To what extent do oral and maxillofacial surgery residents suffer from imposter syndrome?

OBJECTIVE: This study aims to evaluate the frequency and severity of imposter syndrome (IS) in oral and maxillofacial surgery (OMS) residents and identify factors associated with higher Clance Imposter Phenomenon Survey (CIPS) scores. STUDY DESIGN: A cross-sectional study was performed with a survey including CIPS, demographic, and training program structure questions distributed to all OMS training programs and residents in the United States. The primary predictor variable was gender, and the main outcome variable was the CIPS score. Statistical analyses were performed using linear regression in R v4.3.1; statistical significance was set to P value < .05. RESULTS: A total of 175 OMS residents responded. The average CIPS score was 59.8 (IQR 52, 70). Statistically significant differences were found between average male and female resident scores (56.5 vs 66.9; P < .001) and male and female single-degree residents (54.3 vs 73.1; P < .001), but not for dual-degree residents (58.8 vs 63.9; P = .35). CONCLUSIONS: The average male resident experiences moderate IS, whereas the average female resident experiences frequent IS. Loss of significance between male and female dual-degree resident scores may be due to the completion of a doctoral degree, an internship, and/or dental board exams upon entering medical school, leading to more favorable accomplishment comparisons among medical school peers.

A retrospective study of orthognathic surgery reimbursement and volume changes at an American academic medical center over a 13-year period.

OBJECTIVE: This study aimed to measure the association between orthognathic surgeon reimbursement and surgical volume over time. STUDY DESIGN: A retrospective cohort study of patients who underwent orthognathic surgery from January 1, 2010, to December 23, 2022, at an academic medical center was performed. Five patients per year were randomly selected and evaluated for insurance type and associated costs to create representative averages. Pearson correlation analysis was performed to test associations over 13 years with 2-tailed significance reported and statistical significance set at P < .05. RESULTS: A total of 618 patients who underwent 942 procedures were included. The average procedure charge was $6,153.76, and the average total surgeon collection was $1,535.75 per procedure. When monetary values were adjusted to reflect 2010 purchasing power, there was a negative correlation between the average charge per procedure and the year (r[11] = -0.59, P = .04). The year was not significantly correlated with the average amount collected (r[11] = -0.09, P = .78) or average insurance reimbursement (r[11] = -0.52, P = .07). CONCLUSIONS: Collections by surgeons did not change significantly over 13 years and were not correlated with the volume of procedures performed. Increased collections were correlated with increased patient costs. The stagnation of surgeon collection is concerning in the face of increased monetary inflation during this period. Increased volume of surgeries per year was correlated with decreases in patient cost and total collections.

Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution.

BACKGROUND: Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied. PURPOSE: This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI). STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records. PREDICTOR VARIABLE: The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density. MAIN OUTCOME VARIABLE(S): The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable. COVARIATE(S): Covariates included sex, age, and race. ANALYSES: Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05. RESULTS: Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR) = 0.91; 95% confidence interval (CI) 0.78 to 1.05; P = .18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR = 0.91; 95% (CI) 0.86 to 0.97; P = .004), and higher population density (IRR = 0.87; 95% CI 0.79 to 0.94; P < .001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients. CONCLUSIONS AND RELEVANCE: Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.

Rhinocerebral Mucormycosis as a Sequelae of COVID-19 Treatment: A Case Report & Literature Review.

A large volume of reports detailing a marked increase in Mucormycosis infections in India has filtered its way into world news articles. These patients frequently have 2 risk factors: recent treatment of COVID-19 with high dose steroids, and uncontrolled diabetes. Recently, at the University of Tennessee Medical Center in Knoxville, we successfully treated an uncontrolled diabetic patient with rhinocerebral Mucormycosis as a sequela of his COVID-19 treatment.

Fall-Related Facial Trauma: A Retrospective Review of Fracture Patterns and Medical Comorbidity.

PURPOSE: Medical comorbidities may contribute to falls and thus require identification for education and prevention. We hypothesized that the epidemiology and injuries seen will be similar to the literature, with most falls that result in injury occurring in the elderly, to prominent facial structures, and are associated with specific comorbidities. METHODS: A retrospective review was performed of patients evaluated by the Trauma and Oral and Maxillofacial Surgery services after sustaining traumatic facial injury from July 2015 to June 2016 as a result of a fall. Associations between injury patterns, previous falls, and medical comorbidities were analyzed, and descriptive and bivariate statistics were reported. RESULTS: Of 152 patients included, 53.3% were females with a mean age of 61.2 years. Soft tissue laceration was seen in 59.9% of patients. The 3 most common fracture patterns seen were nasal fracture in 30.9%, orbital fracture in 30.3%, and zygoma fracture in 20.4%. Cardiovascular disease (53.3%) was the most common comorbidity. No major comorbidity was seen in 32.9% of patients. There was a significant association between orbital fracture and neurologic disease (P = .04). Patients with neurologic disease had a significantly longer length of stay (P < .001), and those without any major comorbidities had a significantly shorter length of stay (P = .02). Patients with previous emergency department visits for falls were significantly older (P = .03), had more comorbidities (P = .005), and were more likely to have cardiovascular disease and associated comorbidities (P = .001). CONCLUSIONS: The results are consistent with the literature, with the most fall-related trauma occurring in the elderly with injury to prominent facial structures. The most common comorbidity was cardiovascular disease, which was associated with previous falls. There is a significant association between neurologic disease and orbital fractures. Future studies should focus on recurrent falls after receiving appropriate education to reduce risk based on their specific comorbidities.

Early inhibitory effects of zoledronic acid in tooth extraction sockets in dogs are negated by recombinant human bone morphogenetic protein.

PURPOSE: This study was conducted with 2 purposes. The first was to determine the effect of a single dose of zoledronic acid (ZA) on the healing of a tooth extraction socket in dogs. The second was to determine if placement of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge (ACS) - INFUSE, (Medtronic, Memphis, TN) into these extraction sockets would inhibit the inhibition on bone healing and remodeling by ZA. MATERIALS AND METHODS: Nine adult female beagle dogs (2 to 3 yr old) were placed into 3 groups of 3 dogs each. Group I received 15 mL of sterile saline intravenously; group II received 2.5 mg of ZA intravenously; and group III received 5 mg of ZA intravenously. Forty-five days after treatment, all dogs underwent extraction of noncontiguous right and left mandibular first molars and second premolars. In group I, the right mandibular extraction sockets had nothing placed in them, whereas the left mandibular sockets had only ACS placed in them. In groups II and III, the right mandibular sockets had rhBMP-2/ACS placed in them, whereas the left mandibular sockets had only ACS placed. All extraction sockets were surgically closed. Tetracycline was given intravenously 5 and 12 days later, and all animals were euthanized 15 days after tooth extraction. The extraction sockets and rib and femur samples were harvested immediately after euthanasia, processed, and studied microscopically. RESULTS: A single dose of ZA significantly inhibited healing and bone remodeling in the area of the tooth extractions. The combination of rhBMP-2/ACS appeared to over-ride some of the bone remodeling inhibition of the ZA and increased bone fill in the extraction sites, and remodeling activity in the area was noted. The effects of rhBMP-2/ACS were confined to the area of the extraction sockets because bone activity at distant sites was not influenced. CONCLUSIONS: A single dose of ZA administered intravenously inhibits early healing of tooth extraction sockets and bone remodeling in this animal model. The combination of rhBMP-2/ACS significantly increased bone fill and bone remodeling in these areas, negating much of the effect of the ZA.

Periodontal disease and bisphosphonates induce osteonecrosis of the jaws in the rat.

Bisphosphonates (BPs) are medications used commonly to treat primary and metastatic bone cancer, as well as osteoporosis. Although BPs improve bone mineral density, reduce fracture risk, and reduce hypercalcemia of malignancy, some patients develop BP-related osteonecrosis of the jaws (BRONJ). This devastating complication is defined as clinically exposed bone in the maxillofacial region for more than 8 weeks. Despite an increasing number of BRONJ cases since first reported, the disease pathophysiology remains largely unknown. Since published studies suggest a significant role for dental disease in the pathophysiology of BRONJ, we developed a BRONJ animal model where aggressive periodontal disease is induced by ligature placement around the crown of the right maxillary first molar in the presence of vehicle (veh) or zoledronic acid (ZA), a potent BP. Ligature placement induced significant alveolar bone loss, which was attenuated by ZA treatment. Osteonecrosis was observed associated with ligature-induced periodontitis in the ZA-treated group. This was seen as sequestration and extensive periosteal alveolar bone formation on micro-computed tomography (µCT) in the ligated site of BP-treated animals. Histologic examination confirmed these findings, seen as necrotic bone with diffuse loss of osteocytes and empty lacunae, rimming of the necrotic bone by squamous epithelium and inflammation, and exposure to the oral cavity. Importantly, the rat lesions were strikingly similar to those of BRONJ patients. Our data suggest that dental disease and potent BP therapy are sufficient for BRONJ development in the rat.

Effects of platelet-rich plasma at the cellular level on healing of autologous bone-grafted mandibular defects in dogs.

PURPOSE: This study describes the effect of platelet-rich plasma (PRP) at the cellular level on immediate autologous bone grafts in dog mandibles. MATERIALS AND METHODS: Twelve adult dogs weighing 40 to 50 pounds received bilateral inferior mandibular border resections measuring 2 cm x 1 cm. The right side was grafted with milled autologous iliac corticocancellous bone along with 2 cc of PRP taken from the same animal. The left side had the same amount of milled bone placed in the defect without PRP. Three animals were sacrificed at 1, 2, 3, and 6 months postsurgery. Ten and 3 days before sacrifice, all dogs received 10 mg/kg body weight of intravenous tetracycline. At sacrifice, the grafts along with adjacent native bone were harvested and immediately fixed in Carson's fixative for 48 to 72 hours. The samples were then dehydrated over a 2-week period in a graded ethanol series and embedded in Spurr's plastic. Two 100-micron sections from the center of each graft were cut, mounted on glass slides, ground to 40 microns, and stained. A digitally generated grid was superimposed over each section, to give 32 fields of 2.5 mm2. Each of these fields was examined at a magnification of x100 to determine the number of osteoblasts and osteoclasts present. RESULTS: The mean average of the total numbers of osteoblasts and osteoclasts were significantly higher in the PRP graft sites than in the non-PRP graft sites at 1 month. However, if specific fields were compared, then 14 of the 32 fields showed no difference in the number of osteoblasts and osteoclasts. At 2, 3, and 6 months, there was no significant difference in the total number of osteoblasts or osteoclasts in the PRP and non-PRP grafts, or in any of the 32 fields. CONCLUSIONS: At the cellular level, PRP increased the number of osteoblasts and osteoclasts recruited to the graft site at 1 month, and this overall increase was more evident at the superior and lateral margins of the graft than in other areas. Fields along the inferior margin showed the fewest number of cells for both the PRP and non-PRP grafts. At later times there was no significant difference in the number of osteoblasts and osteoclasts in the PRP and non-PRP graft sites in any region of the grafts. This study indicates that the increased number of osteoblasts and osteoclasts in the graft sites due to the addition of PRP was short-lived, and that autologous bone grafts without PRP had similar numbers of active bone cells after 1 month in this animal model.

Effects of platelet-rich plasma on the healing of autologous bone grafted mandibular defects in dogs.

PURPOSE: This study was undertaken to describe both radiographically and with histomorphometric analysis the effect platelet-rich plasma (PRP) has on immediate autologous bone grafts in a dog model. MATERIALS AND METHODS: Thirteen dogs comprised the study. Twelve adult dogs received bilateral inferior mandibular border defect resections measuring 2 cm x 1 cm. The right defect was immediately grafted with milled autologous iliac corticocancellous bone along with 2 cc of PRP that was developed in a standardized fashion. The left side was immediately grafted with the same amount of autologous iliac corticocancellous bone placed without PRP. Three animals were sacrificed at 1, 2, 3, and 6 months. A thirteenth dog underwent bilateral inferior border resections with only PRP placed in the right defect, and nothing placed in the left defect. This dog was sacrificed at 6 months. Ten and 3 days before sacrifice all animals received 10 mg/kg body weight tetracycline intravenously. At sacrifice, grafts along with adjacent native bone were harvested, fixed, radiographed, and processed for epifluorescence analysis. RESULTS: Analysis of digitized radiographs indicated that at 1 and 2 months the non-PRP grafts were significantly more dense than the PRP grafts, and at 3 and 6 months there was no significant difference. Histomorphometric analysis showed that at 1 and 2 months there was significantly less grafted bone and more new bone in the PRP grafts than in the non-PRP grafts. At 3 and 6 months there was no difference in the amount of grafted bone or new bone between the PRP and non-PRP grafts. Histology of the control dog showed incomplete bony healing at 6 months, suggesting that this was a critical sized defect. The bone apposition rate for all times in the PRP and non-PRP graft sites did not significantly change. CONCLUSION: PRP appeared to enhance early autologous graft healing. However, after 2 months this effect is no longer significant. The early enhanced healing occurred by increasing the amount of non-viable grafted bone that was removed and increasing the amount of new bone that was formed. PRP did not change the rate at which new bone was formed, and no increase in trabecular density was realized in these grafts.