A Comparison of 2,845 Head and Neck Injuries in Various Martial Arts.

PURPOSE: The primary purpose of this study is to estimate and compare the frequencies, types, and hospital admission rates of head and neck injuries in subjects who practice different martial art fighting styles, including karate, kung fu, kickboxing, taekwondo, judo, and jiu jitsu. METHODS: The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Information related to head and neck martial art injuries from January 2000 through December 2019 was included in this study. Study variables were obtained from both patient demographics and injury characteristics (date of injury, diagnosis, body part, type of martial art, and disposition). Patient and injury characteristics were compared through χ2 and independent sample tests. RESULTS: Taekwondo was the most likely type of martial art to lead to a head injury (P < .01), whereas jiu jitsu (P < .01) and judo (P < .01) were most likely to cause neck injuries. The type of martial art was not significantly associated with admission rates (P = .190); however, patients with head injuries were more likely to be admitted relative to patients who did not suffer head injuries (P < .05). Moreover, injuries secondary to judo were more likely to result in admissions relative to that of all other martial arts (P < .05). CONCLUSIONS: Judo was the most severe martial art during this time period as it led to the highest rate of hospital admissions. Karate injuries are most likely to occur in younger populations of fighters under the age of 18 years.

Autogenous Iliac Crest Versus rhBMP-2 for Alveolar Cleft Grafting: A 14-Year Single-Institution Experience.

PURPOSE: This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting. MATERIALS AND METHODS: This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6 months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or 2. RESULTS: The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilateral repairs, and 17.4% were retreatments. The cumulative success rate was 89.5%. There were no differences in success between materials (rhBMP: 90.3%; AICBG: 89.1%; P = .85). Patients presenting for retreatment were more likely to receive rhBMP-2 than AICBG (48.6 vs 3.8%, P < .01). After controlling for other significant confounders, the rhBMP-2 group required less personnel (P < .01) and operating room time (P < .01). Only 1 patient in the rhBMP-2 group was admitted, whereas all AICBG patients were admitted a minimum of 1 night. CONCLUSIONS: Compared with AICBG, rhBMP-2 produced a similar height of bone but required less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent.

Oral Pseudomyogenic Hemangioendothelioma: Case Report and Review of the Literature.

Pseduomyogenic hemangioendothelioma (PMH) is a vascular neoplasm of intermediate biological potential first described by Hornick and Fletcher (Am J Surg Pathol 35:190-201, 2011). Despite its initial categorization as a malignant entity, PMH often demonstrates an indolent behavior profile, and thus was classified as a rarely metastasizing endothelial neoplasm in the 2013 WHO Classification of Tumors of Soft Tissue and Bone. It is a tumor primarily of skin and soft tissue, with most reported cases involving the trunk or extremities. To date, only one case of PMH involving the oral cavity has been reported. Herein, we present a case of PMH involving the mandibular gingiva and vestibule of a 33-year-old female and discuss the salient features of this entity.

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications.

OBJECTIVE: The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden. MATERIALS AND METHODS: This was a retrospective cohort study of the Kids' Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome. RESULTS: The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures. CONCLUSIONS: Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.

Which Factors Affect Length of Stay and Readmission Rate in Mandibular Distraction Osteogenesis?

PURPOSE: Because Robin sequence (RS) is clinically heterogeneous, there is uncertainty as to whether different presentations yield different perioperative outcomes. The purpose of this study was to evaluate factors associated with postoperative length of stay and readmission rate after mandibular distraction osteogenesis (MDO) for RS. MATERIALS AND METHODS: This was a 10-year retrospective cohort of patients with RS who had MDO performed from 2007 through 2017 at the Morgan Stanley Children's Hospital of the NewYork-Presbyterian/Columbia University Irving Medical Center (New York, NY). Predictor variables were the presence of multiple anomalies, airway intervention used before MDO, and feeding method used before MDO. Outcome variables were postoperative day (POD) of discharge and number of readmissions from the period of discharge to hardware removal. Patient characteristics and outcomes were compared within predictors using Fisher's exact and 2-tailed Student's t tests. Multiple regression models were calculated for each outcome variable using univariate predictors with P values less than or equal to .25. RESULTS: Twenty-four patients who had MDO performed at a mean age of 18.1 weeks were included in this study. On average, patients were extubated on POD 6.6 and distracted to 13.9 mm. Seven patients (29.2%) were readmitted from the period of discharge to hardware removal. Patients receiving an invasive airway intervention before MDO were significantly older at the time of the operation (55.0 vs 8.4 weeks; P = .01). In addition, these patients had a significantly higher readmission rate (80.0 vs 15.8%; P = .01) with a trend toward longer postoperative stays (45.0 vs 21.6 days; P = .06). Feeding status and presence of multiple anomalies did not appear to influence these outcomes. CONCLUSIONS: Baseline airway intervention may be useful for predicting length of stay and readmission rate after MDO.

Lingual cyst with respiratory epithelium: report of 2 cases and review of the literature.

The lingual cyst with respiratory epithelium, a congenital cyst of the tongue or floor of the mouth, is lined predominately by respiratory-type epithelium. The terminology for this lesion was first proposed in 1999 by Manor et al., who stated that a descriptive term is best for this cyst of debatable pathogenesis. Although it is a cyst of foregut origin, the lingual cyst with respiratory epithelium is distinguished from the traditional enteric (foregut) duplication cyst in that the latter contains gastric and/or intestinal-type mucosa and has smooth muscle within the cyst wall. This article presents 2 new cases of this entity, as well as reviews the 19 cases that have been reported in the literature and were found to fulfill the histologic criteria of an lingual cyst with respiratory epithelium.

Foreign Body Giant Cell Reaction to a Proplast/Teflon Interpositional Implant: A Case Report and Literature Review.

After discectomy, interpositional implants (IPIs) are believed to provide temporomandibular joint stability and protect against degenerative joint space remodeling. Alloplastic IPIs gained popularity in the late 1970s because the practice showed early success without donor site morbidity. Unfortunately, these implants were subject to substantial fragmentation resulting in an exuberant foreign body giant cell response that progressively eroded adjacent structures. Most of these alloplastic implants were removed in the years following their recall by the US Food and Drug Administration in 1991, however some remained in circulation. This report describes a case of a failed Proplast/Teflon IPI 27 years after its placement. This case highlights the considerations for managing a patient with a Proplast/Teflon IPI and serves to remind providers that, although increasingly rare, these implants are still present and subject to delayed failure.

Oral manifestations of lipoid proteinosis in a 10-year-old female: A case report and literature update.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. Here, we present a case of LP with significant oral, dermatologic, and neurologic manifestations occurring in a 10 year-old female of Asian descent. In addition to the more typical oral findings of restricted tongue movement and labial and buccal mucosal involvement, this case highlights an unusual pattern of gingival enlargement infrequently reported in the literature. As LP almost always involves the oral cavity, often before the onset of cutaneous lesions, it is important for dental providers to be familiar with the oral manifestations of this disease. Early detection and diagnosis of LP by the dental practitioner can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.

Mandibular embryonal rhabdomyosarcoma with cartilaginous metaplasia: report of a case and review of literature.

Rhabdomyosarcoma (RMS) is a malignant tumor of skeletal muscle origin and frequently involves the head and neck region. It represents the second most common pediatric soft tissue sarcoma and accounts for 3% of all childhood cancers. Here, we report a case of embryonal RMS presenting as a right-sided facial swelling in a 7-year-old boy. Histologically, the tumor consisted of classic embryonal rhabdosarcomatous areas with metaplastic cartilage, in both initial biopsy and final resection specimens. Cartilaginous metaplasia arising in the background of RMS is a rare finding, thus raising a diagnostic challenge. To the best of our knowledge, this represents the first case of RMS with cartilaginous metaplasia in the oral cavity.

Diabetes and periodontal disease: an example of an oral/systemic relationship.

Periodontal disease has been identified as a major complication of diabetes mellitus. Diabetics experience increased destruction of periodontal tissues as a result of an abnormal immune response, altered fibroblast function and levels of collagen, as well as the microvascular effects of advanced glycosylation end products (AGE). The accumulation of AGE in the periodontium is correlated with an increase in the level of inflammatory mediators, which are associated with tissue destruction. These inflammatory mediators may contribute to the severity of tissue destruction in diabetics with periodontal disease. The increased prevalence of periodontal disease in diabetics is an example of an oral/systemic relationship. There is evidence that this relationship may be two-dimensional as well, as diabetics with active periodontitis tend to have poor glycemic control when compared to patients without periodontitis.

Immunolocalization of Alk8 during replacement tooth development in zebrafish.

The novel type I transforming growth factor-beta (TGF-beta) family member receptor Alk8 was previously identified in a degenerate RT-PCR screen for zebrafish type I and II TGF-beta family member receptors. Functional analyses revealed that Alk8 acts through Bmp signaling pathways in early embryonic dorsoventral patterning, in neural crest cell specification, and in patterning and differentiation of neural crest cell-derived pharyngeal arch cartilages. In addition, Alk8 forms active signaling complexes with TGF-beta1 and the TGF-beta RII receptor, suggesting that Alk8 mediates cross talk between Bmp and TGF-beta subfamily members. In this study, immunohistochemical analysis was performed on zebrafish aged 2 days postfertilization to 1 year, revealing immunolocalization of Alk8 to tissues of the tooth-bearing ceratobranchial 5 (cb5) arch including dental epithelial and mesenchymal tooth tissues of developing primary and replacement teeth, mucous-producing crypt epithelium, keratinized bite plate, and developing taste buds. These results suggest roles for Alk8 in patterning tooth-bearing pharyngeal epithelium, in the initiation of tooth development, in odontoblast and ameloblast differentiation, and in osteoblast maturation. The ability for zebrafish to continuously form teeth throughout their lives allows for the comparison of Alk8 expression in both primary and replacement tooth development, revealing identical Alk8 expression profiles. This study advances our current understanding of the functions of Alk8, particularly with respect to primary and replacement tooth formation, reveals additional roles for Alk8 in dental epithelial patterning and in odontoblast, ameloblast and osteoblast differentiation, and demonstrates the utility of the zebrafish as a model for primary and replacement tooth development.