Faculty Bibliography

BACKGROUND:Odontogenic infections can spread beyond the oral cavity into potential spaces of the head, neck, and thorax. Identifying predictors for these severe complications can improve early risk stratification and guide timely intervention. PURPOSE/OBJECTIVE:This study aimed to estimate the frequency and identify risk factors for severe extraoral complications among patients with odontogenic infections. STUDY DESIGN, SETTING, AND SAMPLE/UNASSIGNED:This retrospective cohort study utilized the 2022 Nationwide Emergency Department Sample. Subjects diagnosed with odontogenic infections (ICD-10-CM K12.2, K04) were included. PREDICTOR VARIABLES/METHODS:Predictor variables included demographics, medical comorbidities, and social history. MAIN OUTCOME VARIABLES/METHODS:The primary outcome was the presence or absence of a severe complication. Secondary outcomes included the type of severe complication (intracranial abscess, cavernous sinus thrombosis, orbital cellulitis, Lemierre's syndrome, descending mediastinitis, and necrotizing fasciitis), inpatient admission, and mortality. COVARIATES/UNASSIGNED:Not applicable. ANALYSES/METHODS:test. A logistic regression model was used to identify independent predictors of a severe complication. A P value of <.05 was considered statistically significant. RESULTS:The final sample included 2,530 subjects with a mean age of 43 years (SD = 20), and 1,386 (55%) were male. The frequency of severe complications was 248 (9.8%), which included 31 (1.2%) intracranial abscess, 16 (0.6%) cavernous sinus thrombosis, 78 (3.1%) orbital cellulitis, 42 (1.7%) Lemierre's syndrome, 30 (1.2%) mediastinitis, and 70 (2.8%) necrotizing fasciitis. Overall, 1,756 (69%) subjects required inpatient admission and mortality was 15 (0.6%). Independent predictors of severe complications were male sex (odds ratio [OR]: 1.51; 95% CI: 1.15 to 2.01; P < .01), immunodeficiency (OR: 2.91; 95% CI: 1.32 to 6.41; P < .01), obesity (OR: 1.88; 95% CI: 1.11 to 3.19; P = .02), and alcohol use (OR: 1.88; 95% CI: 1.11 to 3.19; P = .02). Severe complications were associated with inpatient admission (relative risk: 1.35; 95% CI: 1.28 to 1.41; P < .01) and mortality (relative risk: 10.52; 95% CI: 3.85 to 28.75; P < .01). CONCLUSION AND RELEVANCE/CONCLUSIONS:Patients with immune dysfunction, metabolic disorders, or substance use disorders may benefit from early recognition and aggressive management to prevent severe complications of odontogenic infections.

BACKGROUND:Facial trauma surgeons consulted by emergency departments (EDs) for mandible fractures must decide whether hospital admission is warranted. While admission may allow for closer monitoring and expedited surgery, many patients present with clinically stable injuries for which outpatient management is feasible. PURPOSE/OBJECTIVE:This study aims to identify biological, situational, and socioeconomic predictors of admission for mandible fractures presenting to EDs across the United States. STUDY DESIGN, SETTING, AND SAMPLE/UNASSIGNED:This was a retrospective cohort study of the 2022 Nationwide Emergency Department Sample. Subjects diagnosed with mandible fractures (International Classification of Diseases, 10th Revision, Clinical Modification S02.6-) were included. Subjects who died in the ED or left against medical advice were excluded. PREDICTOR VARIABLES/METHODS:The predictor variables consisted of a heterogeneous set of demographic, hospital-related, and injury-related risk factors. MAIN OUTCOME VARIABLES/METHODS:The outcome variables were admission status and ED charges. COVARIATES/UNASSIGNED:None. ANALYSES/METHODS:tests. A multivariable logistic model was used to identify independent predictors of admission. A P value <.05 was considered statistically significant. RESULTS:The sample was composed of 12,160 subjects with a mean age of 39 years (SD = 19), and 9,117 (75%) were male. A total of 5,236 (43%) subjects were admitted. Mandibular symphysis fractures had the highest likelihood of admission (P < .001), whereas body fractures had the lowest likelihood (P < .001). In a multivariable logistic model, male sex (OR: 1.23; 95% CI: 1.11 to 1.36), number of mandible fractures (OR: 2.81; 95% CI: 2.61 to 3.02), concomitant midface fractures (OR: 3.25; 95% CI: 2.89 to 3.65), and firearm injuries (OR: 16.16; 95% CI: 11.50 to 22.71) were associated with admission, whereas uninsured patients were less likely to be admitted (OR: 0.84; 95% CI: 0.75 to 0.94). Admissions were more costly than discharges ($15,511 vs $4,899, P < .001). CONCLUSION AND RELEVANCE/CONCLUSIONS:Disposition decisions for mandible fractures are influenced by not only injury severity (eg, multiple mandible fractures, concomitant facial fractures) but also patient characteristics and socioeconomic factors. These findings support the development of standardized admission criteria to improve equity and resource utilization.

PURPOSE/OBJECTIVE:Pre-surgical point-of-care (POC) pregnancy testing in women of child-bearing age has become routine practice in hospitals across the United States. Its application in the ambulatory care setting is less ubiquitous. The authors herein present its application in their outpatient oral and maxillofacial surgery clinic, as implemented prior to procedures under intravenous sedation. METHODS:This study was implemented as a retrospective, single-center review of clinical records. The authors examined data from Bellevue Hospital Center's oral and maxillofacial surgery clinic for women of child-bearing age undergoing outpatient procedures performed under intravenous sedation during a 22 month time period. The review focused on POC urine human gonadotropin (hCG) results. A basic statistical analysis was performed on the data. Additionally, an examination of the associated costs of this testing was performed. RESULTS:The study included women between 12 and 50 years of age, of which there were 176. Five of the subjects (2.8%) were found to have an elevated hCG suggestive of pregnancy. The average age of those found to be pregnant was 22. All patients were originally scheduled for extraction of third molars. The cost of a single POC hCG test at the authors' institution was $2.00. The cost to identify a single pregnancy within the study period was found to be $70.40. CONCLUSION/CONCLUSIONS:In the authors' experience, POC hCG testing for women of childbearing age is easily integrated into a standardized pre-sedation workflow. Although the medications utilized for outpatient sedation procedures are generally considered safe for both mothers and developing fetuses, implementation of POC hCG testing allows for providers and patients to make more fully informed decisions regarding how to proceed with elective cases in the case of a previously undiagnosed pregnancy. Determination of pregnancy status prior to a procedure may prompt referral for appropriate prenatal care, while limiting surgeons' exposure to medicolegal liability. This study contributes to a small body of extant reports from ambulatory surgery centers and outpatient clinics offering IV sedation, offering providers a context in which to consider their own implementation of routine hCG testing.

OBJECTIVE:The purpose of this study was to provide a cross-sectional view of all registered clinical trials enrolling patients with osteonecrosis of the jaw (ONJ). The primary aim was to report predictors of trial completion and publication of results. MATERIALS AND METHODS/METHODS:This is a cross-sectional study of ONJ trials registered with ClinicalTrials.gov. For each included entry, trial characteristics and endpoints were recorded. Predictors were enrollment size, etiology, study type, intervention type, sponsor, funding, study locations, number of centers, and specialty of the principal investigator. Outcomes were trial status, publication on PubMed, journal of publication, and length of time between endpoints. Associations between predictors and outcomes were evaluated using chi-square tests and t-tests. RESULTS:The final sample included 26 trials. Overall, 50% of trials were completed and 69% of completed trials were published. Three out of four terminated trials were suspended due to lack of funding. The median enrollment for completed trials was 149 participants with a mean length of five years. All trials included medication-related osteonecrosis of the jaw (MRONJ) patients and 26% also included osteoradionecrosis of the jaw (ORNJ) patients. The majority of trials were observational (65%), conducted internationally (62%), and involved multiple centers (54%). Published trials had a mean time of 5.9 years between trial start and publication, which was comparable to trial length (p=0.90) and appeared in either dental (44%) or cancer (56%) journals. Completion and publication rates were not significantly increased by industry sponsorship/funding, larger enrollment sizes, or multi-center involvement. Oral and maxillofacial surgery was the most represented dental specialty of principal investigators (56%). CONCLUSIONS:The majority of completed ONJ trials had their results published in a timely manner. Evidence-based investigation of ONJ is a multi-disciplinary and international effort. Among all specialists, oral and maxillofacial surgeons led the most ONJ trials.

PURPOSE/OBJECTIVE:A hoverboard, or self-balancing scooter, is a battery-powered vehicle with 2 wheels connected by a longboard that requires handsfree operation. The purpose of the present study was to characterize the emergency department visits for hoverboard-related craniomaxillofacial trauma and determine predictors of injuries and hospital admission. MATERIALS AND METHODS/METHODS:and t tests. RESULTS:The final sample included 440 patients, of whom 51% were male and 74% were pediatric (age, ≤18 years). Pediatric and male patients were both less likely to wear helmets (P < .01). The injuries had most commonly occurred in the winter (38%) and in a home setting (77%). Facial fractures were more likely in adults (P = .03) and in the summer (P = .04). The overall admission rate was 4.3%. The admission rates were greater for those with facial fractures (P = .02) and intracranial injuries (P = .03) but lower for those with soft tissue injuries (P < .01). Street injuries resulted in a greater admission rate compared with home injuries (P = .01). CONCLUSIONS:Craniomaxillofacial injuries from hoverboard accidents have resulted in emergency department visits and hospital admissions since the vehicle's introduction to the consumer market in 2015. Most cases occurred in the winter, which might reflect increased sales and novice riders during the holiday season. Injuries to adults, in the summer or outdoors, appear to be more severe. Intracranial injuries were the most frequent diagnosis; thus, helmet wear is recommended.

PURPOSE/OBJECTIVE:The utility of social media in oral and maxillofacial surgery (OMS) residency programs has never been investigated, despite the increasing popularity of such platforms in academic medicine. As a specialty that strives for constant innovation, it is important for OMS programs to participate in the emerging concept of incorporating social media into medical and surgical education. Therefore, this study aimed to evaluate the use of Instagram in OMS residency programs in the United States. METHODS:A cross-sectional study of Instagram search data was performed. The Instagram accounts of OMS residency programs were searched, and their metrics were retrieved from June 1 to June 5, 2020. Factors correlated with the total number of followers were identified. The use of Instagram in OMS residency programs was compared with that in other related dental and surgical residency programs. RESULTS: = 0.98) since December 2018. The median number of followers was 326 (range, 94 to 2,152), and the median number of posts was 9 (range, 2 to 40). The number of Instagram followers was positively correlated with the number of accounts followed, the number of total posts, and the number of educational posts, and it was negatively correlated with the Instagram engagement rate. Instagram presence did not differ among residency programs for orthodontics (18.2%), periodontics (5.5%), and OMS (P = .067). However, Instagram presence in OMS residency programs was significantly lower than that in plastic surgery (74.7%; P < .001) and otolaryngology residency programs (35.0%; P = .011). CONCLUSIONS:Instagram use in OMS residency programs is growing but is significantly lower than that in related surgical fields. This may represent a missed opportunity for promoting collaboration and efficiently delivering useful information to trainees.

PURPOSE/OBJECTIVE:The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. MATERIALS AND METHODS/METHODS:We performed a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in the present study if they had involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. RESULTS:A total of 11,916 records were included in the present study, of which 9.5% had involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries had occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and had resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooters had resulted in more than triple the admission rate compared with nonmotorized scooters (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double odds of hospital admission (odds ratio, 2.03; P < .01). CONCLUSIONS:Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters could pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.