Does Game-Based Learning Promote Academic Engagement Among Millennial Oral and Maxillofacial Surgery Residents?

BACKGROUND: House staff participating in surgical residency programs are often comprised of adult learners from the millennial generation (Gen Y). With the increasing gap in both age and learning styles between these residents and their educators, their educators are struggling to keep them academically engaged. PURPOSE: The purpose of this study was to measure the association between implementing a digital online Jeopardy! (Sony Pictures Studios, Culver City, CA) style game (digital game) (Factile Solace Creative, LLC, Melbourne Beach, FL) into oral maxillofacial surgery (OMS) resident didactic training and Oral and Maxillofacial Surgery In-service Training Examination (OMSITE) scores. STUDY DESIGN, SETTING, SAMPLE: This study was a retrospective cohort study conducted at The New York Presbyterian Hospital/Weill Cornell Medicine. OMS residents who took the OMSITE examination were included in the study. Exclusion criteria included OMS residents who did not take the OMSITE in a given year. INDEPENDENT VARIABLE: The independent variable was the timing of the implementation of the digital game, divided into before and after implementation. MAIN OUTCOME VARIABLES: The primary outcome variable was OMSITE scores. COVARIATES: Covariates included demographics (age, gender, and race), year of training, and number of examination attempts. ANALYSES: Descriptive and bivariate statistics included Fisher's exact test and Wilcoxon rank sum test. Linear mixed modeling was performed to take into account multiple observations per participants. RESULTS: The sample composed of 14 resident subjects with a median age of 27.5 (27.0, 28.7) years. Females represented 29% of the cohort. Seventy-one percent of the participants were Post Graduate Year 1. The median (interquartile range) OMSITE score preimplementation: 61 (48, 71) and postimplementation: 79 (68, 87). On average, the OMSITE scores improved significantly following the implementation of this study modality (P < .001). CONCLUSION AND RELEVANCE: Digital games may be an effective learning tool to prepare residents for OMSITE by promoting academic engagement.

Does the Use of Botulinum Toxin in Treatment of Myofascial Pain Disorder of the Masseters and Temporalis Muscles Reduce Pain, Improve Function, or Enhance Quality of Life?

BACKGROUND: The efficacy of botulinum toxin for management of myofascial pain disorder (MPD) remains controversial. PURPOSE: The purpose was to determine if the use of onabotulinumtoxinA (onabotA) in patients with MPD reduces pain, improves function, or enhances quality of life (QoL). STUDY DESIGN, SETTING, AND SAMPLE: This is a multicenter, prospective, randomized, double-blinded, placebo-controlled clinical trial. Subjects with orofacial pain were screened for MPD as defined by the Diagnostic Criteria for Temporomandibular Disorders. PREDICTOR VARIABLE: The primary predictor variable was MPD treatment with random assignment to onabotA or placebo (saline). MAIN OUTCOME VARIABLE: The primary outcome variable was pain before treatment (T0) and at 1 month (T1) using a visual analog scale. Secondary outcome variables included pain at 2 months (T2) and 3 months (T3), maximal incisal opening (MIO), jaw function (jaw functional limitation scale), and QoL (Short Form 36) measured at T0, T1, T2, and T3. COVARIATES: Covariates included subject demographics, prior treatments, and temporomandibular joint signs/symptoms. ANALYSES: Descriptive and bivariate statistics included χ2 test, Fisher's exact test, or t-test. RESULTS: Seventy five subjects with a mean age of 37 (±11) and 35 (±12) years in the onabotA and placebo groups, respectively (P = .6). Females represented 32 (86%) and 29 (76%), respectively (P = .3). Mean visual analog scale pain score in the onabotA group was 58 (±15), 39 (±24), 38 (±23), and 38 (±20) at T0, T1, T2, and T3, respectively; and the placebo group was 54 (±14), 40 (±23), 34 (±20), and 36 (±22) at T0, T1, T2, and T3, respectively. There was no statistically significant difference in pain between groups at any time point (P = .36). There was no statistically significant difference between groups in MIO (P = .124), jaw function (P = .236), or QoL domains (P > .05) at any time point. Within-group improvement in pain was seen in both groups (P < .005). Within-group improvement in jaw function was seen in the onabotA (P = .007) and placebo (P = .005) groups. There was no within-group improvement in MIO or QoL with either group (P > .05). CONCLUSIONS: OnabotA and saline (placebo) injections both decrease pain and improve jaw function in subjects with MPD.

Oral epithelium response of electronic cigarette users to electronic cigarette.

BACKGROUND: Electronic cigarettes are increasing in popularity, but there is only little information on their biologic effects on the oral epithelium, the initial site exposed to electronic cigarette smoke. METHODS: We assessed the oral epithelium response to electronic cigarettes by comparing the histology and RNA transcriptome (mRNA and miRNA) of healthy electronic cigarette vapers to nonsmokers. mRNA was assessed based on: (1) genome-wide; (2) genes previously identified as dysregulated in the oral epithelium of electronic cigarette vapers versus nonsmokers; (3) immune and inflammatory-related genes previously identified as dysregulated in the nasal epithelium of electronic cigarette vapers compared to nonsmokers; (4) genes previously identified as dysregulated in the small airway epithelium of nonsmokers following an acute exposure to electronic cigarette; and (5) genes related to the initial steps of COVID-19 infection. In addition, miRNA was assessed genome-wide. Comparisons were performed using analysis of variance, and Benajmini-Hochberg corrected p < 0.05 was considered significant. RESULTS: The histology of the epithelium, lamina propria and basal layer in electronic cigarette vapers appeared normal. Assessment of mRNA and miRNA, based on all gene lists, did not identify any genes significantly modified in the oral epithelium of electronic cigarette vapers in response to electronic cigarette use. CONCLUSION: An average history of 2 years of vaping results in no detectable histologic or transcriptome abnormalities in the buccal mucosa.

Microsurgical Head and Neck Reconstruction in Patients With Fanconi Anemia.

ABSTRACT: Patients with Fanconi anemia (FA) are at increased risk for head and neck cancers that often necessitate extensive reconstructions. Such patients have multiple comorbidities including anemia and thrombocytopenia frequently requiring bone marrow transplant, and they are at an increased risk of cancer recurrence and need for further extirpation. in the present study, charts from 3 patients with FA who underwent microvascular free tissue transfer by the senior author were retrospectively reviewed for pertinent pre- and peri-operative details in addition to functional and cosmetic outcomes. Two of these patients ultimately required metachronous free flap reconstructions for recurrence. All patients had acceptable functional and cosmetic outcomes following each instance of free flap reconstruction, thereby demonstrating the utility of microvas- cular free tissue transfer in patients with FA. The authors herein present each patient's clinical history in addition to a discussion of the current literature and an outline of our approach to these challenging cases.

Low-Intensity Pulsed Ultrasound Therapy: A Nonsurgical Treatment Modality for Mandible Fracture Nonunion?

Standard treatment of mandibular nonunion includes debridement and application of maxillomandibular or rigid internal fixation techniques, with adjunctive bone grafting when necessary. Frequently described in the orthopaedic literature, low-intensity pulsed ultrasound therapy (LIPUS) is a noninvasive treatment modality used to accelerate healing of fresh fractures and established nonunions. The purpose of this study was to conduct a systematic review to determine the extent of LIPUS study in the treatment of mandibular nonunions to identify whether LIPUS represents an effective nonsurgical alternative or adjunct for nonunion management. A literature review was conducted to investigate published reports on the utilization of LIPUS in treating mandible fracture nonunions. The search yielded two randomized controlled trials demonstrating favorable healing parameters in fresh human mandible fractures treated with LIPUS, two randomized controlled trials demonstrating osteogenic differentiation in human mandibular fracture cellular components, and one study reporting improved healing at rabbit mandibular osteotomy sites. No articles published reports studying LIPUS in facial fracture nonunion were identified. This report reviews published literature on mandibular nonunions, and the evidence of LIPUS use in long bone nonunions. There are no known studies presenting LIPUS treatment of mandible fracture nonunions. However, on the basis of published orthopaedic data, LIPUS therapy could be considered as an adjunct or alternative to traditional surgical management of select mandible fracture nonunions.