Delivery of A Jagged1-PEG-MAL hydrogel with Pediatric Human Bone Cells Regenerates Critically-Sized Craniofacial Bone Defects.

Treatments for congenital and acquired craniofacial (CF) bone abnormalities are limited and expensive. Current reconstructive methods include surgical correction of injuries, short-term bone stabilization, and long-term use of bone grafting solutions, including implantation of (i) allografts which are prone to implant failure or infection, (ii) autografts which are limited in supply. Current bone regenerative approaches have consistently relied on BMP-2 application with or without addition of stem cells. BMP2 treatment can lead to severe bony overgrowth or uncontrolled inflammation, which can accelerate further bone loss. Bone marrow-derived mesenchymal stem cell-based treatments, which do not have the side effects of BMP2, are not currently FDA approved, and are time and resource intensive. There is a critical need for novel bone regenerative therapies to treat CF bone loss that have minimal side effects, are easily available, and are affordable. In this study we investigated novel bone regenerative therapies downstream of JAGGED1 (JAG1). We previously demonstrated that JAG1 induces murine cranial neural crest (CNC) cells towards osteoblast commitment via a NOTCH non-canonical pathway involving JAK2-STAT5 (1) and that JAG1 delivery with CNC cells elicits bone regeneration in vivo. In this study, we hypothesized that delivery of JAG1 and induction of its downstream NOTCH non-canonical signaling in pediatric human osteoblasts constitute an effective bone regenerative treatment in an in vivo murine bone loss model of a critically-sized cranial defect. Using this CF defect model in vivo, we delivered JAG1 with pediatric human bone-derived osteoblast-like (HBO) cells to demonstrate the osteo-inductive properties of JAG1 in human cells and in vitro we utilized the HBO cells to identify the downstream non-canonical JAG1 signaling intermediates as effective bone regenerative treatments. In vitro, we identified an important mechanism by which JAG1 induces pediatric osteoblast commitment and bone formation involving the phosphorylation of p70 S6K. This discovery enables potential new treatment avenues involving the delivery of tethered JAG1 and the downstream activators of p70 S6K as powerful bone regenerative therapies in pediatric CF bone loss.

The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

INTRODUCTION: The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. MATERIALS AND METHODS: This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. RESULTS: Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d). CONCLUSION: Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.

Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck?

BACKGROUND: In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE: The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE: This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S): The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES: Patient, injury, and hospital-related covariates were collected. ANALYSES: Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS: Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE: HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.

Epidemiology and Etiology of Facial Injuries in Children.

Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.

Pediatric Dog Bites to the Face May Have Been Less Severe During COVID-19 Pandemic: A Retrospective Cohort Study.

PURPOSE: Pediatric dog bite injuries are one of the most common nonfatal injuries. During the COVID-19 pandemic, children stayed at home more than pre-pandemic. The effect of the pandemic on severity of dog bites to the face in children has not been examined. The objective of this study was to determine the frequency and severity of dog bite injuries to the face in children during the first year of the COVID-19 pandemic when compared to the previous year. MATERIALS AND METHODS: A retrospective cohort study was conducted for children with dog bite injuries to the head and neck region who presented to the emergency department at Children's Healthcare of Atlanta from March 2019 to March 2021. The predictor variable was the time of injury, and this was divided into pre-lockdown [control group (March 15, 2019, to March 15, 2020), ie pre-L] and lockdown (March 15, 2019, to March 15, 2020), ie post-L. The outcome variable was severity of dog bite defined as one or more of the following: 1) patient required sedation or general anesthesia for repair, 2) 3 or more regions in the head and neck were involved, and/or 3) surgical consultation took place. The investigators used a two-sample t-test, multivariable linear regression models, and modified analysis of variance and multivariate ANOVA tests to analyze the data (P-value < .05 determined significance). RESULTS: 712 children (370 males) with an average age of 6 years old (range, 7 months-18 years) fit the inclusion criteria. There were 381 cases in the pre-L and 331 in the post-L period. There were more cases on average per month pre-L (31.8 cases/month) than post-L (27.6 cases/month) (P-value = .26). There were 183 pre-L surgical consults compared to 75 post-L (48 vs 22.8% of cases, respectively; P-value ≤ .001). There were 52 pre-L cases that had 3 or more sites in the head and neck compared to 28 during the post-L period (P-value = .032). CONCLUSIONS: During the COVID-19 pandemic, there may have been a decrease in the severity of dog bite injuries. This trend may demonstrate a consequence that is not a direct result of the virus.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations.

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.

Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck.

PURPOSE: Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS: This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS: Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS: Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.

Do Gender Differences Exist Among Victims of Head and Neck Injuries due to Intimate Partner Violence?

PURPOSE: The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women. MATERIALS AND METHODS: This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS: One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03). CONCLUSION: Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.

Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life?

PURPOSE: There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS: This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS: A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION: ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.

How Accurate Are Surgeons at Calculating Orbital Volumes?

PURPOSE: Bilateral orbital volume (OV) symmetry is imperative for successful orbital reconstruction to prevent complications such as enophthalmos, diplopia, and orbital dystopia. The purpose of this study was to determine the accuracy of surgeon-led in-house OV calculation for reconstructed orbits after orbital floor fracture. MATERIALS AND METHODS: This is a retrospective cross-sectional observational study of maxillofacial computed tomography scans for patients undergone orbital fracture repair by Emory Oral and Maxillofacial service at Grady Memorial Hospital (Atlanta, Georgia) from 2018 to 2020.The primary predictor variable was OV calculation approach (outsourced vs surgeon-led in-house approach). The primary outcome variable was OV. Secondary variables were age, gender, and race. Interobserver reliability was calculated with a 2-way mixed-effects model, intraclass correlation coefficients, 95% confidence intervals, and P values. Differences between OV (in-house and outsourced) were calculated using student t-test. Statistical significance was determined at P < .05. RESULTS: During the study period, 172 patients sustained orbital floor fracture. Of them, 49 patients (31 male, 18 females; 98 orbits) with the mean age of 41.3 years (range, 19 to 89 years) met inclusion criteria. Subjects with incomplete medical records and inadequate computed tomography scans were excluded from the study. The racial distribution in descending order was 87.8% African American, 8.2% Caucasian, 2% Hispanic, and 2% Asian. There was excellent inter-rater reliability for calculating uninjured OV (OV-U, P < .0001) and reconstructed OV (OV-R, P < .0001). The mean OV difference of outsourced approach was 0.8 cm3and for surgeon-led in-house approach was 0.07 cm3. There was no significant difference in OV difference between outsourced and in-house approach (P = .16). CONCLUSIONS: In conclusion, using open-source 3-dimensional imaging software is a reliable and a predictable method at calculating reconstructed OV in patients who underwent open reduction and internal fixation of orbital fractures. By having this software in our personal computers and laptops, one can easily calculate OVs in an efficient manner.

What do dental students expect from oral and maxillofacial surgery externships?

INTRODUCTION: Limited information exists on the goals and expectations of dental students from oral and maxillofacial surgery (OMS) externships. This information is valuable to OMS residency programs. Dental students use externships to gain insight into various OMS residency programs.  The purpose of this project was to answer the following question: "what do dental students expect from OMS externships?" PURPOSE: The aim of this study was to report the expectations of dental students from OMS externships. MATERIALS AND METHODS: This cross-sectional study took place from June 2015 to September 2019. Every student completing an Emory OMS externship completed an anonymous survey. The survey consisted of questions regarding (1) demographics, (2) previous OMS experience, and (3) open-ended questions regarding expectations and sources of anxiety. Answers were grouped into categories with similar answers. Descriptive statistics summarized data. RESULTS: Of 116 externs who completed the survey, the majority were males (n = 80, 68.9%) with a mean age of 25 (range 21-30) years old in the 3rd/4th year of dental school. Most had previous OMS experience (n = 103, 89.6%) and plan to apply to OMS residency (n = 104, 90.4%). Most externs hoped to learn about life as a resident and the scope and culture of the program. Externs expressed the highest level of anxiety regarding their own experience and/or knowledge level. CONCLUSIONS: This project demonstrated that during the externship, externs expect to gain insight into the daily activities, scope, and culture of the OMS program they are visiting.

Pediatric head and neck burns increased during early COVID-19 pandemic.

OBJECTIVE: The purpose of this study was to describe patterns of burns to the head and neck in children during the early COVID-19 pandemic. STUDY DESIGN: This cross-sectional study reviewed pediatric patients in the Burn Care Quality Platform Registry. Patients were included if they were ≤17.9 years old and had sustained burns to the head and neck. Patients were separated into the following groups: March 13 to September 13, 2019 (before COVID-19 pandemic, BC) or March 13 to September 13, 2020 (during the initial 6 months of the COVID-19 pandemic, C19). The study team collected patient-related variables, details regarding burn injury, burn severity, and hospital course. Univariate and bivariate analyses were calculated. The chi-squared test was used for categorical variables. Statistical significance was P < .05. RESULTS: Fifty-five children with head and neck burn injuries were included. There was a 200% increase in burns to the head and neck region in children in April 2021 compared with previous year. Burns to head and neck in White children occurred more often during C19 (P = .03). The study revealed differences in timing of presentation (time of burn injury to emergency department admission) in different racial groups during (White children [P = .05]), and after the pandemic (African American children [P = .02]). CONCLUSIONS: There was a transient increase in burns to the head and neck region in children during the early pandemic compared with the historic cohort.

Temporomandibular Joint Acoustic Emissions in Children With Juvenile Idiopathic Arthritis Differ From Those in Healthy Children.

PURPOSE: Articulation of the temporomandibular joint (TMJ) generates sounds with specific characteristics known as joint acoustic emissions (AEs). The purpose of this project was to determine if AEs as described by the joint health score (JHS) in children with juvenile idiopathic arthritis (JIA) differ from AEs in healthy children. METHODS: The investigators implemented a cross-sectional study with age- and sex-matched controls to compare AEs from 4 groups: (1) healthy subjects without TMJ sounds, (2) healthy subjects with TMJ sounds, (3) subjects with JIA without TMJ sounds, and (4) subjects with TMJ sounds. Predictor variables were JIA status (ie JIA/healthy) and joint sounds (present/absent). The outcome variable was AEs. Subjects wore a specialized headset and performed specific jaw movements that generated AEs. AEs were recorded and analyzed using an aggregated decision tree classification model that calculates a JHS for each group. JHSs were compared using a receiver operating characteristic curve and classification accuracies. The study team used a 2-tailed unpaired t-test to determine if score distributions were different. Significance was P < .05. RESULTS: A total of 51 subjects (102 TMJs; 37 females) with an average age of 13.1 years (range, 7 to 18) participated. Children with JIA and TMJ sounds had AEs with large repetitive clicks. Children with JIA without sounds had smaller repetitive clicks. Healthy children had grinding sounds with lower amplitude. The receiver operating characteristic curve had a classification accuracy of 71.6%. This accuracy compares against the gold standard clinical assessment for placing these patients into their groups (JIA vs healthy). JHSs of children with TMJ sounds and children with JIA and TMJ sounds were statistically significant (P < .0001). CONCLUSION: In our sample, the AE of TMJs in healthy children may be different than that in children with JIA. Assessment of an AE is a promising and noninvasive technique to determine involvement of TMJs in children with JIA.

An evidence-based approach to antibiotic use in maxillofacial trauma.

A patient with craniomaxillofacial (CMF) trauma often receives consultations from multiple medical and surgical services. Antibiotics are sometimes prescribed without consistent evidence. This article reviews current literature regarding antibiotic prophylaxis of patients with CMF fractures. This article also presents the guidelines for the appropriate use of antibiotics for patients with CMF fractures at 2 level I trauma centers.

Comprehensive analysis of patients with failure of mandibular hardware.

OBJECTIVE: The purpose of the study was to characterize patients who had failure of mandibular hardware (FMH). STUDY DESIGN: This retrospective cohort study consisted of patients with mandible fractures (MFs) that required surgical intervention from 2012 to 2020. Patients were included when mandibular hardware failed. Descriptive variables were collected. RESULTS: During the study period, 57 patients (47 male, average age 38.7 years) met the inclusion criteria. Incidence of FMH was 7.4%. Most patients were African American (n = 45, 78.9%) with American Society of Anesthesiologists classification II (n = 40, 70.2%). Tobacco use (n = 31, 54.4%) and/or alcohol (n = 33, 57.9%). The most common etiology was assault (n = 28, 49.1%). The most common location was the angle of the mandible. Most mandibles had fracture at 1 location (n = 31, 54.4%) and a tooth was involved in the fracture line (n = 44, 77.2%). More than half of patients were treated with transoral surgical approach (n = 35, 61.4%). The majority of patients received preoperative antibiotics (n = 51, 89.4%). Patients had varying levels of compliance with postoperative care, and most were not compliant. Infection (n = 45) was the most common presentation of FMH. CONCLUSION: High American Society of Anesthesiologists score, smoking, excessive alcohol use, parafunctional habits, and compliance with postoperative instructions may affect surgical outcome.

Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma.

PURPOSE: Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. METHODS: The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. RESULTS: Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P = .07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P = .71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P = .013). CONCLUSIONS: African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.

Preliminary experience with black bone magnetic resonance imaging for morphometry of the mandible and visualisation of the facial skeleton.

BACKGROUND: Children with orofacial deformity may require repeated imaging of the facial skeleton. OBJECTIVE: To test the feasibility and accuracy of "black bone" magnetic resonance imaging (MRI) for assessing facial deformity in children. MATERIALS AND METHODS: Three-dimensional (3-D) black bone gradient echo sequences (flip angle 5°, submillimetre spatial resolution) from 10 children (median age: 13 years, range: 2-16 years), who underwent MRI of the temporomandibular joints, were evaluated with multiplanar reconstruction and 3-D rendering tools. Intra- and inter-reader agreement was investigated for measuring the height of the mandibular ramus and condyle, basal length of the mandible, gonion angle and mandibular inclination angle by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Absolute percentage error was calculated with the average of all measurements serving as reference. RESULTS: Sixty linear and 40 angle measurements were obtained on reformatted multiplanar black bone images with excellent inter-reader agreement (ICC > 0.99, agreement bias < 1.4 mm/ < 1.5°) and small error (median absolute error < 3%). The black bone images required inversion of the signal intensity and removal of air before they could be processed with standard volume rendering tools. The diagnostic utility of 3-D views for assessing the facial skeleton was sufficient except for assessing dental relationship. CONCLUSION: Morphometric measurements of the mandible can be obtained from black bone MRI with comparable inter-rater agreement to that reported for cone beam computed tomography (CT). With improvements of 3-D rendering techniques and software, black bone MRI may become a radiation-free alternative to CT in children with facial deformities.

Pharmacology of Aesthetic Medicines.

The realm of aesthetic medicine is broad, and there are countless medications and topical agents used in the practice of aesthetic medicine. The most commonly used injectable medicines include botulinum toxin for mimetic lines and hyaluronic acid fillers for deeper facial rhytids and volume rejuvenation. Topical aesthetic medicines are useful adjuncts for facial rejuvenation and commonly include tretinoin, hydroquinone, growth factors, and vitamin C, as well as a wide range of chemical peels.

Head and Neck Langerhans Cell Histiocytosis in Children.

PURPOSE: Controversy exists among head and neck surgical specialties regarding management of Langerhan's Cell Histiocytosis (LCH). The purpose of this study was to evaluate diagnosis, management, and treatment outcomes in children with LCH of the head and neck. METHODS: This is a retrospective cohort study of children with LCH of the head and neck who presented to Children's Healthcare of Atlanta hospital from 2009 to 2021. The independent variables were demographic information, lesion locations, clinical presentation, radiographic findings, diagnostic workup, treatment, and length of follow-up. The patients were grouped based on these variables. The outcome variable was disease reactivation. Descriptive statistics were calculated. RESULTS: There were 3 presentations of LCH of the head and neck. Group 1 presented as a lesion in 1 system without CNS risk (SS-). There were 24 patients with an average age of 10 years. Lesions were located in calvaria and/or mandible. Majority of the patients were treated with only debridement. Two of the patients experienced reactivation. Group 2 presented as a lesion in 1 system with CNS risk (SS+). There were 30 patients with an average age of 6 years. Common locations were temporal bone and/or orbit. These patients present with recurrent ear infections and ptosis. Majority of the patients were treated with chemotherapy (n = 28). One patient had disease reactivation. Group 3 presented with multisystem involvement. There were 13 patients with an average age of 2 years. LCH was found in skin and the lymphatic system. Imaging demonstrated extracranial organ involvement. All of them were treated with chemotherapy. There was 40% reactivation of LCH. CONCLUSIONS: Treatment of LCH depends on presentation. SS- subgroup can be adequately treated via surgical debridement. SS+ and multisystem groups benefit from an early disease diagnosis and require chemotherapy.

Current Concepts in Prophylactic Antibiotics in Oral and Maxillofacial Surgery.

Antibiotic prophylaxis is the use of antibiotics in the perioperative period to prevent surgical site infections from local flora. Specific guidelines and criteria exist to prevent these infections while also practicing antimicrobial stewardship. Most dentoalveolar procedures do not require antibiotic prophylaxis. For nondentoalveolar procedures, the decision to provide antibiotic prophylaxis is based on involvement of the respiratory, oral, or pharyngeal mucosa. Special considerations exist for patients at high risk for infective endocarditis, patients with head and neck cancer, and temporomandibular joint replacement procedures. This article discusses indications for antibiotic prophylaxis during oral and maxillofacial surgical procedures.