Faculty Bibliography

BACKGROUND/UNASSIGNED:Virtual reality (VR) has not been tested for cleft surgery training in low-resource settings where the surgical instructor provides the lesson from another continent. METHODS/UNASSIGNED:Fifty-one plastic and maxillofacial surgery trainees in India participated in a VR simulation of the Furlow palatoplasty given by a New York-based cleft surgeon. Participants completed pre- and postsurveys, which included a knowledge assessment regarding the Furlow technique, confidence in VR as an educational tool, and opinions on the use of VR in surgical education. Satisfaction and acceptance of the technology were assessed with learning measures postsimulation. RESULTS/UNASSIGNED:< 0.001). The opinion that VR should be included in surgical education began high and remained high. Learners reported that the simulation was stimulating (4.63 ± 0.49), increased interest (4.51 ± 0.67), was clear (4.45 ± 0.67), and was effective for teaching (4.78 ± 0.47), and they would recommend the lecture to others (4.78 ± 0.46). VR simulation increased control and active learning (4.73 ± 0.49), facilitated comprehension (4.76 ± 0.51), allowed for reflective thinking (4.59 ± 0.57), had high fidelity (3.98 ± 0.93), was easy to use (4.29 ± 0.73), and was enjoyable (4.78 ± 0.42). CONCLUSIONS/UNASSIGNED:VR cleft simulation can be effectively used in low- to emerging-resource settings. Surgical instructors can provide real-time, immersive surgical experiences to trainees across the world.

BACKGROUND:Severe proximal interphalangeal (PIP) contractures in Dupuytren disease significantly impair hand function and quality of life. Surgical correction is common, but the relationship between improved joint mobility and patient-reported outcomes remains unclear. This study evaluated surgical outcomes for severe PIP contractures and assessed patient-reported function using Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS:< .05). RESULTS:The study included 60 digits from 48 patients. Significant contracture reductions were observed across all groups, averaging more than 60%. However, PROMIS scores did not consistently reflect improvements in pain, activity interference, or upper extremity function. A significant decrease in upper extremity function was noted in group 3 (60°-89°). No operative complications or reoperations occurred. CONCLUSIONS:Surgical correction markedly improves joint contracture but does not consistently enhance PROMIS-reported outcomes. These results question PROMIS applicability in this context and highlight the need for alternative assessment tools to better address functional recovery in patients with severe PIP contractures.

BACKGROUND:The severity of unilateral cleft lip significantly influences surgical outcomes, yet no standardized system exists to classify cleft severity or assess the impact of presurgical infant orthopedics (PSIO). This study proposes an objective classification system integrating anthropometric measurements with expert evaluations. METHODS:Deidentified pre- and post-PSIO photographs of 50 infants with unilateral cleft lip from the Smile Train Express database were analyzed. Three anthropometric parameters-nostril width ratio (NWR), columellar angle (CA), and subnasale lateral displacement (SN)-were measured. An expert panel of orthodontists and surgeons independently rated cleft severity and PSIO outcomes in a structured three-stage process. Severity thresholds were established through consensus, and interrater agreement was analyzed using weighted kappa. RESULTS:Consensus-derived thresholds categorized NWR, CA, and SN into four severity levels. Interrater agreement for cleft severity improved across stages, reaching near-perfect levels in Stage 3 (weighted kappa = 0.91 pre-PSIO, 0.93 post-PSIO). While pre-PSIO agreement was similar between surgeons and orthodontists, post-PSIO assessments showed greater variability. PSIO had a disproportionate effect on nasal morphology (CA) compared to maxillary segments (NWR, SN), with severe NWR and SN frequently coexisting with mild CA. The proposed classification system demonstrated substantial reliability, aligning at least two parameters within the same severity subclassification. CONCLUSIONS:This study introduces a standardized classification system for cleft severity and PSIO outcomes, demonstrating strong interrater reliability. By integrating anthropometric data with expert assessments, it provides a reproducible framework for clinical and research applications. Further refinements, including intraoral measurements and 3D imaging, may enhance its precision and applicability.

ObjectiveTo describe and demonstrate the effectiveness and reproducibility of a modified enhanced recovery after surgery (ERAS) protocol for patients with cleft palate (CP).DesignProspective cohort study.SettingOutreach Medical Programs, resource-limited settings.PatientsPediatric patients with CP who underwent CP repair.InterventionsModified ERAS protocol.Main Outcome Measure(s)Complication rate, post-operative pain management, time to discharge.Results52 CP repairs done during three outreach medical programs were included in the study. 22 (42.3%) procedures were performed in GYE SEP 2022, 6 (11.5%) procedures in SAL JAN 2023, and 24 (46.2%) in GYE MAR 2023. The mean age was 4.9 years across all programs. 22 (42.4%) patients were between 1 and 3 years of age, 26 (50%) were between 3 and 12 years of age, and 4 (7.6%) were older than 12 years of age. Patients were equally distributed among gender with 26 (50%) being males and 26 (50%) females. A total complication rate of 5.8% was reported. 51 patients were discharged on post-op day one and only one patient was kept for an additional day for monitoring. Four patients required Fentanyl in PACU for post-operative pain, ketamine was used in 1 patient, 7 patients received Dexmedetomidine (Precedex), and ketorolac was used in 16 patientsConclusionsA modified ERAS protocol for CP surgery has been developed and implemented for outreach settings. This approach showed decreased post-operative complications, decreased length of hospital stay, and decreased opioid use while maintaining adequate pain control, establishing early enteral feeding and thus enhancing patient recovery.

CONTEXT.—/UNASSIGNED:The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain. OBJECTIVE.—/UNASSIGNED:To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations. DESIGN.—/UNASSIGNED:Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population. RESULTS.—/UNASSIGNED:Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort. CONCLUSIONS.—/UNASSIGNED:The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.

BACKGROUND/PURPOSE/UNASSIGNED:The ability to save a digital copy of a fabricated denture is poignant for large dental institutions. The purpose of this study was to evaluate the trueness and precision of an intraoral scanner (IOS) in its ability to digitally duplicate a complete denture (CD) and evaluate the possible effects of file resolution reduction on different exported media types. MATERIALS AND METHODS/UNASSIGNED:A desktop scanner was used to scan a complete mandibular denture and utilized as the control file. An IOS was used to scan the same denture and exported into both standard triangular language (STL) and polygon (PLY) file types and stored for additional analysis. The different file types at original resolution were compared to the desktop scan (DS100) to evaluate the accuracy of the IOS. Then the STL (Groups S100, S75, S50, S25) and PLY (Groups P100, P75, P50, P25) files were reduced in their resolutions to evaluate any statistical discrepancies in the volumetric analysis of the scan using the Hausdorff distance (HD) and dice similarity coefficient (DSC). RESULTS/UNASSIGNED:) files from the IOS produced a similarity of 98.34% and 98.39% respectively. The similarity of the IOS files at different resolutions ranged from 99.99% to 99.96%. CONCLUSION/UNASSIGNED:We conclude that the IOS used in this study demonstrates very high trueness and precision when digitally duplicating complete dentures.

BACKGROUND: While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction. METHODS: A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups. RESULTS: A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%). CONCLUSION/CONCLUSIONS: Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.

Achieving the appropriate primary stability for immediate or early loading in areas with low-density bone, such as the posterior maxilla, is challenging. A three-dimensional (3D) stabilization implant design featuring a tapered body with continuous cutting flutes along the length of the external thread form, with a combination of curved and linear geometric surfaces on the thread's crest, has the capacity to enhance early biomechanical and osseointegration outcomes compared to implants with traditional buttressed thread profiles. Commercially available implants with a buttress thread design (TP), and an experimental implant that incorporated the 3D stabilization trimmed-thread design (TP 3DS) were used in this study. Six osteotomies were surgically created in the ilium of adult sheep (N = 14). Osteotomy sites were randomized to receive either the TP or TP 3DS implant to reduce site bias. Subjects were allowed to heal for either 3 or 12 weeks (N = 7 sheep/time point), after which samples were collected en bloc (including the implants and surrounding bone) and implants were either subjected to bench-top biomechanical testing (e.g., lateral loading), histological/histomorphometric analysis, or nanoindentation testing. Both implant designs yielded high insertion torque (ITV ≥ 30 N⋅cm) and implant stability quotient (ISQ ≥ 70) values, indicative of high primary stability. Qualitative histomorphological analysis revealed that the TP 3DS group exhibited a continuous bone-implant interface along the threaded region, in contrast to the TP group at the early, 3-week, healing time point. Furthermore, TP 3DS's cutting flutes along the entire length of the implant permitted the distribution of autologous bone chips within the healing chambers. Histological evaluation at 12 weeks revealed an increase in woven bone containing a greater presence of lacunae within the healing chambers in both groups, consistent with an intramembranous-like healing pattern and absence of bone dieback. The TP 3DS macrogeometry yielded a ~66% increase in average lateral load during pushout testing at baseline (T = 0 weeks, p = 0.036) and significantly higher bone-to-implant contact (BIC) values at 3 weeks post-implantation (p = 0.006), relative to the traditional TP implant. In a low-density (Type IV) bone model, the TP 3DS implant demonstrated improved performance compared to the conventional TP, as evidenced by an increase in baseline lateral loading capacity and increased BIC during the early stages of osseointegration. These findings indicate that the modified implant configuration of the TP 3DS facilitates more favorable biomechanical integration and may promote more rapid and stable bone anchorage under compromised bone quality conditions. Therefore, such improvements could have important clinical implications for the success and longevity of dental implants placed in regions with low bone density.