Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ?

OBJECTIVE: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.

What is the impact of veterans affairs rotations in oral and maxillofacial surgery residency?

PURPOSE: Oral and maxillofacial surgery (OMS) residencies commonly affiliate with Veterans Affairs Medical Centers (VAMC) to extend care for veterans. This study quantifies the surgical experience of residents at the Corporal Michael J. Crescenz (CMC) VAMC in Philadelphia, Pennsylvania and determines the number of programs affiliated with VA Medical Centers, to enumerate the educational benefits and improve veteran healthcare. METHODS: The dental project manager logs from 2012 through 2021 of the CMC VAMC operating room were analyzed, and cases were categorized into 12 groups. The implant cases from 2012 through 2021 were quantified. Program affiliations were determined using a VA Office of Academic Affiliation report. RESULTS: There were 1359 procedures (760 cases) performed. Dentoalveolar (n = 967) was the most common category, and extractions (n = 384) were the most common procedure. The least cases and procedures were performed in 2012 (n = 14; n = 23). The most cases were performed in 2019 (n = 137), and the most procedures were performed in 2019 and 2021 (n = 255). There were 3133 implants placed. There are 40 OMS programs affiliated with VA Medical Centers; more dual degree (n = 24) than single degree (n = 16) programs having an affiliation. CONCLUSION: The CMC VAMC offers robust dentoalveolar experience and is increasing in surgical volume, representing the expected needs of an aging veteran population. An increasing budget and millions of eligible veterans indicates VA medical centers nationally will continue to provide valuable surgical experiences.