Is Weekend Presentation Associated With Odontogenic Infection Severity?

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

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

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

Factors Affecting Outcomes of Craniofacial Clinical Trials.

PURPOSE: This study aims to provide a cross-sectional view of craniofacial trials and to identify factors associated with completion, publication, and trial longevity. MATERIALS AND METHODS: This is a cross-sectional study of cleft and craniofacial clinical trials registered with ClinicalTrials.gov between September 1999 and April 2020. Predictor variables included funding source, trial design, trial location, number of recruitment sites, and investigator specialty.Study outcomes were completion status, publication status, and trial duration. Univariate comparisons and multivariate regression models were calculated for each outcome. RESULTS: The final sample included 179 clinical trials pertaining to craniofacial care. Nearly all trials were single-center (86.5%), and roughly half of trials were interventional (57.0%) or conducted in the United States (40.5%). No single specialty predominated, although plastic surgery (13.4%) was the most common investigator specialty. The completion rate was 82.7%, the publication rate was 40.8%, and the mean trial duration was 39.1 months. Interventional design (odds ratio = 0.30, P = 0.02) and United States location (odds ratio = 0.15, P < 0.01) were each independently associated with lower odds of trial completion. Trial longevity was independently associated with the National Institute of Health-funding (P < 0.01) and multicenter design (P < 0.01). CONCLUSIONS: Craniofacial trials are multidisciplinary and have a high rate of completion. Although most existing trials were conducted at only a single-center, multicenter efforts significantly increased trial longevity without compromising completion and publication rates. Given the diverse array of conditions and lines of inquiry that compose craniofacial care, it is reassuring that collaboration did not negatively affect trial outcomes.

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

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

Vascular Compromise After Soft Tissue Facial Fillers: Case Report and Review of Current Treatment Protocols.

The use of facial fillers for soft tissue augmentation is becoming a mainstream treatment modality for patients. Owing to the relative ease of administration, as well as the lucrative nature of such procedures, the number of providers offering facial fillers has been expanding. Although many adverse effects of facial fillers are minor and localized to the site of injection, 1 potential serious, albeit uncommon, adverse effect of facial filler treatment is avascular necrosis. In this article, we review soft tissue filler complications and describe the case of a 52-year-old female patient in whom vascular compromise developed after facial filler administration. In addition to reviewing complications and best practices for treatment management, we discuss anatomic considerations, present an overview of the most common filler materials, describe histologic changes with dermal fillers, and discuss litigation consequences with the use of these minimally invasive procedures. Although facial filler treatment is regarded as a minimally invasive and extremely safe procedure, it is not without complications. Avascular necrosis after soft tissue augmentation with facial fillers is exceedingly rare, with only a few cases reported in the literature, but practitioners who offer this procedure need to be well versed in treatment protocols.

A 20-Year Analysis of Adverse Events and Litigation With Light-Based Skin Resurfacing Procedures.

PURPOSE: The popularity and availability of facial rejuvenation procedures have increased exponentially during the previous decade. The present study aimed to provide an overview of photorejuvenation and evaluate the complications and litigation related to light-based skin resurfacing procedures. MATERIALS AND METHODS: A retrospective study was performed using the US Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) registry and the Thomson Reuter Westlaw Edge database from May 1, 1999 to May 1, 2019. The MAUDE registry was queried using the manufacturer brands. Adverse events were individually reviewed, and data were gathered regarding the company, complication, body location, and device type. The litigation cases were individually reviewed, and information was gathered on plaintiff gender, defendant specialty, allegation, jury verdict, the appeals verdict, and the award amount, if applicable. RESULTS: A total of 697 adverse events were included in the final sample. The most commonly reported complications were burns (61.1%), followed by scarring (16.2%), hyperpigmentation (7.8%), and hypopigmentation (7.0%). More rare, noncosmetic complications included infection (3.9%) and nerve (1.4%) and ocular (1.3%) damage. The rates of scarring with facial treatments were greater (24.3 vs 10.3%; P < .01) and the rates of burns with ablative lasers were lower (25.9 vs 66.0%; P < .01). With respect to litigation, of the 9 cases identified, all the plaintiffs were women. The most common allegation was procedural negligence (88.8%), followed by cosmetic deformity (77.7%) and the lack of informed consent (55.5%). The jury ruled in favor of the plaintiff in 4 cases (44.4%), and the mean award was $656,000. CONCLUSIONS: The most common adverse events were burns, scars, and pigmentation changes. Patient expectations could play a role in the reporting of adverse events. Negligence was the most common basis for litigation, consistent with what has been reported for other procedures. Future studies should evaluate whether increasing exposure to cosmetic phototherapies during residency and fellowship training will reduce future complication rates and alleged malpractice.

Thread-Lift Sutures: Anatomy, Technique, and Review of Current Literature.

The use of thread-lift sutures as an alternative to traditional surgical rhytidectomy or neck lifting is becoming a more common practice among surgeons. The Silhouette InstaLift (Sinclair Pharma, London, UK) is marketed as a minimally invasive procedure that immediately lifts and tightens the skin while stimulating fibroblast activation and collagen production. The evidence in the literature to support thread-lift sutures for facial augmentation is limited, with many studies having various degrees of bias. Our intention is to educate the oral and maxillofacial surgeon on the thread-lift suture materials, techniques, and relevant facial anatomy, as well as review the current limited data available. Using thread-lift sutures for facial augmentation is a relatively low-risk procedure that surgeons familiar with facial anatomy can offer patients either as an alternative to or in conjunction with other facial esthetic procedures such as facial filler treatment, neuromodulator treatment, or surgical procedures.

An Overview of Infections Associated With Soft Tissue Facial Fillers: Identification, Prevention, and Treatment.

PURPOSE: The purpose of this study was to provide an overview of infections associated with facial soft tissue fillers. MATERIALS AND METHODS: A literature review was performed which evaluated infections associated with facial soft tissue fillers. RESULTS: Infection rates with soft tissue fillers are low and are estimated at 0.04 to 0.2%. Most of these infections arise when skin contaminants infiltrate the injection site at the time of injection. These infections can occur early, up to several days after treatment, or delayed, occurring weeks to years after treatment. Reactions vary based on the filler absorbability and duration. Early recognition and treatment are important factors in managing our cosmetic surgery patients. CONCLUSION: Although facial fillers are safe and predictable, infections can still occur. Oral and maxillofacial surgeons need to be able to prevent, recognize, and properly manage infections related to these popular injections.

Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits.

PURPOSE: The purpose of this study was to provide an overview of platelet-rich plasma (PRP) injected into the scalp for the management of androgenic alopecia. MATERIALS AND METHODS: A literature review was performed to evaluate the benefits of PRP in androgenic alopecia. RESULTS: Hair restoration has been increasing. PRP's main components of platelet-derived growth factor, transforming growth factor, and vascular endothelial growth factor have the potential to stimulate hard and soft tissue wound healing. In general, PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality. Currently, different PRP preparations are being used with no standard technique. CONCLUSION: This review found beneficial effects of PRP on androgenic alopecia. However, more rigorous study designs, including larger samples, quantitative measurements of effect, and longer follow-up periods, are needed to solidify the utility of PRP for treating patients with androgenic alopecia.

Antibiotic Prophylaxis in Blepharoplasty: Review of the Current Literature.

The purpose of this study was to provide an evidence-based overview of antibiotic prophylaxis in blepharoplasty. We performed a literature search that evaluated the risk of infection associated with blepharoplasty, as well as the risks and benefits of antibiotic prophylaxis. The overall infection rate associated with eyelid surgery is extremely low. However, the use of antibiotic prophylaxis has increased over the past 25 years in esthetic facial procedures. There is no standard of care for or against antibiotic prophylaxis, and routine practices vary widely. This leads to the question of whether reducing the risk of surgical-site infection to near zero outweighs the real danger of antibiotic-related complications, including the escalating emergence of antibiotic-resistant bacteria. No direct consensus can be drawn from the current literature; thus, at this time, there is no current standard of care for oral and maxillofacial surgeons to adhere to in terms of when and if antibiotic prophylaxis is needed when performing blepharoplasty.

Surgeon's Guide to Facial Soft Tissue Filler Injections: Relevant Anatomy and Safety Considerations.

The purpose of this study is to provide a review of the relevant facial anatomy related to soft tissue filler injections. Facial fillers are used daily in our clinical practice. Although their use is safe and predictable, adverse events do occur. Some of these dire events include vascular complications leading to blindness, ischemia, and even stroke. Proper knowledge and understanding of the anatomic landmarks can minimize the risk of these vascular events. In addition, early recognition and treatment are necessary to prevent permanent complications.

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

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