Lower Insertional Torque of Fixation Screws for Mandibular Angle Fractures Is Associated With Complications.

BACKGROUND: Open reduction and internal fixation (ORIF) is a common treatment for mandibular angle fractures. It is unknown, however, whether the insertional torque of the fixation screws is a risk factor for postoperative complications. PURPOSE: The purpose of the study was to determine the association between fixation screw insertional torque and postoperative inflammatory complications (POICs). STUDY DESIGN, SETTING, SAMPLE: The authors conducted a prospective cohort study consisting of all adult patients treated with ORIF of mandibular angle fractures using a single six-hole lateral border plate secured with monocortical screws from January 1, 2020, to October 31, 2022, at a large, urban academic hospital. Patients with gunshot wounds, prolonged maxillomandibular fixation, and bilateral angle fractures were excluded. PREDICTOR VARIABLE: The predictor variables were the average and lowest insertional torque of the six screws placed for fixation during ORIF. MAIN OUTCOME VARIABLE: The outcome variable was the presence of POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation. COVARIATES: Demographics, medical history, mechanism, diagnosis, and treatment-related variables were also analyzed. ANALYSES: Descriptive and bivariate analyses were performed. A P value of ≤ .05 was considered significant. RESULTS: There were 51 patients included in the study, 37 (72.5%) men, with a mean age of 31.2 ± 10.1 years. POICs occurred in 15.7% of patients. The average insertional screw torque was 46.9 ± 7.8 Ncm, and the mean lowest insertional screw torque per plate was 34.3 ± 10.2 Ncm. The average torque values were not lower in patients who had POICs versus those who did not (45.0 ± 8.6 Ncm vs 48.4 ± 7.6 Ncm, respectively, P = .16). However, the lowest torque value was less in patients who had POICs compared to those who did not (27.5 ± 11.0 Ncm vs 35.6 ± 9.7 Ncm, respectively, P = .04). CONCLUSION AND RELEVANCE: Among patients with mandibular angle fractures treated with ORIF, decreased insertional torque for the lowest of the six screws placed for fixation was associated with complications. While previous studies have shown certain plating schemes have been associated with complications, the quality of fixation also plays a role.

Is Bipolar Radiofrequency-Assisted Liposuction Equivalent to Open Anterior Platysmaplasty in Facelift Surgery?

BACKGROUND: During facelift surgery, anterior platysmaplasty (AP) has been used for decades, but it limits lateral advancement and can induce contour irregularities. Radiofrequency (RF)-assisted-liposuction in the anterior neck can avoid these disadvantages by tightening skin without open surgery. PURPOSE: The purpose of the study was to compare the esthetic outcomes of facelift surgery with those of AP and RF. STUDY DESIGN, SETTING, SAMPLE: A 5-year retrospective cohort study was performed on facelift patients treated by a single surgeon. Exclusions were single-side surgery, previous facelift, chin/lip augmentation/reduction, and inadequate data. PREDICTOR VARIABLE: The predictor variable was neck management technique (AP vs RF). MAIN OUTCOME VARIABLES: The primary outcome variable was the change in cervicomental angle (CMA) following surgery as measured on facial photographs. Secondary outcomes included distance changes from the central CMA point in vertical and horizontal planes to repeatable reference planes. COVARIATES: Covariates were age, body mass index, American Society of Anesthesiologists classification, smoking, and simultaneous procedures. ANALYSES: The statistical analysis was performed using Wilcoxon rank-sum, Fisher's exact, Kruskal-Wallis tests, Pearson's correlation, and linear regressions. The level of statistical significance was P < .05. RESULTS: There were 132 patients included in the study; 67 received AP and 65 received RF. AP trended toward better performance in CMA change in the unadjusted analysis (-18.7° ± 13.8° vs -22.3° ± 13.7°, respectively, P = .08). AP and RF performed similarly in the adjusted analysis (P = .29). Techniques were similar in horizontal distance change to the CMA (P = .31). RF was associated with less change in the vertical distance to the CMA in the unadjusted analysis (-11.9 mm ± 11.0 mm vs -6.7 mm ± 8.7 mm, respectively, P = .01) and adjusted analysis (ß = 4.3 mm, 95% confidence interval .8 to 7.9 mm, P = .02). CONCLUSION AND RELEVANCE: Utilization of the RF technique for management of the anterior neck in facelift surgery is associated with similar outcomes to the AP technique in horizontal distance to the CMA, but AP performed better in CMA change and vertical distance to the CMA.

Does Preoperative Surgical Delay Lead to Increased Postsurgical Length of Stay or Reoperation in Patients With Severe Odontogenic Infections?

BACKGROUND: While severe odontogenic infections can be life-threatening and emergent surgery can be required more often, surgical management in the operating room (OR) is completed as soon as feasible. However, provider schedules and OR availability can occasionally lead to longer delays before surgery, but their effect on outcomes is unknown. PURPOSE: The purpose of this study was to determine the association of preoperative surgical delay with postsurgical length of stay (LOS) and reoperation in patients with severe odontogenic infections. STUDY DESIGN, SETTING, SAMPLE: The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with incision and drainage for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital. PREDICTOR VARIABLE: The primary predictor variable was the length of presurgical delay-the number of hours between arrival in the emergency department and the start of surgery. MAIN OUTCOME VARIABLES: The primary outcome variable was the postsurgical LOS and the secondary outcome variable was the rate of reoperation. COVARIATES: Demographics, medical history, exam findings, diagnosis, and treatment-related variables were also analyzed. ANALYSES: Descriptive and bivariate analyses were performed along with multivariable linear and logistic regression. A P value of < .05 was considered significant. RESULTS: There were 401 patients included in the study with 50.9% men and a mean age of 39.1 years. Increased length of presurgical delay (hours) was associated with a decreased postsurgical LOS (ß = -0.05 days, P = .01) and length of presurgical delay was not associated with reoperation (P = .51) in the unadjusted analyses. However, length of presurgical delay was not found to be associated with either LOS (ß = -0.02, 95% confidence interval (CI) -0.05 to 0.01, P = .12) or reoperation (adjusted odds ratio (aOR) 1.0, 95% CI 0.96 to 1.02, P = .67) in the adjusted analyses. CONCLUSIONS AND RELEVANCE: The association of decreased length of presurgical delay with increased postsurgical LOS in the unadjusted analysis could reflect the practice of rapid intervention for the most ill patients. After adjusting for number of spaces, a primary indicator of infection severity, length of presurgical delay was not associated with either LOS or return to the operating room.

Does a Short Period of Maxillomandibular Fixation Decrease Complications in Open Reduction Internal Fixation of Mandibular Angle Fractures?

PURPOSE: A short duration of postoperative maxillomandibular fixation (MMF) has the potential to reduce complications following open reduction and internal fixation (ORIF) of mandibular angle fractures. The purpose of this study was to determine if a short duration of MMF is associated with a reduced rate of postoperative inflammatory complications (POICs) in patients with mandibular angle fractures undergoing ORIF. METHODS: The authors conducted a retrospective cohort study consisting of patients treated with ORIF for mandibular angle fractures from August 1, 2015 to May 31, 2020 at an urban, level 1 trauma center. Patients under the age of 18 years, bilateral angle fractures, those with MMF periods of more than 3 weeks, and those patients without documentation of the duration of MMF were excluded from the study. The primary predictor variable was the use of a short duration (less than 2 weeks) of postoperative MMF. The outcome variable of interest was the presence of POICs. Categorical covariates were compared using Fisher's exact tests, while continuous variables were compared using Wilcox rank-sum tests. Multivariable logistic regression adjustment was also performed. RESULTS: There were 307 patients included in the study, 84.4% of which were men. The average age was 32.5 years. Patients with a short duration of MMF had a POIC rate of 8.3% compared to 18.2% for no MMF (P = .08). In the adjusted analysis, patients with a short duration of MMF time had a significant decrease in POIC risk compared to no MMF (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.11 to 0.97). Other significant variables in the regression analysis included plating type and noncompliance. Inferior border rigid fixation was associated with decreased POIC risk compared to ladder plates and lateral border plates (aOR 5.8, 95% CI = 1.8 to 18.4 and aOR 5.1, 95% CI = 1.4 to 18.7, respectively). CONCLUSION: The findings from our study suggest that a short duration of postoperative MMF may reduce POICs following ORIF of mandibular angle fractures.

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

PURPOSE: Granuloma and delayed inflammatory reaction to hyaluronic acid facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1, 2018 and October 31, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18 to 2/29/20) or post-COVID (3/1/20 to 10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data were analyzed using chi-squared test, t-tests, and logistic regression. RESULTS: Over the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, P = .009). Juvederm Vollure was used in 64% of patients who developed granulomas but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (P = .02). CONCLUSIONS: Granuloma formation is a rare complication of hyaluronic acid filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence.

Do Antibiotics Prevent Infectious Complications in Critically Injured Patients With Blunt Nonoperative Midfacial Trauma?

BACKGROUND: While recent literature suggests antibiotics are not needed in patients with nonoperative facial fractures involving sinuses, the existing studies do not focus on critically injured patients who are known to be at higher risk for sinusitis and ventilator-associated pneumonia, which could be exacerbated by facial fractures. PURPOSE: The purpose of this study was to determine if antibiotics reduce the rate of infectious complications in critically injured patients who have blunt midfacial trauma treated nonoperatively. STUDY DESIGN, SETTING, SAMPLE: The authors conducted a retrospective cohort study consisting of patients admitted to the trauma intensive care unit who sustained blunt midfacial injuries managed nonoperatively at an urban Level 1 trauma center from August 13th, 2012, to July 30th, 2020. Adults who were critically injured on admission and sustained a midfacial fracture involving a sinus were included in the study. Patients who underwent operative repair of any facial fracture were excluded. PREDICTOR VARIABLE: The predictor variable was the use of antibiotics. MAIN OUTCOME VARIABLE: The primary outcome variable was the development of infectious complications, such as sinusitis, soft tissue infection, or any type of pneumonia, including ventilator-associated pneumonia (VAP). ANALYSES: The data were analyzed using Wilcoxon rank sum tests, Fisher exact tests, and multivariable logistic regression as appropriate for analysis type with significance level set at <0.05. RESULTS: The study included 307 patients, with a mean age of 40.6 years. Men accounted for 85.0% of the study population. Antibiotics were administered to 229 (74.6%) of the study population. Complications developed in 13.6% of the patients, which included sinusitis (0.3%), VAP (7.5%), and other types of pneumonia (5.9%). Clostridioides difficile colitis developed in 2 patients (0.6%). Antibiotics were not associated with a decrease in infectious complications in either the unadjusted analysis (13.1% in antibiotic group, 15.4% in no antibiotic group, RR = 0.85 [95% confidence interval = 0.5 to 1.6], P = .7) or the adjusted analysis (odds ratio 0.74 [0.34 to 1.62]). CONCLUSIONS AND RELEVANCE: Even in this critically injured patient population thought to be at elevated risk for infectious complications from their midfacial fractures, the rates of infectious complications in those who received antibiotics and those who did not were no different. These results suggest that consideration of more judicious use of antibiotics is warranted in critically ill patients with nonoperative midface fractures.

Surgical Treatment of Impacted Mandibular Second Molars: A Systematic Review.

PURPOSE: The evidence on surgical uprighting and surgical exposure for the management of impacted mandibular second molars is limited. This systematic review evaluated the efficacy of both of these surgical procedures in the management of impacted mandibular second molars. METHODS: The authors conducted a systematic review without meta-analysis of English language articles on Pubmed and Embase databases without publication date restrictions. Additional studies were identified by searching reference lists and manually reviewing published literature in key journals. Potential included study types were cases series, cohort studies, and randomized clinical trials studying surgical uprighting or surgical exposure of impacted mandibular second molars. The outcomes studied were the positioning of the tooth in the dental arch, pulpal obliteration or calcification, infection, root resorption, and root fracture. RESULTS: Of the 1,438 records identified, 8 were included in the review, representing a total of 433 molars. The age of study participants in the included studies ranged from 7 to 20 years. A total of 22 of 27 (81.5%) impacted mandibular second molars included in this study were reported to be successfully positioned in the dental arch after surgical exposure. A total of 374 of 408 (91.7%) mandibular second molars included in this study were successfully positioned in the dental arch after surgical uprighting. There were no reported cases of infection and root fracture of impacted mandibular second molars treated by surgical exposure. In surgical uprighting, the overall reported rates of pulpal obliteration or calcification, infection, root resorption, and root fracture were 27.1, 1.9, 14.9, and 1.0%, respectively. CONCLUSIONS: While there are few studies comparing treatment strategies for the management of impacted mandibular second molars, surgical uprighting appears to be a successful treatment option for these patients with few reported complications.

Prediction of Residual Alveolar Bone Height in the Posterior Maxilla After Dental Extractions.

PURPOSE: After tooth extraction in the posterior maxilla, bone resorption often limits implant placement unless additional grafting procedures are performed. However, it is difficult to predict the amount of bone that will remain after extraction based on current evidence. The purpose of this study was to develop a method for predicting the postextraction alveolar bone height in the posterior maxilla. PATIENTS AND METHODS: The authors conducted a retrospective cohort study that included all patients who were treated for the extraction and replacement of a maxillary first molar with a dental implant from 2008 to 2019. Potential predictor variables included thirteen pre-extraction radiographic measurements obtained via cone-beam computed tomography. The outcome variable was having more than 6 mm of bone height from the alveolar crest to the sinus floor after extraction. Decision tree analyses were used to search for the best predictors of this outcome using random forest analysis with a maximum of 3 randomly chosen covariates in each candidate tree. RESULTS: A total of 63 patients were included in the study; 55.6% were women, and the mean age was 57.6 ± 14.5 years. In this study population, having a bone height from the furcation to the maxillary sinus floor of <6.7 mm had a 7.1% chance of having >6 mm of bone height postoperatively, whereas those patients with ≥6.7 mm at the same position preoperatively had a 61.9% chance of having >6 mm of bone height postoperatively (P < .001). CONCLUSIONS: This study suggests that patients with <6.7 mm of bone from the furcation to the sinus are at increased risk of having insufficient bone to support a dental implant without additional grafting at the maxillary first molar position. When treating these patients, the surgeon should consider performing a procedure at the time of extraction to increase bone height or explain additional bone grafting is expected for ideal implant placement.

Do Patient-Specific Implants Decrease Complications and Increase Orbital Volume Reconstruction Accuracy in Primary Orbital Fracture Reconstruction?

PURPOSE: Patient-specific titanium implants are increasingly used in orbital trauma as a means of achieving improved surgical outcomes as well as decreasing postoperative complications; however, the data to support their use remain limited. The purpose of this study is to compare the complication rates and accuracy of orbital reconstruction using preformed titanium mesh implants and patient-specific implants. METHODS: The authors conducted a retrospective cohort study consisting of patients with orbital floor and/or medial wall fractures treated by reconstruction with either preformed or patient-specific implants from August 1, 2015 to December 31, 2020. The primary predictor variable was the implant type. Outcome variables were the percent volume difference between the reconstructed and uninjured orbital volume and complications. Statistical analysis was performed using Fisher exact test and Wilcoxon rank-sum test. RESULTS: Of the 85 patients in the study, 73% were male and the average age was 38.7 ± 16.6 years. Sixty-one patients (72%) were treated with preformed implants and 24 (28%) with patient-specific implants. Complications occurred in 8.3% of the patient-specific implant group and 26.2% of the preformed implant group (P = .08). Percent volume difference between the reconstructed and nontraumatized orbit was 4.2% and 6.8% in the patient-specific and preformed implant group, respectively (P = .03). CONCLUSIONS: Patient-specific implants improved orbital volume reconstruction accuracy but did not decrease complications when compared to preformed implants.

Development of a US national-scale, mixed-source, pesticide, rural well database for use in drinking water risk assessment: an atrazine case study.

For pesticide registrations in the USA under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), as implemented by the United States Environmental Protection Agency, drinking water risk assessments for groundwater sources are based on standard scenario modeling concentration estimates. The conceptual model for the drinking water protection goals is defined in terms of (1) a rural well in or near a relatively high pesticide use area, a shallow well (4-10 m); (2) long-term, single-station weather data; (3) soils characterized as highly leachable; (4) upper-end or surrogate, worst-case environmental fate parameters; and (5) maximum, annual use rates repeated every year. To date, monitoring data have not been quantitatively incorporated into FIFRA drinking water risk assessment; even though considerable, US national-scale temporal and spatial data for some chemistries exists. Investigations into drinking water monitoring data development have historically focused on single-source efforts that may not represent wide geographies and/or time periods, whereas Safe Drinking Water Act groundwater monitoring data are focused on a community-level scale rather than an individual, shallow, rural well. In the current case study, US national-scale, rural well data for the herbicide atrazine was collected, quality controlled, and combined into a single database from mixed sources (termed the atrazine rural well database) to (1) characterize differences between exposure estimates from standard EPA modeling approaches for specific characterization, (2) evaluate monitoring data toward direct use in US drinking water risk assessments to compliment or supersede standard modeling approaches to define risk, and (3) evaluate monitoring trends a function of time relative to label changes implemented as part of the registration review process. Of the 75,665 drinking water samples collected from groundwater, atrazine was only detected in 3185, a 4% detection rate.

Subnasal Lip Lift and Its Effect on Nasal Esthetics.

BACKGROUND: The subnasal lip lift has emerged as a standard procedure for the treatment of an elongated upper lip. Despite its popularity, limited literature has studied its effect on nasolabial esthetics. The purpose of this study is to describe the effect of the subnasal lip lift on nasal and labial esthetic parameters. METHODS: The authors conducted a retrospective case review of patients who underwent a subnasal lip lift procedure without concurrent rhinoplasty between January 1, 2008, and December 31, 2019. The outcome variables were lip length, tooth show, vermillion display, alar width, nasolabial angle, columellar-lobular angle, Crumley analysis, and Simons analysis. Preoperative and postoperative values were compared and analyzed using paired sample t-tests. RESULTS: Overall, 55 female patients with an average age of 52 years and a mean follow-up of 14 months were included in the study. Subnasal lip lift resulted in a statistically significant 21.5% reduction in lip length, 31.5% increase in the vermilion show, and a 1.52 mm increase in tooth show (P < .0001). In relationship to nasal esthetics, there was a statistically significant decrease in nasolabial angle of 4.56° (P < .0001), a 2.2% increase in alar width (P < .001), and a 26.3% increase in nasal projection per Simons analysis (P < .0001). The study did not demonstrate a significant change in columellar-lobular angle or Crumley projection analysis. CONCLUSIONS: Subnasal lip lift procedure can significantly impact lower nasal esthetics, specifically by decreasing the nasolabial angle and potentially contribute to pseudo-overprojection of the nasal tip, as shown by the results of this study.

Porous Bone Increases the Risk of Posterior Mandibular Implant Failure.

PURPOSE: Our recent study indicated that patients with osteoporosis had an increased risk for early and late implant failure perhaps due to a large cancellous space. Therefore, the purpose of the article is to explore the relationship between the amount of cancellous space in an implant site and implant failure. PATIENTS AND METHODS: The authors conducted a retrospective cohort study on patients who received dental implants in the posterior mandible at the senior author's practice from January 1, 2008 to October 1, 2019. The primary outcome variable was time to implant failure. The primary predictor variable was the amount of cancellous bone between the buccal and lingual cortices (cancellous space). Other study variables included demographic variables, medical history variables, and implant site measurements. Statistical analysis was performed using descriptive statistics, chi-squared tests, single variable and multiple Cox proportional hazard analyses. RESULTS: The study cohort (n = 220) was composed of 62.3% women and the average age was 58.2 years. The median follow-up time was 3.5 years (range: 1-12). Five-year survival rates for patients with a cancellous space of <4 mm was 100%, with a cancellous space of 4-6 mm was 95.3%, with a cancellous space of 6-8 mm was 88.2%, and with a cancellous space of >8 mm was 64.1%. In the final multivariate Cox proportional hazard model adjusting for age, gender, smoking status, site and buccal cortex width, cancellous space remained significantly associated with time to implant failure (aHR 1.7 per millimeter change [1.4 - 2.2], P < .0001). CONCLUSIONS: The width of the cancellous space and subsequent gap between implant and cortical bone should be considered when placing implants into the mandibular molar sites. When the patient presents for an implant in the mandibular molar region, if the cancellous space is large, the patient should be informed of the risk.

Is Screw-Fracture Proximity or Residual Fracture Displacement Correlated to Outcomes After Open Reduction and Internal Fixation of Mandibular Angle Fractures?

PURPOSE: Computed tomography (CT) imaging is commonly obtained following open reduction and internal fixation (ORIF) of mandibular fractures but the significance of common findings is unknown. The purpose of this study is to examine the relationship of screw-to-fracture proximity and residual fracture displacement to post-operative complications following ORIF of mandibular angle fractures treated with monocortical fixation techniques. METHODS: The authors conducted a retrospective cohort study consisting of all patients with mandibular angle fractures treated with ORIF using monocortical fixation at the lateral surface of the mandible from the dates August 1, 2015 to May 31, 2020. The predictor variables were the distance measurements between the 2 closest screws to the fracture and the fracture line and the amount of residual fracture displacement, both measured on postoperative CT. The primary outcome variable was the presence of postoperative inflammatory complications (POICs). Statistical analysis was performed using logistic regression and Bayesian variable selection to calculate posterior probability of importance for the variables of interest. RESULTS: Of the 285 patients included in the study, 84.6% were men and the average age was 30.8 years. POICs occurred in 22.1% of the patients. Age, smoking, homelessness, noncompliance and drug use were associated with POICs. However, none of the screw-to-fracture distances were associated with POICs, including linear, dichotomous or polynomial transformations of these variables. Additionally, the residual fracture displacement distances and transformations of these distances were also not associated with POICs. CONCLUSION: The present study did not find any evidence to suggest that a closer screw-fracture distance or increased residual fracture displacement on postoperative CT imaging increased the risk of POICs for mandibular angle fractures treated with ORIF using monocortical fixation at the lateral border.

The Use of Tranexamic Acid in Facial Cosmetic Surgery Procedures: A Technical Note.

Tranexamic acid (TXA) has been widely used as an antifibrinolytic in dentoalveolar surgery and only recently has its effects been explored in facial procedures. Multiple studies have reported the use of TXA in facial cosmetic surgery; and to date, only a limited number of them utilized TXA as a local infiltrative technique for rhytidectomy procedures. We present a technical note to using lower concentrations of TXA in tumescent anesthesia for an array of facial cosmetic procedures. Our experience thus far has shown improved hemostasis, reduction of intraoperative bleeding and a more profound reduction in postoperative ecchymosis, edema and seroma formation.

Risk Factors for Postoperative Inflammatory Complications After Maxillofacial Reconstruction Using Polyether-Ether-Ketone Implants.

PURPOSE: Polyether-ether-ketone (PEEK) implants are increasingly used for the reconstruction of craniomaxillofacial deformities, but limited data exist on their limitations or risk factors for complications associated with their use. The purpose of the present study was to identify risk factors for postoperative inflammatory complications (POICs) after the use of PEEK implants in craniomaxillofacial reconstruction. METHODS: A retrospective cohort study was conducted, incorporating all patients treated with patient-specific PEEK implants at the authors' institution from August 1, 2012 to June 30, 2019. The outcome variable was the presence of POICs. The potential predictor variables were demographic, medical, anatomic, and treatment related. Statistical analysis was performed using Fisher exact tests, t tests, and multivariable logistic regression analysis where appropriate. RESULTS: The 32 patients included in the study were composed of 68.8% men; mean age was 40.6 years. The PEEK implant was placed adjacent to the paranasal sinuses in 56.3% of patients. The indication for use was malar depression in 50.0%, orbital dystopia in 46.9%, forehead or skull defects in 21.9%, and mandibular contour deformities in 6.2%; 8 patients had more than 1 indication. The overall rate of POICs was 28.1%. Of the POICs, 66.7% were managed with incision and drainage, revision surgery, or removal and 33.3% were managed with outpatient wound care or antibiotics. Tobacco use, the presence of an intraoral incision, and the presence of multiple incisions were all associated with POICs. On multivariable analysis, tobacco use approached significance (odds ratio, 17.3 [95% confidence interval, 0.98 to 306.7]) and multiple incisions (odds ratio, 6.9 [95% confidence interval, 1.5 to 32.3]) had a statistically significant association with the occurrence of complications. CONCLUSIONS: The present study identified several variables potentially associated with complications after the use of PEEK implants in maxillofacial reconstruction. Consideration should be given in the preoperative evaluation when a smoker is identified and when multiple incisions are planned.

Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections.

PURPOSE: One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections. PATIENTS AND METHODS: We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ2 test and logistic regression, and from these results, a multiple logistic regression model was created. RESULTS: A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation. CONCLUSIONS: Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.

What Factors Are Associated With Implant Failure?

PURPOSE: Recognition of patient-specific risk factors should reduce implant failure. The purpose of this study was to identify risk factors associated with implant failure and to determine if these factors differ over time after implant placement. METHODS: The investigators implemented a retrospective case-controlled study and enrolled a sample composed of patients who had 1 or more implants removed from December 1, 2007 to February 29, 2020. Risk factors were grouped into demographic, medical history, and treatment-related variables. The primary outcome variable was whether the patient's implant failed, with control patients including those without implant failure. The duration was recorded for follow-up from the time of implant placement to the last visit or implant removal. Backward variable selection was used to predict whether an implant failed within 1 year, 1 to 4 years, or after 4 years in 3 multivariable logistic regressions. RESULTS: Of 224 patients in this cohort, 82 experienced an implant failure. The mean age was 58.6 ± 15.3 years, and 53.1% were females. Patients with osteoporosis had an increased risk of failure in each period. Alcohol use, smoking, depression, and penicillin allergy were all associated with an increased probability of failure within 1 or more of the periods considered. CONCLUSIONS: This study has identified multiple discrete risk factors for implant failure and has demonstrated that these factors are associated with implant failure at different periods after placement.

Is Arthroscopic Disk Repositioning Equally Efficacious to Open Disk Repositioning? A Systematic Review.

PURPOSE: Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The procedure can be arthroscopic disc repositioning or open disc repositioning. This systematic review measured and compared the efficacy of arthroscopic and open disc repositioning procedures. MATERIALS AND METHODS: The authors conducted a systematic review without meta-analysis by performing a literature search electronically and manually covering arthroscopic and open disc repositioning studies published up to July 2020 in Pubmed, Embase, and Cochrane databases. Surgical outcomes such as changes in maximal incisal opening (MIO) and pain scores, temporomandibular joint noises, diet consistency, malocclusion, and postoperative complications were extracted and analyzed. RESULTS: A total of 28 studies were included in the review and split into those assessing open disc repositioning (n = 13) and those assessing arthroscopic disc repositioning (n = 15). The average age of the study patients in the included studies was 31.5 ± 6.8 years, and women represented 83.3% of the study population. Both arthroscopic and open disc repositioning showed to be efficacious in reducing pain and increasing MIO. Due to heterogeneity in study designs and data reporting between the studies, no quantitative analysis was performed, and the groups were not directly compared. CONCLUSIONS: Both arthroscopic and open disc repositioning led to significant improvements in clinical outcomes based on pain scores and MIO. This study highlights the need for comparative studies of the 2 techniques with well-documented case selection including standardized diagnosis based on Wilkes stages and rigorous outcomes assessment including patient reported outcomes.

Factors influencing milk osteopontin concentration based on measurements from Danish Holstein cows.

Our objective was to determine the content of the bioactive protein osteopontin (OPN) in bovine milk and identify factors influencing its concentration. OPN is expressed in many tissues and body fluids, with by far the highest concentrations in milk. OPN plays a role in immunological and developmental processes and it has been associated with several milk production traits and lactation persistency in cows. In the present study, we report the development of an enzyme linked immunosorbent assay (ELISA) for measurement of OPN in bovine milk. The method was used to determine the concentration of OPN in milk from 661 individual Danish Holstein cows. The median OPN level was determined to 21.9 mg/l with a pronounced level of individual variation ranging from 0.4 mg/l to 67.8 mg/l. Breeding for increased OPN in cow's milk is of significant interest, however, the heritability of OPN in milk was found to be relatively low, with an estimated value of 0.19 in the current dataset. The variation explained by the herd was also found to be low suggesting that OPN levels are not affected by farm management or feeding. Interestingly, the concentration of OPN was found to increase with days in milk and to decrease with parity.

Development of a mixed-source, single pesticide database for use in ecological risk assessment: quality control and data standardization practices.

Inclusion of pesticide monitoring data in pesticide risk assessment is important yet challenging for several reasons, including infrequent or irregular data collection, disparate sources procedures and associated monitoring periods, and interpretation of the data itself in a policy context. These challenges alone, left unaddressed, will likely introduce unintentional and unforeseen risk assessment conclusions. While individual water quality monitoring programs report standard operating procedures and quality control practices for their own data, cross-checking data for duplicated data from one database to another does not routinely occur. Consequently, we developed a novel quality control and assurance methodology to identify errors and duplicated records toward creating an aggregated, single pesticide database toward use in ecological risk assessment. This methodology includes (1) standardization and reformatting practices, (2) data error and duplicate record identification protocols, (3) missing or inconsistent limit of detection and quantification reporting, and (4) site metadata scoring and ranking procedures to flag likely duplicate records. We applied this methodology to develop an aggregated (multiple-source), national-scale database for atrazine from a diverse set of surface water monitoring programs. The resultant database resolved and/or removed approximately 31% of the total ~ 385,000 records that were due to duplicated records. Identification of sample replicates was also developed. While the quality control and assurances methodologies developed in this work were applied to atrazine, they generally demonstrate how a properly constructed and aggregated single pesticide database would benefit from the methods described herein before use in subsequent statistical and data analysis or risk assessment.