Dental Rehabilitation of the Unilateral Cleft Dental Gap: A Single Institution Experience With Long-Term Follow-Up.

OBJECTIVE: The purpose of this study was to identify factors associated with the management of the cleft dental gap after alveolar bone grafting. METHODS: This was a retrospective cohort study of patients with unilateral cleft lip and alveolus or palate who had successful alveolar bone grafting. Our primary study outcome was alveolar cleft management (orthodontic closure or space maintenance). Our secondary study outcome was the rate of fixed dental rehabilitation. Univariate comparisons were made with SAS 9.4. RESULTS: The final study sample consisted of 54 patients. Most patients were treated with orthodontic closure (55.6%). Patients missing multiple teeth ( P < 0.01) were less likely to receive orthodontic closure. Orthodontic closure was not associated with differences in intermaxillary midline coincidence ( P = 0.22) or the need for LeFort advancement ( P = 0.15). Only 41.7% of patients who were managed with space maintenance obtained a fixed prosthesis. Hispanic ethnicity ( P < 0.01) and Medicaid insurance ( P < 0.01) were associated with lower rates of fixed dental rehabilitation. CONCLUSIONS: Orthodontic closure was the most common approach, and it did not result in significant maxillary midline distortion. Less than half of patients treated with space maintenance obtained fixed restorations. Socioeconomic barriers are likely preventing access to definitive dental rehabilitation in patients with unilateral cleft lip and alveolus or palate.

Bimaxillary Immediate Prosthetic Rehabilitation Using a Custom Maxillary Subperiosteal Implant and Fibula-Free Flap Mandibular Reconstruction After Tumor Ablation.

Subperiosteal implants (SPIs) using rigid fixation have recently emerged as an acceptable alternative to conventional endosteal implants when there is limited or absent alveolar bone. Modern advances in digital technology and manufacturing have improved the usability and stability of this latest generation of SPIs. Herein, we present the first reported case of a modern patient-specific SPI placed in the United States and, to the authors' knowledge, the first reported case performed in conjunction with a simultaneous free flap reconstruction of the opposing arch, and immediate dental rehabilitation of both arches in the world.

Contemporary Surgical Management of Craniofacial Fibrous Dysplasia Using Computer-Assisted Surgery and Intraoperative Navigation.

Craniofacial fibrous dysplasia (CFD) is a rare developmental disease of bone, which typically presents as a painless, expansile mass causing deformity of the craniofacial skeleton. In rare circumstances, compression of neurovascular structures may arise, causing symptoms such as pain, visual impairment, and hearing loss. Traditionally, CFD debulking has been performed with "freehand" techniques using preoperative imaging and anthropometric norms to determine the ideal amount of tissue removal. The advent of computer-assisted surgery, computer-aided design, and computer-aided manufacturing (CAD/CAM) has revolutionized the management of CFD. Surgeons can now fabricate patient-specific osteotomy/ostectomy guides, allowing for increased accuracy in bone removal and improved cosmetic outcomes. This series of 3 cases describe our institution's technique using patient-specific ostectomy "depth guides", which allow for maximum removal of fibro-osseous tissue while sparing deep and adjacent critical structures. These techniques can be widely applied to the craniofacial skeleton to assist in the surgical management of CFD.

Remodeling of the Temporomandibular Joint After Mandibular Setback Surgery: A 3D Cephalometric Analysis.

BACKGROUND: Condylar adaptations following orthognathic surgery remain an area of interest. Prior studies do not use 3-dimensional imaging modalities and lack standardization in the choice of osteotomy and movement when assessing condylar changes. PURPOSE: The purpose of this study was to use 3-dimensional cephalometry to measure the association between osteotomy type (sagittal split osteotomy [SSO] vs vertical ramus osteotomy [VRO]) and changes in condylar volume and position. STUDY DESIGN, SETTING, AND SAMPLE: This is a retrospective cohort study from January 2021 through December 2022 of patients at Bellevue Hospital in New York City, New York who were treated with either SSO or VRO for the correction of Class III skeletal malocclusion. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor was the type of mandibular osteotomy, sagittal split osteotomy, and vertical ramus osteotomy. MAIN OUTCOME VARIABLES: The primary outcomes were changes in condylar volume (change measured in mm3) and relative position (anterior-posterior change utilizing the Pullinger and Hollinder method). COVARIATES: Covariates included patient age, sex, setback magnitude, temporomandibular joint symptoms, and fixation method for SSO patients. ANALYSES: Univariate comparisons were performed between independent variables and study outcomes. Volume changes were compared within each predictor using paired t-tests. Position changes were compared within each predictor using χ2 tests. If there were multiple significant univariate predictors, multiple regression models were created to predict volume and position changes. A P < .05 value was considered statistically significant. RESULTS: The final sample comprised 30 condyles derived from 30 subjects. Mean age was 22.7 years (SD = 5.7) and mean setback was 3.9 mm (SD = 0.9). Twenty two condyles (73.3%) were subject to SSO with fixation, while the remaining 8 (26.7%) condyles were subject to intraoral VRO without fixation. When compared to VRO, condyles manipulated with SSO had greater volume loss (-177.2 vs -60.9 mm3; P = .03) and positional change (68.2 vs 12.5%; P < .01). Self-reported measures of postoperative pain, internal derangement, and myofascial symptoms were not significantly associated with either volume or positional changes. CONCLUSIONS AND RELEVANCE: The SSO resulted in greater postoperative condylar volume loss and positional changes. These volume and positional changes were not correlated with self-reported temporomandibular disorder symptoms.

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.

Distinct microbiota composition and fermentation products indicate functional compartmentalization in the hindgut of a marine herbivorous fish.

Many marine herbivorous fishes harbour diverse microbial communities in the hindgut that can play important roles in host health and nutrition. Kyphosus sydneyanus is a temperate marine herbivorous fish that feeds predominantly on brown seaweeds. We employed 16S rRNA gene amplicon sequencing and gas chromatography to characterize microbial communities and their metabolites in different hindgut regions of six K. sydneyanus. Measurements were confined to three distal sections of the intestine, labelled III, IV and V from anterior to posterior. A total of 625 operational taxonomic units from 20 phyla and 123 genera were obtained. Bacteroidota, Firmicutes and Proteobacteria were the major phyla in mean relative abundance, which varied along the gut. Firmicutes (76%) was the most dominant group in section III, whereas Bacteroidota (69.3%) dominated section V. Total short-chain fatty acid (SCFA) concentration was highest in sections IV and V, confirming active fermentation in these two most distal sections. The abundance of Bacteroidota correlated with propionate concentration in section V, while Firmicutes positively correlated with formate in sections III and IV. Acetate levels were highest in sections IV and V, which correlated with abundance of Bacteroidota. Despite differences in gut microbial community composition, SCFA profiles were consistent between individual fish in the different hindgut regions of K. sydneyanus, although proportions of SCFAs differed among gut sections. These findings demonstrate functional compartmentalization of the hindgut microbial community, highlighting the need for regional sampling when interpreting overall microbiome function. These results support previous work suggesting that hindgut microbiota in marine herbivorous fish are important to nutrition in some host species by converting dietary carbohydrates into metabolically useful SCFAs.

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.

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.

Substrate degradation pathways, conserved functions and community composition of the hindgut microbiota in the herbivorous marine fish Kyphosus sydneyanus.

Symbiotic gut microbiota in the herbivorous marine fish Kyphosus sydneyanus play an important role in digestion by converting refractory algal carbohydrate into short-chain fatty acids. Here we characterised community composition using both 16S rRNA gene amplicon sequencing and shotgun-metagenome sequencing. Sequencing was carried out on lumen and mucosa samples (radial sections) from three axial sections taken from the hindgut of wild-caught fish. Both lumen and mucosa communities displayed distinct distributions along the hindgut, likely an effect of the differing selection pressures within these hindgut locations, as well as considerable variation among individual fish. In contrast, metagenomic sequences displayed a high level of functional similarity between individual fish and gut sections in the relative abundance of genes (based on sequencing depth) that encoded enzymes involved in algal-derived substrate degradation. These results suggest that the host gut environment selects for functional capacity in symbionts rather than taxonomic identity. Functional annotation of the enzymes encoded by the gut microbiota was carried out to infer the metabolic pathways used by the gut microbiota for the degradation of important dietary substrates: mannitol, alginate, laminarin, fucoidan and galactan (e.g. agar and carrageenan). This work provides the first evidence of the genomic potential of K. sydneyanus hindgut microbiota to convert highly refractory algal carbohydrates into metabolically useful short-chain fatty acids.

Decompression of Odontogenic Keratocysts Before Enucleation Reduces the Rate of Recurrence.

BACKGROUND: The purpose of this study was to determine if 2-stage conservative treatment (decompression followed by enucleation) of odontogenic keratocysts reduced the rate of recurrence compared to single-stage conservative treatment. METHODS: This was a pooled cohort study composed of both patients identified at our institution and cases reported in the literature. The primary predictor variable was treatment modality (single versus 2-staged conservative treatment). The outcome variable was the overall recurrence rate. RESULTS: A total of 684 patient cases were included in the final pooled sample. The mean age was 39.80years (range: 7-80 years). The mandible (76.8%) was the most common site, with the rest of the lesions manifesting in the maxilla (23.0%). A total of 58.1% of the lesions were unilocular, whereas the remaining 41.9% were multilocular. Two-stage conservative treatment demonstrated a lower recurrence rate (14.5% versus 22.1%; P = 0.029). CONCLUSIONS: Decompression is known to reduce lesion size and optimize the favorability of conservative treatment. Furthermore, we propose that 2-staged treatment may also be associated with a lower recurrence rate.

Handball-Related Head and Neck Trauma: An Analysis of the 2000-2019 National Electronic Injury Surveillance System (NEISS) Database.

PURPOSE: The purpose of this study was to report on the characteristics of head and neck injuries secondary to the sport of Handball in the United States. MATERIALS AND METHODS: This is a 20-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System. Handball injuries were included in the study if they involved the head, face, eyeball, mouth, ear, or neck. The primary study predictor was age group. The study outcome was the type of injury (diagnosis) and the location of injury. Chi-squared testing (χ2) was performed to compare categorical variables. RESULTS: Males composed more than three-fourths of the sample of patients (76.2%). White patients (38.7%) composed the most common racial group. The most common anatomical location injured was the head (45.9%). The most common primary diagnoses were contusion/abrasion (22.5%). Children were most likely to injure their head (P < 0.01) among all the anatomic regions. Young adults were least likely to injure their eyeball (P < 0.05). In contrast to children, adults were least likely to injure their head (P < 0.01). In contrast to young adults, adults were most likely to injure their eyeball (P < 0.01). With regards to types of injuries, Children were least likely to incur lacerations (P < 0.01). In contrast, young adults were most likely to incur lacerations (P < 0.01); however, young adults were least likely to suffer from contusions/abrasions (P < 0.01). In contrast to young adults, adults were most likely to suffer from contusions/abrasions (P < 0.01). CONCLUSIONS: Contusions/abrasions and brain damage were the two most common injuries in this sport. The head was the most commonly injured anatomical region. Both the type of injury and the anatomical location of injury that occur during the practice of handball significantly vary depending on the age group involved in the game.

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.

Clinical Practice Trends and Postoperative Outcomes in Primary Cleft Rhinoplasty.

PURPOSE: Optimal correction of the cleft nasal deformity remains challenging. The purpose of this study was to examine the practice patterns and postoperative course of patients undergoing cleft lip repair with rhinoplasty compared to those who have primary lip repair without rhinoplasty. METHODS AND MATERIALS: A retrospective cohort study was conducted based on the Kids' Inpatient Database. Data were collected from January 2000 to December 2011 and included infants aged 12 months and younger who underwent cleft lip repair. The predictor variable was the addition of rhinoplasty at primary cleft lip repair. Primary outcome variables included hospital setting, year, and admission cost, while secondary outcome variables included length of stay and postoperative complication rate. Independent t-tests and chi-squared tests were performed. Continuous variables were analyzed by multiple linear regression models. RESULTS: The study sample included 4559 infants with 1422 (31.2%) who underwent primary cleft rhinoplasty. Over time, there was a significant increase in the proportion of cleft lip repairs accompanied by a rhinoplasty (p < .01). A greater proportion of patients with unilateral cleft lips received simultaneous rhinoplasty with their lip repairs (33.8 vs 26.0%, p < .01). This cohort had a significantly shorter length of stay (1.6 vs 2.8 days, p < .01) when compared to children that underwent cleft lip repair alone. CONCLUSIONS: Performing primary cleft rhinoplasty is becoming more common among cleft surgeons. Considering comparable costs and complication rates, a rhinoplasty should be considered during the surgical treatment planning of patients with cleft nasal deformities.

In vivo deciduous dental eruption in LuiKotale bonobos and Gombe chimpanzees.

OBJECTIVES: Existing data on bonobo and chimpanzee dental eruption timing are derived predominantly from captive individuals or deceased wild individuals. However, recent advances in noninvasive photographic monitoring of living, wild apes have enabled researchers to characterize dental eruption in relatively healthy individuals under naturalistic conditions. At present, such data are available for only one population of wild chimpanzees. We report data for an additional population of wild chimpanzees and the first dental eruption data for wild bonobos. MATERIALS AND METHODS: We collected photographs and video footage of teeth from the open mouths of wild bonobos and East African chimpanzees of known age from LuiKotale, Democratic Republic of the Congo, and Gombe National Park, Tanzania, respectively. We scored the presence and absence of deciduous teeth from photographs and video footage to characterize deciduous dental eruption timing in these two populations. RESULTS: Deciduous dental eruption ages in our sample fall within the range of variation previously documented for captive chimpanzees, but eruption ages are later in wild than in captive contexts. We found substantial variation in deciduous canine eruption timing, particularly among bonobos. One bonobo had a deciduous canine present by 227 days old while another did not have a deciduous canine present at 477 days old. DISCUSSION: Our data indicate that deciduous teeth erupt later in wild individuals than in captive individuals. We also found that deciduous dental eruption timing varies considerably between individuals within our study populations, a pattern that is consistent with previous studies. Future studies should consider sources of variation in deciduous canine eruption timing and relationships with other aspects of life history as additional data become available.

Quantitative estimates of glacial refugia for chimpanzees (Pan troglodytes) since the Last Interglacial (120,000 BP).

Paleoclimate reconstructions have enhanced our understanding of how past climates have shaped present-day biodiversity. We hypothesize that the geographic extent of Pleistocene forest refugia and suitable habitat fluctuated significantly in time during the late Quaternary for chimpanzees (Pan troglodytes). Using bioclimatic variables representing monthly temperature and precipitation estimates, past human population density data, and an extensive database of georeferenced presence points, we built a model of changing habitat suitability for chimpanzees at fine spatio-temporal scales dating back to the Last Interglacial (120,000 BP). Our models cover a spatial resolution of 0.0467° (approximately 5.19 km2 grid cells) and a temporal resolution of between 1000 and 4000 years. Using our model, we mapped habitat stability over time using three approaches, comparing our modeled stability estimates to existing knowledge of Afrotropical refugia, as well as contemporary patterns of major keystone tropical food resources used by chimpanzees, figs (Moraceae), and palms (Arecacae). Results show habitat stability congruent with known glacial refugia across Africa, suggesting their extents may have been underestimated for chimpanzees, with potentially up to approximately 60,000 km2 of previously unrecognized glacial refugia. The refugia we highlight coincide with higher species richness for figs and palms. Our results provide spatio-temporally explicit insights into the role of refugia across the chimpanzee range, forming the empirical foundation for developing and testing hypotheses about behavioral, ecological, and genetic diversity with additional data. This methodology can be applied to other species and geographic areas when sufficient data are available.

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.

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.

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.

Autogenous Iliac Crest Versus rhBMP-2 for Alveolar Cleft Grafting: A 14-Year Single-Institution Experience.

PURPOSE: This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting. MATERIALS AND METHODS: This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6 months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or 2. RESULTS: The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilateral repairs, and 17.4% were retreatments. The cumulative success rate was 89.5%. There were no differences in success between materials (rhBMP: 90.3%; AICBG: 89.1%; P = .85). Patients presenting for retreatment were more likely to receive rhBMP-2 than AICBG (48.6 vs 3.8%, P < .01). After controlling for other significant confounders, the rhBMP-2 group required less personnel (P < .01) and operating room time (P < .01). Only 1 patient in the rhBMP-2 group was admitted, whereas all AICBG patients were admitted a minimum of 1 night. CONCLUSIONS: Compared with AICBG, rhBMP-2 produced a similar height of bone but required less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent.

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.