internal organ injury compared to field hockey. However, ice hockey was not associated with increased risk of hospitalization relative to field hockey.

A Comparison of 2,845 Head and Neck Injuries in Various Martial Arts.

PURPOSE: The primary purpose of this study is to estimate and compare the frequencies, types, and hospital admission rates of head and neck injuries in subjects who practice different martial art fighting styles, including karate, kung fu, kickboxing, taekwondo, judo, and jiu jitsu. METHODS: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Information related to head and neck martial art injuries from January 2000 through December 2019 was included in this study. Study variables were obtained from both patient demographics and injury characteristics (date of injury, diagnosis, body part, type of martial art, and disposition). Patient and injury characteristics were compared through χ2 and independent sample tests. RESULTS: Taekwondo was the most likely type of martial art to lead to a head injury (P < .01), whereas jiu jitsu (P < .01) and judo (P < .01) were most likely to cause neck injuries. The type of martial art was not significantly associated with admission rates (P = .190); however, patients with head injuries were more likely to be admitted relative to patients who did not suffer head injuries (P < .05). Moreover, injuries secondary to judo were more likely to result in admissions relative to that of all other martial arts (P < .05). CONCLUSIONS: Judo was the most severe martial art during this time period as it led to the highest rate of hospital admissions. Karate injuries are most likely to occur in younger populations of fighters under the age of 18 years.

Early Childhood (0 to 5 years) Presents the Greatest Risk for Facial Dog Bites.

PURPOSE: The purpose of the present study is to compare the characteristics of dog bite wounds to the face and that of the rest of the body among the pediatric population in the United States and to determine independent risk factors for dog bite wounds to the face. METHODS: A retrospective cohort study was conducted using the Kids' Inpatient Database. There were multiple, heterogenous predictor variables. The primary outcome variable was a facial dog bite. A multivariate logistic regression was employed to identify independent risk factors for the primary outcome variable. A P value less than .05 was the threshold for statistical significance. RESULTS: Our final sample consisted of 9,057 patients who suffered dog bite injuries, of which 2,913 (32.2%) occurred on the face. Relative to individuals aged 16-20 years, individuals aged 0-5 (odds ratio [OR] 5.7; confidence interval [CI] 4.0, 8.1), 6-10 (OR 3.8; CI 2.6, 5.5), and 11-15 years (OR 1.6; CI 1.1, 2.5) were all independently associated with increased odds of incurring a facial dog bite injury. Patients who were not admitted electively were 2.5 times (CI 1.4, 4.6) more likely to incur a facial dog bite injury relative to patients who were admitted electively. CONCLUSIONS: Young children (0-5 years) were at the greatest risk for facial dog bites relative to children aged 16-20 years. Dog bites that were admitted on emergency were more likely to occur on the face relative to those that were electively admitted to the hospital. To reduce the risk for facial dog bites and the host of chronic psychological ramifications that accompany them, established preventative strategies ought to be exercised.

Exploring the Severity of Craniomaxillofacial Injuries From Horseback Riding.

PURPOSE: The purpose of our study is to assess the severity of craniomaxillofacial injuries from horseback-riding accidents. MATERIALS AND METHODS: This is a 20-year retrospective cross-sectional study of the National Electronic Injury Surveillance System. Injuries from the activity of horseback-riding were included if they occurred in the craniomaxillofacial complex. Study predictors were derived from both patient and injury characteristics. The study outcome was the presence or absence (probability) of hospital admission from the emergency department. A multiple logistic regression model was created to model the odds of admission using all significant univariate predictors. RESULTS: The final sample consisted of 6730 patients. The decrease in horseback riding injuries from 2000 to 2019 was significant (P = 0.042).The mean age of the sample was 27.80 years (range: 2-91 years). Gender-wise, females composed the majority of injured horseback riders (71.9%). Over two-thirds of the sample consisted of White patients (68.1%). Over three-fourths of the injuries occurred in the head (80.9%), rendering it the most frequently injured region of the craniomaxillofacial complex. The most common primary diagnoses were internal organ injury (40.2%). On univariate analysis, the admission rates were significantly associated with gender (P < 0.01), age group (P < 0.01), body part injured (P < 0.01), diagnosis (P < 0.01), location of injury (P < 0.01) and mechanism of injury (P < 0.05). Relative to young adults, children (odds ratio [OR], 1.579; 95% OR confidence interval [CI] [1.31, 1.91]; P < 0.01), adults (OR, 1.857; 95% OR CI [1.55, 2.22]; P < 0.01), and seniors (OR, 3.738; 95% OR CI [2.73, 5.12]; P < 0.01) were each independently associated with an increased odds of admission. Relative to the mouth, the head had 4.8 odds of admission (P < 0.01) and the face had 2.5 odds of admission (P < 0.01). Relative to contusions/abrasion, concussions (OR, 3.542; 95% OR CI [2.28, 5.49]; P < 0.01) and internal organ injuries (OR, 9.020; 95% OR CI [5.90, 13.79]; P < 0.01), lacerations (OR, 1.946; 95% OR CI [1.17, 3.24]; P < 0.05), and fractures (OR, 32.068; 95% OR CI [20.53, 50.09]; P < 0.01) were each independently associated with increased odds of admission relative to contusions. Direct trauma from a horse (OR, 1.422; 95% OR CI [1.06, 1.91]; P < 0.05) was associated with independently increased odds of admission relative to other injuries. Injuries that took place in a farm (OR, 1.617; 95% OR CI [1.25, 2.09]; P < 0.01) and a street (OR, 2.735; 95% OR CI [1.83, 4.09]; P < 0.01) were each independently associated with increased odds of admission. Finally, relative to females, males (OR, 1.374; 95% OR CI [1.20, 1.57]; P < 0.01) were independently associated with increased odds of admission. CONCLUSIONS: Many variables contribute to the chance of hospital admission from horseback riding. Fractures seem to be the leading risk factor for hospital admission, therefore, future study may look into how to reduce the incidence of fractures through the employment of more protective equipment than helmets for horseback riders.

Augmentation Rhinoplasty in Cleft Lip Nasal Deformity Using Alloplastic Material and Autologous Cartilage.

Secondary cleft rhinoplasty typically requires large amounts of cartilage grafts for augmentation. The purpose of this study was to present our short-term experience with alloplastic implants in cleft rhinoplasty. This was a retrospective cohort study of cleft lip and palate patients treated with secondary rhinoplasty at Hanoi Medical University Hospital and Ruby Hospital between 2017 and 2020. All rhinoplasty procedures consisted of lower lateral cartilage repositioning, a dorsal augmentation with silicone implant, columellar strut implant or graft, and onlay tip grafts. Cartilage was obtained from the septum and concha, and no cartilage was harvested from the rib. The study outcomes included the Rhinoplasty Outcome Evaluation (ROE) survey, a modified Mortier scoring scale, 8 intranasal measures of symmetry, and 4 nasofacial measures of tip projection and nasal length. Changes in patient satisfaction and nasal esthetics were compared before and after surgery. A total of 38 patients were included in the final study sample, of whom 65.79% had unilateral clefts. The overall complication rate was 7.89%, and there were 2 cases of infection and 1 case of dorsal implant displacement. Following rhinoplasty, ROE satisfaction scores significantly increased (+39.36, P <0.01) and Mortier severity scores decreased (-3.06, P <0.01). Nostril symmetry nearly normalized in width, height, and inclination. Mean columellar deviation decreased from 8.82 to 2.08 degrees, and nasal projection increased as assessed on multiple analyses. Patients with bilateral clefts had similar improvements in ROE and Mortier scores. In our experience, synthetic implants simplified the correction of cleft nasal deformity and eliminated the need for costal cartilage. We found that our protocol produced acceptable and stable short-term clinical results without increasing the complication rate above what has been reported with autologous grafts.

Malar and maxillary fractures among pediatric patients and the risk factors for mortality.

BACKGROUND/AIMS: No studies have characterized the morbidity and mortality of maxillary & malar fractures on a national scale. The aim of this study was to examine the risk factors for mortality in pediatric patients who had sustained maxillary and malar fractures by using a national pediatric hospital inpatient care database. MATERIALS AND METHODS: This retrospective cohort study was conducted using the Kids' Inpatient Database (KID). The primary predictor variable was the cause of injury. The primary outcome variable was mortality rate. Additional predictor variables included age, gender, race, income, payer information, year and place of injury, number of facial fractures, concomitant facial fractures, other fractures of the body, and intracranial/internal organ injury. Univariate and multivariate regression models were performed to assess risk factors for mortality. Statistical significance was set to a p-value <.05. RESULTS: A total of 5859 patients met the inclusion criteria. The most common age group was 13-17 years of age (n = 3816, 65.1%). Motor vehicle accidents were the most common mechanism of injury (n = 2172, 37.1%). The presence of cranial vault (OR = 2.81, p = .017), skull base (OR = 2.72, p < .001), and vertebral column fractures (OR = 2.13, p = .016), as well as sub-arachnoid hemorrhage (OR = 4.75, p = .005), traumatic pneumothorax/hemothorax (OR = 2.16, p = .015), and heart/lung injury (OR = 3.37, p < .001) were each independently associated with increased odds of mortality. CONCLUSIONS: Patients in their late teens most commonly sustained malar and maxillary fractures, likely due to general trends in craniomaxillofacial development. The presence of other fractures located in close proximity to the mid-face increased the risk of mortality among pediatric patients with malar and maxillary fractures. This may be explained by the anatomical approximation of the mid-face to vital neurovascular structures of the head, which, when damaged, may prove fatal.

Stepping into Trouble: Craniomaxillofacial Trauma in the Geriatric Population From Stairway Falls.

PURPOSE: The purpose of this study is to determine what potential factors are associated with increased risk of hospital admission among the geriatric population who suffer stairway falls. MATERIALS AND METHODS: This is a 10-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System (NEISS). Entries whose primary product was categorized under the code 1239 (stairs or steps) were included in this study. Reports were excluded if the injury did not occur within the craniomaxillofacial region. The principal outcome variable was admission rate. Patient and injury characteristics were compared using χ2 and independent sample t tests. RESULTS: Admission rates were significantly associated with sex (P < .01), age group (P < .01), race (P < .05), craniomaxillofacial region (P < .01), and primary diagnosis (P < .01). Relative to the females, males (OR, 1.458; P < .01) were independently associated with an increased odds of admission. Relative to patients aged 65 to 69 years old, patients aged 70 to 79 (OR, 1.247; P < .01), 80 to 89 (OR, 1.438; P < .01), and 90 & over (OR, 1.569; P < .01) were each independently associated with an increased odds of admission. Relative to white patients, black patients (OR, 1.238; P < .01) were each independently associated with an increased odds of admission. Relative to mouth injuries, eyeball injuries (OR, 4.574; P < .01) and head injuries (OR, 4.105; P < .01) were independent risk factors for admission. Relative to abrasions, fractures (OR, 6.013; P < .01) and internal organ injuries (OR, 4.814; P < .01) were each independently associated with an increased odds of admission. CONCLUSIONS: Age, gender, craniomaxillofacial region, type of injury, and primary diagnosis are all independent risk factors for hospital admissions. Preventative measures need to be taken to safeguard the older geriatric population from craniomaxillofacial trauma associated with stairway falls.

Pogo-Sticks and Maxillofacial Injuries: A Review of 619 Head and Neck Injuries.

PURPOSE: The purpose of this study is to explore head and neck injuries secondary to accidents involving pogo sticks. MATERIALS AND METHODS: We conducted a 20-year cross-sectional study using the National Electronic Injury Submission System (NEISS). Head and neck injuries resulting from the use of a pogo-stick were included. The predictor variables were demographics, type, site, context of injury, and season in which the injury occurred. The primary outcome variable was admission rate, used to estimate the severity of the injury. We employed chi-squared and independent sample tests to determine whether an association existed or not. We conducted a multivariate logistic regression model to determine the odds of admission for all significant variables. RESULTS: A total of 619 pogo stick injuries were included, with 96.1% under 18 years of age. The decrease in the number of injuries from the year 2000 to 2019 was significant (P = .003). Nearly all patients were under 18 (96.1%), with the remaining few being 18 or older. Laceration (43.8%) was the most common primary diagnosis. The head (37.2%) was the most commonly injured anatomical region, followed by the face (32.8%). The majority of the injuries took place at the patient's home (85.9%). Patients with head injuries were more likely to be admitted relative to patients who didn't suffer head injuries (P < .01). Concerning primary diagnosis, patients who suffered fractures and internal organ injuries were more likely to be admitted relative to patients without the respective injuries (P < .01). On the contrary, patients who suffered lacerations were less likely to be admitted than patients who did not suffer lacerations (P < .01). After controlling for all possible covariates, fracture (OR, 12.31; P < .01) was independently associated with increased odds of admission. Additionally, compared to all other injuries, fractures were roughly 21 times (P < .05) more likely to get admitted. Patients under 18 were less likely to suffer an internal organ injury relative to patients age 18 or older (P < .05). CONCLUSIONS: Head and neck injuries secondary to pogo sticks illustrated a predilection to the head. Fractures were the culprit behind the significantly increased odds of admission. Hence, all sectors of society should conceive different measures and implement them to protect against skull fractures (ie, helmet). Despite the decline in popularity of pogo sticks over the last two decades, all remaining riders should wear a helmet as religiously as bicycles or scooter riders to protect against skull fractures.

Outcomes of Direct Lingual Nerve Repair After an Injury: A Systematic Review.

PURPOSE: The purpose of this study was to conduct a systematic review with meta-analysis to investigate the outcomes of direct lingual nerve repair after injury. MATERIALS AND METHODS: The studies in this review were compiled by using PubMed/Medline and ScienceDirect, which were searched by a single reviewer (M.K.) from their inception until March 10, 2020. Two independent reviewers (M.K. and V.B.Z.) who were blinded to each other's assessments reviewed full-text articles to assess for study inclusion. Outcomes were dichotomized as either functional sensory recovery (FSR) or no FSR. Clinical testing must have been assessed at a minimum of 6 months postoperatively. FSR was defined as grade S3, S3+, or S4 on the British Medical Research Council scale of neurosensory function. Studies were only eligible if they provided the number of patients treated with conduits or time from injury to repair and the associated rates of FSR with each intervention. RESULTS: The initial search using the key terms yielded 4,921 results, which was then eventually filtered down to 6 articles after multiple levels of appraisal. Five articles were retrospective cohort studies and 1 was a randomized controlled study. Four of the 6 studies reported an FSR of grade S3 or higher in 85% or more of the patients. Conduit use was not associated with a significantly greater likelihood of achieving FSR (pooled risk ratio = 1.10; 95% confidence interval, 0.96 to 1.27; P = .17). Repair within 6 months was associated with significantly improved likelihood of achieving FSR (pooled risk ratio = 0.84; 95% confidence interval, 0.71 to 0.99; P = .04). CONCLUSIONS: The use of conduits during repair was not associated with clinically significant increased FSR. Early repair was associated with a beneficial effect on FSR; however, heterogeneity was an issue with the studies. There is a lack of strong evidence owing to the nature of studies analyzed and the need for further research is required.

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.

Is Psychiatric Illness Associated With the Clinical Decision to Treat Facial Fractures?

PURPOSE: Underlying psychiatric conditions are thought to influence the presentation, management, and outcomes of facially injured patients. Our study sought to determine if psychiatric diagnoses were associated with the decision to repair facial fractures during the index hospitalization. METHODS: This was a cross-sectional review of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of a facial fracture were included in the study. The primary study predictor was the presence of a documented psychiatric illness. Covariates included patient age, insurance, injury mechanism, primary fracture location, other concomitant injuries, and Injury Severity Score. The study outcome was facial fracture treatment status (reduction or no reduction). A multiple logistic regression model was created to identify and measure independent factor associations for fracture treatment. RESULTS: The final sample included 59,378 patients of whom 10,485 (17.7%) had a documented psychiatric illness. Most of these diagnoses involved substance use (62.5%). Patients with psychiatric illness had significantly higher rates of extra-nasal primary fracture location (56.2 vs 47.1%, P < .01) and a greater mean Injury Severity Score (5.0 vs 3.8, P < .01). In the unadjusted analysis, patients with psychiatric illness had higher rates of fracture repair during their index hospitalization (RR = 2.42, P < .01). After adjusting for covariates in the multiple logistic regression model, psychiatric illness became negatively associated with fracture repair (OR = 0.82, P < .01). CONCLUSIONS: Patients with psychiatric illness experienced higher rates of hospitalization and suffered more severe patterns of injury but had lower odds of fracture repair during their index hospitalization after controlling for injury characteristics.

How has the COVID Pandemic Impacted the Clinical Volume and Variety of an Academic Oral and Maxillofacial Surgery Program?

PURPOSE: Attempts to mitigate the coronavirus disease of 2019 (COVID) have disrupted the delivery of non-pandemic care. The purpose of this study was to evaluate the effects of the COVID pandemic on surgical volume and variety at an academic oral and maxillofacial surgery program. MATERIALS AND METHODS: A retrospective cohort study was conducted using the surgical logs of the University of Pennsylvania, Department of Oral and Maxillofacial Surgery from January 2012 through January 2021. Each record identified patient demographics and case classifications. The study predictor was timing of care, which was divided into pre-pandemic, peak pandemic, or post-peak pandemic. The primary study outcomes were the monthly procedure count and the procedure categories. The secondary dependent variables were patient age and race. Multivariate and univariate analyses of variance were used to determine whether pandemic effects existed within outcome groups. RESULTS: The final sample included 64,709 surgical procedures. Before, during, and after the pandemic peak, there were means of 691.0, 209.0, and 789.4 procedures per time period, respectively (P < .01). There was significantly more infection (baseline 2.2%, peak 6.0%, post-peak 2.0%, P < .01) and trauma (baseline 5.3%, peak 26.7%, post-peak 3.9%, P < .01) cases during the pandemic peak. The mean percentage of pediatric patients increased during the peak and post-peak periods (baseline 2.4%, peak 12.9%, post-peak 10.2%, P < .01). No differences were observed among the mean percentage of White (P = .12), Black (P = .21), and Hispanic (P = .25) patients treated. CONCLUSIONS: Along with a predictable decline in surgical numbers, a greater proportion of infection and trauma procedures were performed at the pandemic's peak. Despite these changes, surgery volume normalized and case variety returned to pre-pandemic levels in the post-peak period. Our study suggests that the addition of COVID restrictions did not change the case volume or variety in the months' after the initial crisis.