Faculty Bibliography

Background/Purpose: Orthognathic surgeries (Alveolar Bone Graft, LeFort 1/2/3, Mandibular Advancement, Distraction Osteogenesis) require extensive preoperative assessments/planning/education, as well as individualized orthodontic preparation and ongoing postoperative management. This is a challenging process for both the patient and familyphysically, emotionally and financially. In order to provide optiomal education and support, a comprehensive team approach is needed. Methods/Descriptions: An experienced team's protocol for comprehensive management of the orthognathic patient and family will be presented in a 30 minute panel. This will include: nursing (preparation for surgery, description of the procedures, hospitalization, postoperative course, managing pain/swelling, home care needs, activity restrictions); nutrition (preoperative assessment, calculating postoperative calorie/ protein needs to optimize healing, description of diets-how to progress, foods to allow/avoid, adaptive feeding supplies); orthodontics (preoperative/ postoperative orthodontic requirements, education regarding postoperative mouth care, use of elastics, progression of diet); psychology/social work (preoperative psycho/social assessment- concerns/ anxieties about undergoing surgery, change in appearance, impact on relationships, activities, employment, self-image, transitioning from pediatric to adult care); speech (preo/postoperative assessment of velopharyngeal incompetence (VPI), education about the chances of developing VPI). In addition, insurance issues (including strategies for how to successfully obtain coverage for orthognathic procedures will be discussed, as well as presentation of a short video of the experience from the perspective of a patient and family

Moderate-to-severe fatigue occurs in up to 94% of oncology patients undergoing active treatment. Current interventions for fatigue are not efficacious. A major impediment to the development of effective treatments is a lack of understanding of the fundamental mechanisms underlying fatigue. In the current study, differences in phenotypic characteristics and gene expression profiles were evaluated in a sample of breast cancer patients undergoing chemotherapy (CTX) who reported low (n = 19) and high (n = 25) levels of evening fatigue. Compared to the low group, patients in the high evening fatigue group reported lower functional status scores, higher comorbidity scores, and fewer prior cancer treatments. One gene was identified as upregulated and 11 as downregulated in the high evening fatigue group. Gene set analysis found 24 downregulated and 94 simultaneously up- and downregulated pathways between the two fatigue groups. Transcript origin analysis found that differential expression (DE) originated primarily from monocytes and dendritic cell types. Query of public data sources found 18 gene expression experiments with similar DE profiles. Our analyses revealed that inflammation, neurotransmitter regulation, and energy metabolism are likely mechanisms associated with evening fatigue severity; that CTX may contribute to fatigue seen in oncology patients; and that the patterns of gene expression may be shared with other models of fatigue (e.g., physical exercise and pathogen-induced sickness behavior). These results suggest that the mechanisms that underlie fatigue in oncology patients are multifactorial.

Neurologic diseases can have a major impact on functional capacity. Patients with neurologic disease require individualized management considerations depending on the extent of impairment and impact on functional capacity. This article reviews 4 of the more common and significant neurologic diseases (Alzheimer disease, cerebrovascular accident/stroke, multiple sclerosis, and Parkinson disease) that are likely to present to a dental office and provides suggestions on the dental management of patients with these conditions.

BACKGROUND: Reconstruction of extensive facial and scalp burns can be increasingly challenging, especially in patients that have undergone multiple procedures with less than ideal outcomes resulting in restricting neck and oral contractures, eyelid dysfunction, and suboptimal aesthetic appearance. METHODS: To establish a reconstructive solution for this challenging deformity, a multidisciplinary team was assembled to develop the foundation to a facial vascularized composite allotransplantation program. The strategy of developing and executing a clinical transplant was derived on the basis of fostering a cohesive and supportive institutional clinical environment, implementing computer software and advanced technology, establishing a cadaveric transplant model, performing a research facial procurement, and selecting an optimal candidate with the aforementioned burn defect who was well informed and had the desire to undergo face transplantation. RESULTS: Approval from the institutional review board and organ procurement organization enabled our face transplant team to successfully perform a total face, eyelids, ears, scalp, and skeletal subunit transplant in a 41-year-old man with a full face and total scalp burn. CONCLUSIONS: The culmination of knowledge attained from previous experiences continues to influence the progression of facial vascularized composite allotransplantation. This surgical endeavor methodically and effectively synchronized the fundamental principles of aesthetic, craniofacial, and microvascular surgery to restore appearance and function to a patient suffering from failed conventional surgery for full face and total scalp burns. This procedure represents the most extensive soft-tissue clinical face transplant performed to date. CLINICAL QUESTION/LEVEL OF EVIDEMCE: Therapeutic, V.

The ideal filler for aesthetic surgery is inexpensive and easy to obtain, natural in appearance and texture, immunologically compatible, and long lasting without risk of infection. By most metrics, autologous fat grafts meet these criteria perfectly. Although facial fat grafting is now a commonly accepted surgical procedure, there has been a wave of activity applying stem cells and platelet-rich plasma (PRP) therapies to aesthetic practice. This article addresses technical considerations in the use of autologous fat transfer for facial rejuvenation, and also explores the current evidence for these stem cell and PRP therapies in aesthetic practice.

Background/Purpose: Treacher Collins (TC) and Robin Sequence (RS) are both associated with a retrognathic mandible, glossoptosis, and airway obstruction. TC is associated with aberrations of the lower jaw, upper jaw and nasal airway in a manner distinct from RS. Although in both TC and RS, airway obstructions in severe cases may benefit from mandibular distraction (MDO), the different pathophysiology suggests MDO to be less successful in TC compared to the current literature on RS. The purpose of this study is to report on the clinical outcomes of tracheostomy removal utilizing MDO in the TC patient population. Methods/Descriptions: A single center, twenty-year retrospective review (1991-2010) was conducted of all patients with TC treated with MDO. Recorded variables included: age of MDO, number of MDO procedures, presence of tracheostomy and complications. Literature review of clinical outcomes of MDO in the RS population demonstrates age of MDO of under one year, average on distraction per patient and avoidance of tracheostomy in over 90% of patients. Results: 24 patients with TC who underwent MDO were included in our analysis. The follow up time was 9.2 years (range1.7-17 years). The mean age of the first MDO was 4.97 years. The mean number of distractions was 1.42 with 46% of patients who had more than onedistraction attempted. The distraction devices used were external in 67% and internal in 33% of cases. 19 patients (79%) had a tracheostomy prior to MDO and only 9 (47%) patients were decannulated within one year of distraction. An additional 5 patients were decannulated several years later after further distraction and other airway procedures. Complications were divided into major (ankylosis, device failure) moderate and minor (pin infection, hypertrophic scar). Overall, 67% of TC patients had at least one complication with 41% having major complications. There was a 20% incidence of TMJ ankylosis. Conclusions: Compared to the RS population, TC patients undergo MDO at a later age, require more distraction and have less successful decannulation. Further surgery is required to effectively treat airway obstruction. The incidence of major complications

BACKGROUND: Titanium cranioplasty is commonly used for surgical closure of skull defects post craniectomy. Superficial implantation of the mesh can result in discomfort, palpability, and in extreme patients, exposure of the mesh. Exposed titanium mesh can be complicated by infections and often requires implant revision or removal. Generally, the contour of the titanium mesh is camouflaged in the hairline of the patient and any aesthetic complication can remain inconspicuous. However, in the frontal bone position the thin hairless forehead skin often may not easily hide the contour of the underlying titanium mesh. OBJECTIVES: The goal of this study was to demonstrate the usage of an alloderm covering over the titanium cranioplasty to possibly minimize the contour irregularities of titanium. SURGICAL TECHNIQUE: Our index patient, a 22-year-old woman, was operated for left frontal craniectomy for frontal bone tumor extending to brain parenchyma. This resulted in a surgical defect that was repaired with titanium mesh cranioplasty and dural patch. It was felt that the patient would potentially feel and see the titanium mesh cranioplasty under the thin frontalis muscle. Therefore, over top of the titanium mesh a remnant piece of AlloDerm unused after the dural patch was placed to buffer the potential contour deformity. Postoperatively, the contour appears natural and the patient does not report any complaints of discomfort or mesh palpability. CONCLUSION: In a thin-skinned patient undergoing titanium mesh cranioplasty, the risk of mesh palpability or exposure can be significant, especially in areas of non-hair-bearing scalp and the protruding areas of the skull. Alloderm covering over the titanium mesh can provide improved aesthetic outcomes by minimizing contour deformity and may serve as an additional buffer in thin scalp.