Anesthetic Management of a Cardiac Transplant Patient After Extensive Facial Trauma Caused by a Pit Bull Attack.

A 72-year-old male cardiac transplant patient presented after sustaining facial and extremity trauma caused by a pit bull dog attack. The case was further complicated by the duration of the surgery, bleeding, infection risk, intraoperative hypothermia, immunosuppression, and the risk of sepsis. His anesthetic management required careful coordination with his transplant team. We also sought the expertise of the in-house pharmacist to obtain the appropriate administration strategies for the patient's immunosuppressant agents. As the number of transplant patients increases, oral and maxillofacial surgeons must remain cognizant of the challenges and strategies associated with treating those undergoing graft-preserving immunosuppression. We have presented a more complex case of a cardiac transplant patient requiring extensive facial soft tissue reconstruction. The experience achieved in the management of a complex cardiac patient will no doubt provide guidance in the management of elective surgical procedures in other patients with simpler transplant histories.

What Name Best Represents Our Specialty? Oral and Maxillofacial Surgeon Versus Oral and Facial Surgeon.

PURPOSE: To determine whether changing "oral and maxillofacial surgeon" (OMS) to "oral and facial surgeon" improves the perception and awareness of the OMS's role and surgical scope of practice in undergraduate biomedical and dental students. MATERIALS AND METHODS: This cross-sectional study requested undergraduate and dental students to select 1 of 5 specialists to treat 21 conditions. Two different surveys were presented: 1 designating specialists as "oral and maxillofacial surgeons" and 1 designating specialists as "oral and facial surgeons." The independent variable was the specialist "oral and maxillofacial surgeon" or "oral and facial surgeon." The dependent variables included specialists chosen for the procedure (ear, nose, and throat surgeon; OMS vs oral and facial surgeon; plastic surgeon; periodontist; and "other"). The test of proportions (z test) with the Yates correction was performed. RESULTS: The sample was composed of 1,671 undergraduate upper division science students and 568 senior dental students. Results showed that undergraduate students' perception of an OMS's surgical scope increased significantly from 28 to 33% when "oral and facial surgeon" was used instead of "oral and maxillofacial surgeon." Dental students' perception of an OMS's surgical scope remained the same whether "oral and maxillofacial surgeon" or "oral and facial surgeon" was used. CONCLUSION: The results of this study suggest that using "oral and facial surgeon" instead of "oral and maxillofacial surgeon" increases awareness of an OMS's surgical scope of practice in undergraduate upper division science students, which could be an important step toward increasing the recognition of the profession by the general public and other non-dental medical colleagues.

Does Bone Grafting Improve Outcomes in Coronectomy Surgery? Long-Term (5- to 9-Year) Clinical and Radiographic Follow-Up of 78 Adult Patients.

PURPOSE: To report the long-term outcomes of 78 adult patients who underwent coronectomy with bone grafting (CWG) of the bony crypt. MATERIALS AND METHODS: Seventy-eight patients with follow-up of at least 5 to 9 years underwent CWG. Preoperative imaging and probing depths were recorded, as were yearly follow-up radiographs or cone-beam computed tomograms and yearly postoperative probing depths. RESULTS: Periodontal probing depths and bone levels on the distal surfaces of adjacent mandibular molars showed marked improvement compared with preoperative probing depths and bone levels. All retained roots maintained their immediate postoperative positions with no migrations and no reoperations required. CONCLUSION: CWG is a predictable procedure that should be considered for patients at risk for developing sensory disturbances or for those with deeper (>4 mm) preoperative probing depths on the distal surfaces of the adjacent molars. Adding bone graft appears to aid in preventing root migration and decreasing probing depths on the distal surfaces of adjacent molars.

Common Oral Manifestations of Select Systemic Diseases: Anemia, Diabetes Mellitus and HIV.

In this article, we discuss several common abnormal signs and symptoms that may be present in the oral cavity initially with or without any systemic symptoms at a typical dental practice. The purpose of this discussion is to increase clinical awareness for establishing differential diagnoses so that patients may obtain appropriate referrals for appropriate medical treatment.

A novel regulatory factor recruits the nucleosome remodeling complex to wingless integrated (Wnt) signaling gene promoters in mouse embryonic stem cells.

The nucleosome remodeling and deacetylation (NuRD) complex is required for modulating the transcription of essential pluripotency genes in ESC self-renewal. MBD3 is considered a key player in the formation of a functional NuRD complex. The recruitment of MBD3 to methylated promoters may require other prerequisite factors. We show that cyclin-dependent kinase 2-associated protein 1 (CDK2AP1), an essential gene for early embryonic development, plays a role in pluripotency of ESC by engaging MBD3 to the promoter region of Wnt signaling genes. The occupancy of MBD3 on several promoters of Wnt genes was significantly lost in the absence of CDK2AP1, resulting in hyperactivation of Wnt. We propose that the transcriptional modulation of the Wnt pathway mediated by NuRD requires the presence of essential auxiliary components such as CDK2AP1, which may aid the association of the complex with specific focal regions of the target promoters.

Efficacy and Cost of Maxillary Patient-Specific Implants in Orthognathic Surgery: A Review of Three Patient Cases.

INTRODUCTION: Patient-specific implants (PSIs) are accurate, efficient alternatives to traditional plate fixation. They are well-suited for use in procedures that require the utmost accuracy, stability, and efficiency. Although PSIs have demonstrated such qualities in craniomaxillofacial reconstruction, they have so far found limited utilization elsewhere. CASE PRESENTATION: We explored the departmental protocol for Lefort 1 PSI orthognathic surgery at a high-volume, tertiary referral center. Three cases were selected that matched predetermined criteria, which included treatment by the same surgical team, concurrent Lefort 1 osteotomy and bilateral sagittal split osteotomy, Angle's type 3 malocclusion, lack of interdental osteotomies, and American Society of Anesthesiologists classification 2 or less without metabolic or osseous diseases. The operative outcomes from these patients were then compared to similar cases also meeting the same criteria and conducted within the same time period. CONCLUSION: The use of PSI in Lefort 1 osteotomy is associated with anatomically sound designs that could contribute to postoperative stability of the jaws. They also have not shown increased rates of complications such as infection, dehiscence, or relapse at 6 weeks postoperatively but may in fact decrease the operative duration. These findings are consistent with the results gleaned from literature on the use of PSI in craniomaxillofacial reconstruction.

Vascular Floor of Mouth Mass with Unanticipated Intracranial, Orbital, and Vertebral Associated Involvements.

We report on a case in which a blanching, unobtrusive oral growth proved to be a systemic threat. A blind, epileptic child presented with a bleeding oral floor mass of 4 weeks. Biopsy showed small, dilated vascular spaces with reactive fibroblasts. MRI indicated distribution of expansile lesions in the mandible, cranial base, and right orbit that had possibly contributed to the patient's years-long neurologic deficits. A subsequent bone scan indicated lesions in multiple axial bones. Histologic markers confirmed the presentation of a rare cystic vascular pathology. Cystic Angiomatosis is a disease of intraosseous vascular malformations with occasional visceral involvements. Oral and craniomaxillofacial cases are especially rare and presentations can involve neuropsychiatric deficits, sensory issues, and mucosal bleeding. While clinicians are often dismissive of intraoral bleeding because of the prevalence of periodontal disease, careful evaluation is nonetheless critical to rule out underlying diseases with a possibly significant systemic involvement.

Capacity Degradation Mechanism and Cycling Stability Enhancement of AlF3-Coated Nanorod Gradient Na[Ni0.65Co0.08Mn0.27]O2 Cathode for Sodium-Ion Batteries.

O3-type Na[Ni xCo yMn z]O2 materials are attractive cathodes for sodium-ion batteries because of their full cell fabrication practicality, high energy density, and relatively easy technology transfer arising from their similarity to Li[Ni xCo yMn z]O2 materials, yet their performance viability with Ni-rich composition ( x ≥ 0.6) is still doubtful. More importantly, their capacity degradation mechanism remains to be established. In this paper, we introduce an O3-type Ni-rich AlF3-coated nanorod gradient Na[Ni0.65Co0.08Mn0.27]O2 cathode with enhanced electrochemical performance in both half-cells and full cells. AlF3-coated nanorod gradient Na[Ni0.65Co0.08Mn0.27]O2 particles were synthesized through a combination of dry ball-mill coating and columnar composition gradient design and deliver a discharge capacity of 168 mAh g-1 with 90% capacity retention in half cells (50 cycles) and 132 mAh g-1 with 90% capacity retention in full cells (200 cycles) at 75 mA g-1 (0.5C, 1.5-4.1 V). Through analysis of the cycled electrodes, the capacity-degradation mechanism was unraveled in O3-type Ni-rich Na[Ni xCo yMn z]O2 from a structural perspective with emphasis on high-resolution transmission electron microscopy, providing valuable information on improving O3-type Na[Ni xCo yMn z]O2 cathode performance.

Multiple Oral Mucosal Hamartomas in a 34-Year Old Female.

A case of Cowden syndrome (CS) is described in a 34-year-old African American female who reported a history of breast and thyroid malignancies. Clinical examination demonstrated multiple soft, white-pink papules across multiple mucosal surfaces of the oral cavity. Microscopy of the lesions revealed hyperkeratotic surface squamous epithelium with papillomatosis and acanthosis along with elongated rete processes. A genomic polymerase chain reaction direct sequencing using the patient's blood was positive for mutations of the PTEN gene typical of CS.

Where to position osteotomies in genioglossal advancement surgery based on locations of the mental foramen, canine, lateral incisor, central incisor, and genial tubercle.

PURPOSE: The study aimed to provide precise measurements of anterior mandibular structural anatomy and to explore potential osteotomies for genioglossal advancement. METHODS: Cone beam computed tomography was used to analyze 33 randomly selected patients undergoing surgery for obstructive sleep apnea (OSA) between 2014 and 2016 at an academic surgical hospital. The locations of relevant mandibular structures were measured and statistical modeling was performed. RESULTS: Mean horizontal distances from midline to the mental foramina and the roots of the canine, lateral incisor, and central incisor were 22.11 ± 1.92, 13.56 ± 3.01, 6.19 ± 1.58, and 2.04 ± 0.87 mm, respectively. Mean vertical distances from the inferior border of the mandible were 15.15 ± 1.77, 17.11 ± 3.28, 20.48 ± 3.10, and 21.81 ± 3.49 mm, respectively. The superior border of the genial tubercle was 15.63 ± 2.75 mm, and the inferior border was 6.87 ± 3.29, from the inferior border of the mandible. The angle of decline of the best-fit line through the important structures was about 18° from the occlusion plane at the midline. CONCLUSIONS: A straight line estimating the mental foramen, canine, lateral incisor, and central incisor tooth roots crosses at a mean of 22.3-22.6 mm above the inferior border of the mandible at the midline and has an angle of decline of about 18°. Potential osteotomies made parallel to and below this line result in tradeoffs between maximizing capture of the genioglossus muscle attachment and risk of dental/neurovascular injury.

Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery.

OBJECTIVE: To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. STUDY DESIGN: This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value < .05 was considered to be statistically significant. RESULTS: One hundred ninety-six patients with symmetric bilateral partial bony or full bony impacted mandibular third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides. CONCLUSIONS: MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery.

Raman Evidence for Late Stage Disproportionation in a Li-O2 Battery.

Raman spectroscopy is used to characterize the composition of toroids formed in an aprotic Li-O2 cell based on an activated carbon cathode. The trends in the Raman data as a function of discharge current density and charging cutoff voltage provide evidence that the toroids are made up of outer LiO2-like and inner Li2O2 regions, consistent with a disproportionation reaction occurring in the solid phase. The LiO2-like component is found to be associated with a new Raman peak identified in the carbon stretching region at ∼1505 cm(-1), which appears only when the LiO2 peak at 1123 cm(-1) is present. The new peak is assigned to distortion of the graphitic ring stretching due to coupling with the LiO2-like component based on density functional calculations. These new results on the LiO2-like component from Raman spectroscopy provide evidence that a late stage disproportionation mechanism can occur during discharge and add new understanding to the complexities of possible processes occurring in Li-O2 batteries.