Contemplations and Ruminations of Methodological Error.

PURPOSE: Journal articles in our field of oral and maxillofacial surgery are rife with case studies, cohort reviews, meta-analysis, basic science studies, surgical techniques, and anatomic studies. The data found in these studies often rely on multiple measurements by which the authors draw their conclusions. Accurate measurements play a critical role in the design of the study, which in turn affects the conclusion that the author is attempting to convey. Investigators must determine and develop the processes to determine the methodological errors associated with each project to help with determining the accuracy of these measurements. The aim of this study is to highlight some of the methodological errors contained in the material and methods in oral and maxillofacial surgery studies over the calendar years of 2018 and 2019 and how best to evaluate them. MATERIALS AND METHODS: The inclusion criteria involved articles that used measurements where discrepancies could exist such as clinical measurements, histological measurements, and radiological measurements. The number of specimens or subjects measured in each study was tabulated. RESULTS: Over the 2-year period considered, 744 articles were published, and 116 (15.6%) of them met the inclusion criteria. Of these articles, 37 (32%) reported a methodological error, while 79 (68%) did not. In addition, 31 (84%) of the articles with a methodological error were radiographic, while only 6 (16%) were not radiographic. Among the studies that reported methodological error, there were approximately 7 different types used with no rationale given for the choice. CONCLUSIONS: We believe that it is important to ensure sound methods and materials, including a stated methodological error. An attempt at standardization will help to serve to enhance and strengthen the different research studies seen in our field.

Anatomic Variability of the Human Orbit.

PURPOSE: Knowledge of the bony orbit and how its volume changes are clinically important in addressing traumatic injuries. Restoration of orbital volume in some patients is critical to achieving successful outcomes after such injuries. In this large cadaveric study, we aimed to assess the average volume, range of bony orbit volumes, degree of volume discrepancy between the right and left orbits, and percentage of skulls with 1- and 1.5-mL orbital volume differences via alginate impressions and volume displacement. MATERIALS AND METHODS: This study used 121 skulls (242 orbits) from the University of Texas Southwestern Department of Cell Biology/Anatomy. Seal-press wrap was first adapted to each bony orbit to ensure no damage to the internal orbits, foramina, or fissures. Alginate impressions were then taken and trimmed to encompass the bony orbit. The volume of each impression was calculated via the volume-displacement method. RESULTS: The average orbital volume was 26.75 mL for the right side and 26.65 mL for the left. The average right-to-left difference between orbits was 0.8 mL, with a range from 0.02 to 3.64 mL. The calculated methodologic error was 0.91% for the right orbit and 1.05% for the left. Approximately 14% and 21% of skulls showed normal left-to-right orbital volume differences of 1.5 mL or greater and 1.0 mL or greater, respectively. CONCLUSIONS: Our data suggest that the average normal asymmetry between the right and left orbital volumes is 0.8 mL, which is 50 to 80% of the orbital volume increase implicated in traumatic enophthalmos. Of the skulls, 17 (14%) showed a right-to-left orbital volume asymmetry of 1.5 mL or greater and 25 (21%) showed an asymmetry of 1.0 mL or greater. The skull-to-skull orbital volume range approached 200%. Thus, this study provides surgeons with important information to consider when reconstructing a traumatized orbit using a computed tomography scan of the unaffected, contralateral orbit.

Simulation-Based Medical Emergencies Education for Dental Students: A Three-Year Evaluation.

This aim of this study was to develop and evaluate a simulation program for dental students to supplement a lecture-based medical emergencies course. Students' self-reported knowledge, experience, confidence, and ability regarding medical emergencies were assessed as program outcomes. For three years (in 2014, 2015, and 2016), all second-year students (N=333) at one U.S. dental school were randomly assigned to groups of 15 and participated in 15 simulated clinical scenarios. All students completed a 21-item pre-post survey and rated their knowledge, experience, and confidence using simulated emergencies. Following the intervention, students' ability to complete critical actions was also peer-assessed using a ten-item checklist. Four open-ended questions were included on the post-intervention survey for acquisition of additional data. For all years, students' self-reported measurements significantly improved with high practical impact (p≤0.001, g=|0.62, 3.93|), with the exception of calling 911 (knowledge). Peer-rated performance indicated the students were deficient (<75% success) in the following: inhaler use, dose of local anesthetic, dose of epinephrine, and EpiPen use. Content analysis of students' comments pointed to areas that need improvement but found high satisfaction with the program. These findings indicate that this program improved students' knowledge, experience, and confidence using simulated medical emergencies.