Modified GoPro Hero 6 and 7 for Intraoperative Surgical Recording-Transformation Into a Surgeon-Perspective Professional Quality Recording System.

Recent innovations in wearable action cameras with high-definition video recording enable surgeons to use cameras for their surgical procedures. In this study, the GoPro HERO 6 (and 7) Black edition camera was modified step by step to allow for a completely wireless surgeon-perspective recording with a battery life and memory capacity never previously obtained with such a high level of digital video quality. With this system, a surgeon can record for more than 14 hours 26 minutes in 1,080 pixels at 60 frames per second without breaking scrub and capture the operating surgeon's direct view of the field. By modifying the newest generation of devices, the authors successfully eliminated all shortcomings of the prior generation of GoPro cameras for surgical recording. The modified GoPro HERO6 camera produced professional recording quality for a total cost lower than US$850. This is critically important, because video-based surgical training will continue to be a primary area of development in the future and represents a novel and effective way for young generations of surgeons to attain technical excellence and knowledge in surgery.

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PURPOSE: There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. MATERIALS AND METHODS: This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. RESULTS: From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. CONCLUSIONS: SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned.

Improving the Medical Curriculum in Predoctoral Dental Education: Recommendations From the American Association of Oral and Maxillofacial Surgeons Committee on Predoctoral Education and Training.

Dental procedures are often performed on patients who present with some level of medical fragility. In many dental schools, the exercise of taking a medical history is all too often a transcription of information to the dental chart, with little emphasis on the presurgical risk assessment and the development of a treatment plan appropriate to the medical status of the dental patient. Changes in dentistry, driven by an increasingly medically complex population of dental patients, combined with treatment advances rooted in the biomedical sciences necessitate the adaptation of our dental education to include a stronger background in systemic health. Many predoctoral educators in the American Association of Oral and Maxillofacial Surgeons (AAOMS) have expressed concern about the medical preparedness of our dental students; therefore, the AAOMS and its Committee on Predoctoral Education and Training have provided recommendations for improving the medical curriculum in predoctoral dental education, including a strengthening of training in clinical medicine and biomedical sciences, with specific recommendations for improved training of our dental students and dental faculty.

Clinical Pathway Implementation Improves Efficiency of Care in a Maxillofacial Head and Neck Surgery Unit.

PURPOSE: Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit. MATERIALS AND METHODS: This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ2 test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room. RESULTS: Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups. CONCLUSIONS: The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the clinical care team.

Leading Others Toward Excellence.

This essay puts forth the proposition that academic program excellence does not arise by accident. Effective leadership is required. To support this proposition, the essay discusses the characteristics common to effective leaders. It then proceeds to use the example of a successful academic oral-maxillofacial surgery department and characteristics of its leader to provide evidence that excellence derives from effective leadership.

[Elaboration of health care quality criteria in maxillofacial surgery].

Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

Approaching 3D printing in oral and maxillofacial surgery - suggestions for structured clinical standards.

PURPOSE: With respect to the European Union 2017 amendment of the Medical Device Regulations (MDR), this overview article presents recommendations concerning medical 3D printing in oral and maxillofacial surgery (OMFS). METHODS: The MDR were screened for applicability of the rules to medical in-house 3D printing. Applicable regulations were summarized and compared to the status of medical use of 3D printing in OMFS in Germany. Recommendations were made for MDR concerning medical 3D printing. RESULTS: In-house printed models, surgical guides, and implants fall under the category of Class I-III, depending on their invasive and active properties. In-house medical 3D printing for custom-made medical devices is possible under certain prerogatives: (1) the product is not being used in another facility, (2) appropriate quality systems are applied, (3) the reason for omitting commercial products is documented, (4) information about its use is supplied to the responsible authority, (5) there is a publicly accessible declaration of origin, identification, and conformity to the MDR, (6) there are records of manufacturing site, process and performance data, (7) all products are produced according to the requirements proclaimed before, and (8) there is an evaluation of clinical use and correction of possible issues. CONCLUSION: Several aspects must be addressed for in house medical 3D printing, according to the MDR. Devising MDR related to medical 3D printing is a growing challenge. The implementation of recommendations in OMFS could help practitioners to overcome the challenges and become aware of the in-house production and application of 3D printed devices.

Maxillofacial Surgery in Ukraine During a War: Challenges and Perspectives-A National Survey.

INTRODUCTION: The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians.The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. MATERIALS AND METHODS: A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland).The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. RESULTS: After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. CONCLUSIONS: According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%).

Rating of French maxillofacial surgeons on their Google® business account: Current status and reflections for equitable communication.

INTRODUCTION: Online reputation is misattributed in France in academic publications. However, this phenomenon is growing. The objective of this study was to establish an inventory of the e-reputation of French maxillofacial surgeons through the opinions posted on their professional Google® account. MATERIAL AND METHODS: A descriptive study included all the surgeons registered on the list of the French National Medical Council in "maxillofacial surgery and stomatology". Data collection was carried out from February to April 2022. RESULTS: Among the 483 surgeons included, 61.1% had received at least one opinion, the number of per surgeon was 22.2. The average was 4.3/5. Among the 4433 written comments completing the review, 85% were positive. The average response rate of surgeons was 10% and was all the more important as the rating of the opinion was lower. Stomatology (65.3%), aesthetic surgery of the face (15.1%) and orthognathic surgery (14.5%) were the most commented maxillofacial procedures. DISCUSSION: The online image of French maxillofacial surgeons was very positive. However, faced with a defamatory or insulting comment, the surgeon found in an unbalanced situation where he could not respond without risking betraying medical. We recall some common-sense recommendations for managing one's e-reputation and some legislative adjustments for better regulation of these platforms, also considering legal and ethical aspects.

Development and validation of the Burdens in Oral Surgery Questionnaire (BiOS-Q).

Patients' perspective is increasingly re-cognised as an important outcome measure in oral surgery. However, how patients perceive the surgical treatment cannot be assessed currently. This would be an important indicator for process-related quality of care. It was the aim to develop and to validate an instrument for the assessment of patient-based measures of process-related quality of care in oral surgery. The new Burdens in Oral Surgery Questionnaire (BiOS-Q) was developed in two steps in patients undergoing oral surgery. First, an item pool was created using semi-structured interviews in 90 patients. Second, a preliminary version was applied in 297 consecutively recruited patients to assess redundancy, completion rates, face validity, difficulty and distribution. Psychometric properties of the final version of the questionnaire were evaluated. The BiOS-Q consists of 16 items and showed satisfactory internal consistency (Cronbach's alpha = 0·84) and excellent test-retest reliability (ICC = 0·90). The questionnaire's mean score was significantly correlated with dentists' burdens (r = 0·44) and patients' overall satisfaction (r = 0·39) indicating sufficient validity. The BiOS-Q is a reliable and valid instrument for the assessment of patient-based process-related quality of care in oral surgery.

Maxillofacial injury: a retrospective analysis of time lapse between injury and treatment in a South African academic maxillofacial and oral surgery unit.

BACKGROUND: The study was undertaken in an academic maxillofacial and oral surgical unit in a large quaternary hospital attached to the Medical School of the University of the Witwatersrand, Johannesburg, between 2002 and 2006. OBJECTIVE: To investigate the number of days in seven patient management intervals from facial fracture occurrence to discharge from hospital, to gain insight into reasons for treatment delays. RESULTS: Facial fractures were treated a mean of 20.4 days from occurrence. There was a mean of 10.3 days from fracture to hospital presentation, and an identical period from hospital presentation to treatment. Statistical analysis showed that delay times decreased from 2002 to 2006. CONCLUSION: More rapid referral to the maxillofacial and oral surgical unit is the most practical way to reduce delays further.

[Histological investigations in ambulatory oral surgery practice]. / Szövettani vizsgálatok az ambuláns szájsebészeti gyakorlatban.

In the practice of oral surgery correspondence with the pathologist is required in order to identify the lesions in question by histologic examination. By current legal regulations the histological evaluation of removed tissues is mandatory. In the presentation the authors process the data obtained in their Department since 2008. Coincidence of the clinical and histological diagnosis is analysed statistically such is the occurrence of various types of oral mucosa lesions and cysts. In cases of presumed malignancy the biopsies were carried out in a department with adequate oncological background. In indications of autoimmun deseases mainly in cases of Sjögren's syndrome the Department has been requested to carry out minor salivary gland biopsies. Statistical analysis of the findings of the minor salivary gland biopsies will also be discussed. The histological diagnoses have been provided by Prof. Zsuzsanna Suba MD, DMD, PhD of the Semmelweis University, Department of Oral and Maxillofacial Surgery, Oral Pathology Unit. In order of prevalence the most common histologically verified lesions were: radicular cyst, fibromas and granulation tissue. In 84.5% of the cases the histological findings confirmed the clinical diagnoses. In 44,5% of the cases Sjögren's syndrome was verified by the minor salivary gland biopsy. Although in most cases the histological examination supported the clinical diagnoses, close cooperation of the oral surgeon and pathologist is essential.