Are More Medically Complex Patients Who Undergo Complex Septorhinoplasty at an Increased Risk for Surgical Site Infection?

BACKGROUND: Prophylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiologists (ASA) value greater than or equal to 3. PURPOSE: The study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty. STUDY DESIGN, SETTING, SAMPLE: Retrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records. INDEPENDENT VARIABLE: All patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study's independent variable. MAIN OUTCOME VARIABLE: The main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment. COVARIATES: The demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used. ANALYSES: χ2 Analysis and t-tests were used for calculations, with P values < .05 being considered significant. RESULTS: A total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient's age (P < .01), male sex (P < .01), and a diagnosis of diabetes (P < .01) were associated with an ASA value of 3. In total, there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P = .27, relative risk of .40) was not shown to be associated with an increased risk of SSI. CONCLUSION AND RELEVANCE: Our results suggest that an ASA of 3 is not significant with regard to postoperative infection in patients who undergo a complex nasal septorhinoplasty, and prophylactic postoperative antibiotics are not warranted.

Does the type of planning in orthognathic surgery influence patient satisfaction?

PURPOSE: To determine if the method of orthognathic surgery planning used-computer aided surgical simulation (CASS) versus analog model surgery-influenced patients' post-operative satisfaction. The authors hypothesized that there was no difference in patient satisfaction based on the type of planning in orthognathic surgery. METHODS: This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a 6-year period. Patients were asked to complete a survey questionnaire that consisted of eight questions, each utilizing a five-point Likert scale. RESULTS: There were 643 patients initially identified with 401 potential subjects meeting the inclusion criteria. Of these 401 patients, the survey was successfully administered to 161. Patients whose orthognathic surgery was planned virtually were not only significantly more likely to be satisfied with their appearance post-operatively, but also more likely to go through with surgery again if they could choose to (p < 0.05). CASS patients were also more likely to identify that their surgery was planned virtually. When stratified by age, younger patients were more likely to have read about CASS. When each survey question was stratified based on the type of surgery that was performed, there were no significant differences. CONCLUSION: Patients whose surgeries were virtually planes were significantly more likely than model surgery patients to be satisfied with their post-operative appearance as well as with their decision to have orthognathic surgery. CASS has proven to be an accurate, time-saving, and potentially cost-saving tool for surgeons. Based on the results of this study, the type of surgical planning method matters for post-operative patient satisfaction with their appearance.

Dentinogenic ghost cell tumor: a case report and review of the literature.

The purpose of this report is to highlight the presentation and review the clinical and histopathological features of DGCT. There have been 130 DCGT diagnoses reported in the literature. DGCT is part of the odontogenic ghost cell tumor family which also includes the calcifying odontogenic cyst (COC) and the ghost cell odontogenic carcinoma (GCOC). In June of 2018, a 48-year-old female presented with a painless, soft tissue growth overlying the right mandibular alveolar ridge. Further workup of the lesion included a panoramic radiograph and maxillofacial computed tomography (CT) which revealed a well-defined, multilocular lytic expansile radiolucency occupying the right mandibular body. An incisional biopsy of the right mandibular gingival mass was performed which revealed an unusual odontogenic neoplasm with mineralization and ghost cells. The patient was subsequently treated with excisional biopsy of the right mandibular lesion via enucleation and curettage. The specimen was sent to pathology and the tumor was found to have an epithelial neoplastic proliferation resembling that of ameloblastoma, accompanied by foci of ghost cells. Since mandibular bone was involved, a diagnosis of a benign central DGCT with extension into the overlying gingiva was rendered. She was successfully treated with excisional biopsy via enucleation and curettage and has no evidence of recurrence at three years post-operatively. DGCT can exhibit locally aggressive behavior and is characterized by ameloblastoma-like epithelial cells and the presence of dentinoid material and ghost cells.

Is a Medical Degree Associated With Faculty Leadership Position Attainment in Oral and Maxillofacial Surgery Residency Programs?

PURPOSE: The decision to obtain double-degree versus single-degree training in oral and maxillofacial surgery (OMS) has been a widely debated topic in the United States over the past several decades. The purpose of this study is to determine if OMS faculty holding leadership positions (ie, program directors and chairs/chiefs) are more likely to be single-degree trained versus double-degree trained. METHODS: The authors designed a cross-sectional observational study to address the research purpose. The primary predictor variable was faculty leadership education (single-degree trained vs double-degree trained). The secondary predictor variable was accredited OMS program type led by the faculty with leadership positions (double-degree, both single-degree and double-degree, single-degree, or military program). The primary outcome variable was faculty leadership position (program director or chair/chief). Sums and percentages were calculated and Chi-squared (χ2) tests were used to compare the faculty leadership education with faculty leadership positions for each group. P values less than .05 were considered statistically significant. RESULTS: The study sample was composed of 198 subjects, of which 99 subjects were identified as program directors and 99 subjects were identified as chairs/chiefs. There was no statistically significant difference between the proportions of program directors and chairs/chiefs who were single-degree trained versus double-degree trained when looking at all accredited OMS programs in the United States (52.5% vs 47.5%, P = .615 and 56.6% vs 43.4%, P = .191, respectively). However, program directors of double-degree programs were statistically significantly more likely to be double-degree trained than single-degree trained (77.1% vs 22.9%, P = .001) and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained than double-degree trained (67.4% vs 32.6%, P = .022 and 65.1% vs 34.9%, P = .047, respectively). CONCLUSION: Overall, no statistically significant difference exists between the proportions of program directors and chairs/chiefs that were single-degree trained versus double-degree trained at accredited OMS programs. However, when stratifying programs by program type, program directors of double-degree programs were statistically significantly more likely to be double-degree trained and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained.