Faculty Bibliography

PURPOSE/OBJECTIVE:The various physiological profiles comprising vascularized composite allografts (VCAs) pose unique challenges to preservation. Minimizing ischemia, reperfusion injury, and rejection remains a primary focus of graft pretreatments (PTs). Currently, the gold standard PT consists of flushing the graft and placing it in static cold storage in the University of Wisconsin solution. With this method, graft viability is limited to 4 to 6 hours. Prolonging this time limit will increase donor allocation radius, access to care, and positive patient outcomes. We aimed to evaluate novel PTs that could potentially enhance and lengthen VCA viability. METHODS:Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, we conducted a comprehensive literature search of EMBASE, Cochrane, and PubMed. Studies had to be published prior to June 15, 2022. PTs had to target cell physiology, rather than immunogenicity. We extracted data including study design, PT details, evaluation metrics, and outcomes. RESULTS:We identified 13 studies, categorized into 3 groups: solution-based alterations to the gold standard, ex vivo perfusion, and other novel techniques. The incorporation of hydrogen sulfide and Perfadex as solutions in the gold standard protocol demonstrated a 6-day delay in rejection and limited reperfusion injury markers, respectively. In an ex vivo perfusion study, after 24 hours of PT and 12 hours posttransplant, VCA muscle contractility remained close to normal. The gold standard PT did not demonstrate the same success. However, graft weight gain, up to 50% of baseline among the reviewed articles, is a prominent adverse effect of perfusion. Another technique, cryopreservation, displayed 90% graft failure by venous thrombosis, despite high free graft viability following 2 weeks of storage. CONCLUSIONS:This study of PT modalities found a variety of encouraging preservation techniques for grafts with high levels of tissue diversity. Ex vivo perfusion dominated PT innovation with promising results in preserving the viability and functionality of muscle, which is central to the restoration of movement. Future studies are necessary to evaluate long-term graft outcomes and to optimize PT protocols for extended preservation times to ensure clinical relevance.

BACKGROUND:Needlestick exposures commonly occur with non-disposable metal syringes during the assembly and disassembly of needles due to the manual handling of needles. Disposable syringes are designed to reduce these exposures by using a protective sheath thus eliminating the need to handle needles while uncapping and recapping them. PURPOSE/OBJECTIVE:This pilot study compared the two syringes with two alternating groups of third-year (D3) students during clinical practice under faculty supervision to administer local anesthesia to live patients. METHODS:In 2023, two groups of Year 3 (D3) Doctor of Dental Surgery (DDS) students supervised by faculty in each group alternated over two 4-week sessions using disposable (N = 67) and non-disposable (N = 66) syringes to administer local anesthesia injections to live patients. At the end of each session, each group and supervising faculty completed a survey to capture their experience. RESULTS:While two participants reported needlestick injuries using non-disposable syringes and no injuries incurred using disposable syringes, we found neither a statistically significant increase nor decrease in exposures related to needlesticks using either syringe. Statistically significant outcomes showed that the participants found the non-disposable easier to use and they were more likely to use it going forward than the disposable syringe. Participants preferred using the non-disposable syringe mainly because of the stability and familiarity aspects of prior education. The disposable syringe, while easier and safer to assemble and disassemble, felt less stable to use during the injection procedure, especially during aspiration. CONCLUSION/CONCLUSIONS:While safety continues to be a concern, students and faculty prefer non-disposable metal syringes over disposable syringes. Most dissatisfaction with using the disposable syringe came from the aspiration system. But prior experience and comfort using non-disposable metal syringes, a lack of experience and confidence with local anesthesia procedures and a lack of experience with disposable syringes, may have contributed to these outcomes. Despite usability issues with the disposable syringe, performance was more impacted by lack of experience than the type of syringe used. Introducing both syringes early into the curriculum may help overcome usability factors, further reduce needlestick exposures, and prepare students for different workplace environments. Providing adequate training for faculty, especially on the differences between the two syringes, such as aspiration, will help alleviate discomfort and better promote the use of both.

PURPOSE/OBJECTIVE:The purpose of this study was to conduct a systematic review evaluating the reported complications and outcomes of bone-anchored prostheses in digit and partial hand amputees. METHODS:A literature review of primary research articles on osseointegration and bone-anchored prostheses for digit and partial amputees was performed. The Medline, Embase, Scopus, and Cochrane Library databases were queried. Inclusion criteria were journal articles that evaluated osseointegration and bone-anchored prostheses in digit and partial hand amputees. The main outcome measures were reported complications and the need for revision surgery. Secondary outcomes included all reported outcome assessments. RESULTS:Fifteen articles were included with publication dates ranging from 1996 to 2022. The sample sizes ranged from single-patient case reports to a 13-patient retrospective study. Overall, 33 men and 16 women were reported with a mean age of 33.6 years (range: 12-68) and a total of 71 amputated digits. The median follow-up was 2.1 years (IQR: 1.1-6.8 years). A total of 24 complications were reported in 14 digits (19.7%). Complications included superficial infection in 6 digits (8.5%), abutment loosening or failure in 5 (7%), fixture aseptic loosening in 4 (5.6%), deep infection in 1 (1.4%), and soft tissue instability in 1 (1.4%). Sixteen revision surgeries or component changes were reported. CONCLUSIONS:Bone-anchored prostheses using osseointegrated implants in the hand are associated with favorable outcomes in the limited number of low-quality studies available for review. Superficial infections and implant-related failures were the most frequently reported complications. TYPE OF STUDY/LEVEL OF EVIDENCE/METHODS:Systematic review IV.

OBJECTIVES/OBJECTIVE:The primary objective of this study was to evaluate international practice patterns related to environmental sustainability in pediatric otolaryngology ORs, with a focus on the use of single-use versus reusable supplies. METHODS:An electronic survey was distributed using REDCap to members of an international pediatric otolaryngology WhatsApp group (n = 324). The survey included multiple-choice, Likert-scale, and open-ended questions regarding drape, gown, and glove usage for adenotonsillectomy, ear tube insertion, and laryngoscopy/bronchoscopy procedures, and broader sustainability practices including barriers and enablers. RESULTS:Response rate was 16.0 % (n = 52/324). Respondents were from North America (30.8 %), Europe (25.0 %), Australia/New Zealand (23.1 %), Asia (15.4 %), South America (3.8 %), and Africa (1.9 %). For adenotonsillectomy 61.5 % reported using single-use patient drapes, 61.5 % use single-use table drapes, and 44.2 % use single-use gowns. For ear tube insertions, single-use table drapes (53.8 %) were most frequently reported; single-use patient drapes (38.4 %) and gowns (21.2 %) were less common. For laryngoscopy/bronchoscopy, the majority did not use patient drapes (31.4 %) or gowns (32.7 %), while 62.8 % use single-use table drapes. Top barriers to improving sustainability in the OR were cost (51.9 %) and infection prevention and control (IPAC) practices (44.2 %). Enablers included sufficient technological (46.2 %) and financial (36.6 %) resources, dedicated policies (30.8 %), and supportive leadership (34.6 %). CONCLUSION/CONCLUSIONS:There remains a strong reliance on single-use materials in pediatric otolaryngology ORs globally. Cost, IPAC, education, and leadership are important considerations in sustainability efforts. These findings identify actionable targets for waste reduction and support the need for specialty-specific sustainability interventions.

BACKGROUND:This study aimed to evaluate the risk of fracture with weight-bearing after medial femoral condyle (MFC) harvest with varying harvest size and location using finite element analysis (FEA). METHODS:FEA evaluated the potential impact of MFC harvest on donor femur strength. Donor flaps were modeled as cubes of corticocancellous defects within the descending genicular angiosome (DGA). Stress and safety factors were recorded during simulated single-leg stance as a function of harvest size and location within the DGA. An S-N curve was used to determine the number of cycles to failure due to stress. RESULTS:cycles). CONCLUSIONS:Our results suggest that small corticocancellous flaps centered no more than 0.5 cm proximal to the medial epicondyle are the most favorable for harvest, resulting in physiologically tolerable stress values on the donor femur during single-leg stance. Caution and potential weight-bearing restrictions should be considered when harvesting larger and more proximally based flaps. LEVEL OF EVIDENCE/METHODS:Biomechanical study.

Peri-implant disease and gingival recession may be partially attributed to inadequate keratinized tissue. Soft tissue augmentation procedures utilizing non-autologous biomaterials, such as porcine-derived collagen membranes, have been gaining prominence and exogenous crosslinking is being actively investigated to improve the collagen membrane's stability and potential for keratinized tissue gain. The aim of this preclinical study was to evaluate the performance of a novel, crosslinked porcine collagen membrane (Zderm^TM, Osteogenics Biomedical, Lubbock, TX, USA) relative to an established, commercially available, non-crosslinked counterpart (Mucograft^®, Geistlich Pharma North America Inc., Princeton, NJ, USA) in a canine mandibular model. Bilateral split-thickness mucosal defects were created in adult beagles (n = 17), with each site receiving one membrane. Qualitative and quantitative histomorphometric analyses of groups were performed after 4, 8, and 12 weeks of healing and compared to unoperated, positive controls from the same subject. No significant differences in membrane presence were observed between Zderm^TM and Mucograft^® at 4, 8, and 12 weeks of permitted healing (p > 0.05). Similarly, the average keratinized tissue (KT) length between Zderm^TM and Mucograft^® groups was statistically equivalent across all healing times (p > 0.05). However, qualitative histological evaluation revealed greater rete ridge morphology amongst defects treated with Zderm^TM in comparison to Mucograft^®. Nevertheless, both membranes exhibited excellent biocompatibility and are well-suited for soft tissue augmentation procedures in the oral cavity.

PURPOSE/OBJECTIVE:XPO1 functions in key cellular processes, including nucleo-cytoplasmic export and mitosis. The gene is deleted in a subset of patients with the 2p15p16.1 microdeletion syndrome, however no monogenic XPO1-related disorder has been described to date. MATERIALS AND METHODS/METHODS:We collected clinical data of individuals with de novo XPO1 variants through online matchmaking. We employed Drosophila to study XPO1 function in development and habituation learning. RESULTS:A total of 22 individuals met the criteria to be included in the main study cohort. Of these, half have putative loss-of-function variants and half have coding variants (10 missense and 1 in-frame deletion variant). We find an overlapping phenotype, consistent with a monogenic neurodevelopmental disorder (NDD). We demonstrate XPO1 functions in development by ubiquitous and neuron-specific knockdown in Drosophila. GABAergic neuron specific knockdown flies demonstrated impaired habituation. CONCLUSION/CONCLUSIONS:Our results establish XPO1 as a novel dominant monogenic NDD gene and demonstrate a central role for XPO1 in development.

Patients with unilateral cleft lip and palate (UCLP) often exhibit asymmetric paranasal flatness of soft tissues. Despite clinical recognition of this asymmetry, skeletal paranasal asymmetry remains poorly quantified. Measuring skeletal landmark asymmetries can aid in planning surgical maxillary yaw corrections that simultaneously enhance paranasal symmetry and maxillary dental midline position. This study aims to quantify skeletal paranasal asymmetry in patients with UCLP. Skeletally mature patients with complete UCLP who were orthodontically prepared for orthognathic surgery between 2014 and 2023 were included in this study. Presurgical CBCTs were analyzed using Dolphin 3D. Anterior-posterior discrepancies between affected and unaffected sides were measured at the most lateral point of piriform aperture (PA) and 15 mm lateral to PA (15PA). A one-sample t test was conducted. Analysis of 30 patients (mean age 18-8 y, 17 male, 13 female, 20 left-sided, 10 right-sided) was completed. On the affected side, PA and 15PA were positioned 3.8 mm (P<0.05) and 2.4 mm (P<0.05) more posteriorly, respectively. These results suggest that skeletal paranasal asymmetry should be assessed during the pretreatment stage, as presurgical orthodontics should maintain a maxillary midline deviation toward the affected side when yaw correction is indicated. This approach facilitates simultaneous correction of piriform projection and midline alignment during surgery and may reduce the need for secondary procedures, such as malar implants or fat injections, which add cost and morbidity. This study confirms skeletal paranasal asymmetry in patients with UCLP and establishes a standardized method for measuring these deficiencies using CBCT-based skeletal landmarks.