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.

Squamous Cell Carcinoma of the Tongue in Young Patients: A Case Series and Literature Review.

PURPOSE: The purpose of this study was to describe 3 cases of tongue cancer in patients less than 21 years of age. Secondarily, a literature review was performed to examine disease presentation, risk factors, prognosis, and treatment strategies for young persons with tongue cancer. METHODS: The authors presented 3 cases of childhood tongue cancer between 2009 and 2020 at the University of Michigan Department of Oral and Maxillofacial Surgery (Ann Arbor, MI). An electronic literature review was conducted via PubMed, Embase, Web of Science, and MLibrary. RESULTS: Including the present case series, 64 studies reporting 108 cases were identified. Age at presentation ranged from newborn to 20 years, with a mean age of 14.5 years. The majority of patients were female (52.2%); 68.1% of patients presented with T1 or T2 disease. Nodal metastases were seen in 56.1% of patients. The most commonly identified predisposing factors included Fanconi anemia (13.9%), bone marrow transplant (9.3%), tobacco use (6.5%), and xeroderma pigmentosum (4.6%). Most patients received surgery alone (37.5%), followed by surgery with adjuvant radiation (33.8%); 60.6% underwent neck dissection. Overall survival was 60.3% at 1 year and 43.6% at 5 years. CONCLUSIONS: Oral tongue cancer in the young is a rare disease with poorly understood etiology. There is a need for oncologists and maxillofacial surgeons to collaborate in the study of genetic, social, environmental, and medical risk factors contributing to the disease. All patients should undergo high-throughput genetic sequencing to expand our understanding of the disease process and allow for targeted treatment strategies.

Digital Immediate Complete Denture for a Patient with Rhabdomyosarcoma: A Clinical Report.

Fabricating an immediate complete denture can be very challenging in some clinical situations. This clinical report describes a digital workflow to fabricate a printed maxillary immediate complete denture for a patient with a severely compromised maxilla. Digital data obtained by using an intraoral scanner was utilized to reconstruct the three-dimensional (3D) image of the jaws at the desirable vertical dimension of occlusion. After performing the virtual teeth extraction and alveoloplasty, the denture base and teeth were designed. The resulting data were exported to a 3D printer for denture fabrication and the 3D printed (additively manufactured) denture was successfully inserted immediately after the surgery. After initial healing and confirmation of good retention and function, a new printed denture was fabricated by digitally duplicating the relined denture maintaining the same teeth positions but adjusting the base to a new intraoral scan of the healed ridge.

3D Airway changes using cone beam computed tomography in patients following mandibular advancement surgery with and without constriction.

OBJECTIVES: The aim of this study was to compare three-dimensional airway changes resulting from mandibular advancement surgery and mandibular advancement surgery with constriction. SETTING AND SAMPLE POPULATION: The University of Michigan School of Dentistry and Medical Center. A total of 42 patients undergoing mandibular advancement with or without simultaneous constriction. MATERIALS AND METHODS: A retrospective airway evaluation of patients undergoing mandibular advancement with or without simultaneous mandibular constriction was performed. Cross-sectional evaluation at standardized locations, minimum cross section and volumetric analysis were performed using Dolphin Imaging TM Version 11.7. RESULTS: Patients undergoing mandibular advancement with or without constriction experienced significant airway increases (P < 0.05). Patients who underwent mandibular advancement only gained nearly twice as much airway volume as mandibular advancement with simultaneous constriction (8.69 mm3 vs 4.3 mm3 ). The largest increase for both groups was observed in the minimum axial area in the oropharynx segment (119.5 mm2 ) and the axial area of the retroglossal region (137.2 mm2 ). CONCLUSIONS: The findings demonstrate mandibular advancement with constriction results in airway enlargement following surgery.

Proceedings of the American Association of Oral and Maxillofacial Surgeon's 2017 Clinical and Scientific Innovations in Oral and Maxillofacial Surgery (CSIOMS).

The sixth biennial Clinical and Scientific Innovations in Oral and Maxillofacial Surgery, formerly the Research Summit, of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois from April 28 to 30, 2017. The goal of the symposium is to provide a forum for the latest clinical and scientific advances to be brought to the specialty. It also nurtures collaboration and the development of relationships between oral and maxillofacial surgeons and researchers to bridge the gap between clinical and basic science. The goal is to improve the care of oral and maxillofacial surgical patients through the advancement of translational and clinical research.

Squamous Cell Carcinoma of the Tongue During Pregnancy: A Case Report and Review of the Literature.

Epidemiologic data have shown changes in the demographic profile of patients presenting with oral cavity squamous cell carcinoma (SCC) during the past 4 decades. In particular, there has been a marked increase in the number of young women without a history of smoking presenting with SCC of the tongue. A Surveillance, Epidemiology, and End Results review of patients with head and neck cancer identified 5.3% younger than 40 years. After comparing cohorts from 1973 to 1984 with 1985 to 1997, a 60% increase in tongue cancer in patients younger 40 years was noted. Epidemiologic data also have shown that women are tending to delay childbearing to an older age. These 2 factors have resulted in an increasing prevalence of cancer diagnosed during pregnancy. If current trends continue, oral surgeons and maternal fetal medicine obstetric specialists will see an increasing number of pregnant patients presenting with malignancies. This in turn will lead to a number of complex surgical and adjuvant treatment considerations resulting in ethical and moral decisions for which limited data exist to guide best practice. The treatment chosen will affect not only the health of the patient, but also the health of the fetus and ongoing pregnancy. This report describes the case of a woman who was diagnosed with SCC of the tongue at 14 weeks' gestational age. This report presents her treatment course and a review of the literature to support her decisions related to the care given.

Proceedings of the American Association of Oral and Maxillofacial Surgeons 2015 Research Summit.

The Fifth Biennial Research Summit of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois on May 6 and 7, 2015. The goal of the symposium is to provide a forum for the most recent clinical and scientific advances to be brought to the specialty. The proceedings of the events of that summit are presented in this report.

Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children: Part I.

BACKGROUND: Limited outcome data exist regarding the survival of microvascular free flaps for head and neck reconstruction in children. The objectives of this study were to perform a systematic review of the literature and meta-analysis comparing the survival of the most commonly used free flaps used for head and neck reconstruction in children. METHODS: A systematic search of PubMed, Embase, and Scopus was conducted using various keywords up to January 1, 2015. Meta-analysis was used to compare the survival of the most commonly used free flaps. The primary predictor variable was free flap type. The primary outcome variable was flap failure. The pooled relative risk (RR) with 95% confidence intervals (CIs) was estimated using a Mantel-Haenszel, fixed-effects model. RESULTS: The authors reviewed 25,303 abstracts. Five studies met inclusion criteria. A total of 646 children received a total of 694 free flaps. The pooled survival rate among all free flaps was 96.4%. The fibula free flap (fibula) and subscapular system free flaps (scapula) were the most commonly used flaps. There was no difference in survival when comparing the scapula (RR = 0.59, 95% CI: 0.26, 1.56, P = 0.29), or fibula (RR = 1.91, 95% CI: 0.55, 6.65, P = 0.31) to other free flaps, or when comparing the scapula to the fibula (RR = 2.29; 95% CI: 0.40, 13.08, P = 0.35). CONCLUSIONS: Free tissue transfer is highly successful in children. Although data are limited, there appears to be no difference in survival among various free flaps used for head and neck reconstruction in children.

Significantly Decreased Recurrence Rates in Keratocystic Odontogenic Tumor With Simple Enucleation and Curettage Using Carnoy's Versus Modified Carnoy's Solution.

PURPOSE: A variety of modalities has been suggested for treatment of keratocystic odontogenic tumor (KOT), including Carnoy's solution (CS) and modified Carnoy's (without chloroform) solution (MC). The purpose of the present study was to investigate the effect of CS versus MC as it relates to the KOT recurrence rates when used in conjunction with simple enucleation and curettage (E&C) for treatment of KOT. MATERIALS AND METHODS: A retrospective cohort study of patients with a pathologic diagnosis of KOT treated with E&C and application of CS or MC by 3 surgeons at a single center from January 1996 to April 2014 was completed. The demographic, clinical, radiographic, and histologic data were collected for each patient. All disease recurrences were confirmed by biopsy. The primary outcome variable of the study was the interval to recurrence, with the predictor of CS versus MC. Other variables included in the analysis were gender, age, surgeon, and lesion location. Multivariate analysis, including the Wilcoxon test and χ(2) test of associations, was performed. RESULTS: A total of 210 patient medical records were reviewed, with 80 patients meeting the final study criteria. Of the 80 patients, 44 were in the CS arm and 36 in the MC arm. The median age was 47 years (range 10 to 89) in the CS group and 50 years (range 14 to 72) in the MC group (P = .70). Women accounted for 43% (19 of 44) and 44% (16 of 36) of the patients in the CS and MC treatment arms, respectively (P = .91). The lesions were found in the mandible in 26 of the 44 patients (59%) treated with CS and 22 of the 36 patients (61%) treated with MC (P = .85). Surgeon 1 treated 37 of the 44 patients (84%) and 21 of 36 patients (58%) in the CS and MC groups, respectively (P = .01). The recurrence rate was 10% for the CS arm and 35% for the MC arm (P = .027; hazard ratio 6.9). CONCLUSION: In the present retrospective study, the recurrence rate of KOTs treated by E&C with application of CS is significantly lower than that of MC. The data provided could be considered by the Food and Drug Administration for a clinical trial of CS in patients with KOT.

A case of imperforate Wharton duct.

Congenital oral masses are rare entities. The establishment of formal fetal diagnostic teams has led to an increased antenatal detection of such lesions. The congenital ranula is a distinct entity from the more familiar variant presenting later in life. The congenital variant may result from an anomaly of the Wharton duct with subsequent dilation of the duct. The variant presenting later in life is the more familiar mucous extravasation phenomenon in the floor of the mouth. Management of the congenital ranula is distinct from its noncongenital counterpart and more conservative and is discussed in the present report.

Oral maxillofacial surgery resident, faculty and practitioner role models and dental students' interest in oral maxillofacial surgery careers: Does gender matter?

PURPOSE: Residency programs in oral maxillofacial surgery (OMS) have the lowest percentage (2020: 18.4%) of female graduates among all dental specialty programs. When considering this underrepresentation of female OMS residents, prior studies have not examined how OMS role models might shape dental students' interest in OMS careers. The objectives were to assess female versus male students' OMS-related career motivation, their experiences/attitudes toward three groups of OMS role models (i.e., OMS residents, faculty, and practitioners), and relationships between role model-related experiences/attitudes and career motivation. METHODS: 363 female and 335 male students from 14 United States and two Canadian dental schools participated in this cross-sectional study by responding to an online survey. RESULTS: 13.8% of female and 26% of male respondents (p < 0.001) were much/very much interested in OMS careers. More male than female students had shadowed an OMS in an office setting (43.4% vs. 35.1%; p < 0.05). The groups did not differ in their motivation to learn more and earlier about OMS nor in the quantity of OMS-related experiences prior to and during dental school. However, male students were more satisfied with the quality of these experiences (5-point scale with 5 = most positive: Means: 3.76 vs. 3.53; p < 0.05), were more comfortable approaching/working with OMS instructors (3.51 vs. 3.19; p < 0.01) and reported to have learned more from residents (3.52 vs. 3.31; p < 0.05) and faculty (3.75 vs. 3.45; p < 0.01) than female students. Female students agreed less that OMS residents, faculty, and practitioners encouraged students to pursue OMS (3.27 vs. 3.44; p < 0.01 / 3.46 vs. 3.63; p < 0.01 / 3.45 vs. 3.61; p < 0.01). Role model-related experiences and attitudes correlated with an interest in an OMS career. CONCLUSIONS: The two groups do not differ in the quantity of most OMS experiences before and during dental school and their motivation to learn more and earlier about OMS. However, female students' less positive OMS-related educational experiences and less positive attitudes toward role models correlate with a lower interest in OMS careers.

Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

PURPOSE: This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. MATERIALS AND METHODS: Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. RESULTS: Residents who considered academia were more likely to be women (29% vs 8%; P < .001), from non-European American backgrounds (37% vs 20%; P = .006), were less likely to be married (43% vs 71%; P < .001), and were less likely to have children (17% vs 40%; P < .001) than residents who planned to become private practitioners. A larger percentage of residents with interest in private practice reported having debts of $301,000 to $400,000 compared with the percentage of residents interested in academia. No differences were found in the way they financed their education or in their financial considerations. However, the 2 groups differed in the importance they placed on different characteristics of their professional lives and in their job-related satisfaction. Residents interested in academia responded less positively to the statement that they are extremely satisfied with their career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. CONCLUSIONS: These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia.

Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report.

BACKGROUND: Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon. CASE PRESENTATION: We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible. CONCLUSIONS: Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Dental students' OMFS-related experiences and interest in OMFS careers: An exploration.

PURPOSE: While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still underrepresented. The objectives were to assess dental students' OMFS-related personal and educational experiences and attitudes and explore which factors correlate with their interest in future OMFS careers. METHODS: Data were collected from 493 dental students in 1 dental school and 206 students from 15 other US and Canadian dental schools. RESULTS: The students in the national sample were more likely to have experienced an OMFS procedure themselves (64.6% vs. 50.7%; P = 0.001), have shadowed an OMFS in an operating room (23.2% vs. 14.9%; P = 0.009) prior to coming to dental school and to be much/very much interested in an OMFS career (36.4% vs. 12%; P < 0.001) than the students at the home school. While the majority of both groups rated their experiences with rotations in the OMFS department in the dental school (68% vs. 62.5%) and in the hospital (80.3% vs. 85.7%) as very interesting, the students in the national sample were more likely to agree/strongly agree that they were satisfied with their OMFS experiences (68.1% vs. 36.3%; P < 0.001) and had learned a lot from the OMFS faculty (57.9% vs. 30.8%) than the students in the home school. For both groups, the degree of interest in an OMFS career correlated with having had more personal OMFS experiences (home: r = 0.28; P < 0.001/other: r = 0.39; P < 0.001), more interesting OMFS experiences in the dental school (r = 0.23; P < 0.05/r = 0.40; P < 0.001) and the hospital (0.33; P < 0.05/r = 0.50; P < 0.001) and more positive attitudes toward OMFS faculty (r = 0.26; P < 0.001/r = 0.37; P < 0.001). CONCLUSIONS: Positive personal and educational OMFS experiences and positive attitudes toward OMFS faculty were associated with an interest in OMFS careers. These findings provide a basis for developing educational interventions aimed at increasing the percentage of women and residents from URM backgrounds in OMFS programs.

Impact of sleep-disordered breathing on behavior and quality of life in children aged 2 to 7 years with non-syndromic cleft lip and/or palate.

INTRODUCTION: Children with cleft are at high risk for sleep-disordered breathing (SDB). However, little is known about the impact of SDB in this pediatric population. The aim of this study was to investigate whether SDB play a role in behavior and quality of life (QoL) in young children with cleft. METHODS: Cross-sectional study of 95 children aged 2.0-7.9 years with cleft palate. Parents completed a sleep (Pediatric Sleep questionnaire), a behavior (Conners' Early Childhood scale), and a generic health-related QoL (KINDL questionnaire) assessment. Symptomatic children were referred for a polysomnography (PSG). RESULTS: Overall, 14.7% of children (49.5% boys) screened positive for SDB and 27.4% had a PSG, which identified 84.6% with sleep apnea (apnea-hypopnea index [AHI] ≥1) and 27.2% with AHI ≥5. Positive screening for SDB was associated with elevated T-scores for anxiety and physical symptoms, significant differences in mean T-scores for inattention/hyperactivity (64.2 ± 15.7 vs. 53.9 ± 11.4, p = .02), social functioning/atypical behaviour, social functioning (60.6 ± 11.7 vs. 51.9 ± 7.3, p = .004 and 59.5 ± 10.9 vs. 51.2 ± 8.0, p = .01) and mood (57.5 ± 8.2 vs. 50.7 ± 8.2, p = .03). Lower QoL scores for emotional and family well-being were also reported in children with SDB (80.7 ± 13.4 vs. 90.0 ± 8.7, p = .01, 66.7 ± 15.8 vs. 76.9 ± 11.9, p = .04). Children with AHI ≥5 compared to those with AHI ≥1 and <5 showed significant differences in mean T-score for aggressive behaviour (65.2 ± 12.1 vs. 52.3 ± 11.3, p = .04), defiant temper (62.8 ± 9.2 vs. 51.6 ± 10.2, p = .03) and lower family QoL scores (59.4 ± 15.2 vs. 77.1 ± 9.6, p = .006). CONCLUSIONS: In children with cleft palate the presence of SDB symptoms and moderate/severe sleep apnea was associated with behavioral (internalizing/externalizing) problems and lower family well-being.

Orthodontic Considerations for Cleft Orthognathic Surgery.

Preparation and planning for orthognathic surgery in late adolescence depends on the complexity of unresolved problems with which the patient presents. Different strategies are presented to address these unresolved problems in the adult patient with cleft lip and palate. Different surgical and orthodontic treatments are presented to correct the class III malocclusion in patients with cleft lip and palate in ranges that are analogous to the envelope of discrepancy. For complex cases, the principles of achievability, stability, and esthetics should guide the decision-making process for planning the preparation for orthognathic surgery.

Three-dimensional treatment planning for maxillary and mandibular segmental surgery for an adult Class III: Where old meets new.

Class III open bite malocclusion can be among the most difficult case types to obtain an excellent occlusal, skeletal, and facial outcome. Treatment options include growth modification, extraction for orthodontic camouflage, and orthognathic surgery. For the most severely affected and non-growing patients, orthognathic surgery is often the most predictable and, in some situations, the only viable way of achieving an optimal result. The risks and benefits of surgical treatment options can occasionally be difficult to assess particularly for providers with limited experience. Two-dimensional surgical predictions can assist but do not permit the third dimension to be visualized. New techniques of computer-aided surgical simulation can enable the surgeon, orthodontist, and patient to better visualize and understand the treatment approach and enable them to make the most effective and efficient treatment related decisions. This case merges knowledge of the full spectrum of historical surgical techniques with the new approach of computer-aided surgical simulation (CASS) to perform complex segmental maxillary and mandibular surgery to obtain an excellent functional and esthetic result.