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Objective: The aim of this study was to present a mini review of oral Cementoblastoma and to report a particular case of this tumor. The Cementoblastoma is a rare benign lesion that represents less than 1-6% of all odontogenic tumors. Cementoblastoma, in the current WHO classification of odontogenic tumors, falls under the category of mesenchymal tumors (WHO 2017) and it is characterized by the proliferation of cementum-like tissue and, in all cases, tends to be associated with an erupting permanent tooth, most often the first molar. Case Presentation: A 15-year-old female presented a great Cementoblastoma with cortical expansion that affected the left mandibular body, extending from the canine to the first premolar (size 28x24 mm) and involving the mandibular canal. Surgery was performed under general anesthesia with total excision of the lesion, which was then sent for histological analysis. Due to the high risk of nerve injuries and the extreme fragility of the remaining bone after surgery, which required plates and intermaxillary blockage, the surgical site was regenerated with an iliac crest graft together with autologous and synthetic bone. Results: For the mini-review, 107 articles were found, but only 26 were selected. The patient was monitored for 12 months after surgery; a perfect healing was reported without complications, and she showed no signs of recurrence. Conclusions: This case report emphasizes the usefulness of clinical choices in a rare case of cementoblastoma of great size in a very young patient. In this condition, finding the most effective eradicative and reconstructive treatment, following the last published protocols, could achieve optimal clinical and psychological patient outcomes.

Study Objectives: Obstructive sleep apnea (OSA) is an under-recognized condition that results in morbidity and mortality. Postoperative complications, including medical emergency team activation (META), are disproportionally increased among surgical patients at risk for OSA. A systematic approach is needed to improve provider recognition and treatment, but protocols that demonstrate improvement in META are lacking. As part of a multidisciplinary quality improvement project, DOISNORE50 (DIS), a sleep apnea questionnaire and proactive safety measure, was algorithmically applied to all perioperative patients., Methods: Consecutive sleep screening was conducted among perioperative patients. Of the 49,567 surgical navigation center patients, 11,932 had previous diagnosis of OSA. Of the 37,572 (96%) patients screened with DIS, 25,171 (66.9%) were Low Risk (DIS < 4), 9,211 (24.5%) were At Risk (DIS ≥ 4), and 3,190 (8.5%) were High Risk (DIS ≥ 6) for OSA, respectively. High Risk patients received same-day sleep consultation. On the day of surgery, patients with Known OSA, At Risk, and High Risk for OSA received an "OSA Precaution Band." An electronic chart reminder alerted admission providers to order postoperative continuous positive airway pressure (CPAP) machine and sleep consult for patients High Risk for OSA., Results: Implementation of a comprehensive program was associated with increased sleep consultation, sleep testing, and inpatient CPAP use ( P < .001). For every 1,000 surgical patients screened, 30 fewer META, including rapid responses, reintubation, code blues, and code strokes, were observed. However, inpatient sleep consultation and inpatient CPAP use were not independently associated with reduced META. In the subgroup of patients hospitalized longer than 3 days, inpatient CPAP use was independently associated with reduced META., Conclusions: In this single-center, institution-wide, multidisciplinary-approach, quality improvement project, a comprehensive OSA screening process and treatment algorithm with appropriate postoperative inpatient CPAP therapy and inpatient sleep consultations was associated with increased CPAP use and reduced META. Further prospective studies are needed to assess cost, feasibility, and generalizability of these findings., Citation: Namen AM, Forest D, Saha AK, et al. Reduction in medical emergency team activation among postoperative surgical patients at risk for undiagnosed obstructive sleep apnea. J Clin Sleep Med . 2022;18(8):1953-1965., (© 2022 American Academy of Sleep Medicine.)

Study Objectives: Patients with obstructive sleep apnea (OSA) have a disproportionate increase in postoperative complications and medical emergency team activation (META). We previously introduced DOISNORE50 ( D iseases, O bserved apnea, I nsomnia, S noring, N eck circumference > 18 inches, O besity with BMI > 32, R = are you male, E xcessive daytime sleepiness, 50 = age ≥ 50) from sleep questionnaire ISNORED using features associated with increased odds of META in perioperative patients. Performance of DOISNORE50 (DOISNORE) had yet to be tested., Methods: The performance of DOISNORE was tested along with questionnaire ISNORED and STOP-BANG questionnaires among 300 out of 392 participants without known OSA referred to the sleep lab. In study 2, the performance of DOISNORE was tested among 64,949 lives screened in perioperative assessment clinic from 2016 to 2020., Results: Receiver operating characteristic curve demonstrated that best performance was achieved with responses, with area under curve of 0.801. DOISNORE's predictability of OSA risk remained stable from 2018 to 2020 with area under curve of 0.78 and a Cronbach alpha of 0.65. Patients at high risk for OSA (DOISNORE ≥ 6) were associated with an increase of META (odds ratio 1.30, 95% confidence interval 1.12-1.45). Higher relative risk was noted among patients with congestive heart failure and hypercapnia., Conclusions: DOISNORE is predictive of OSA and postoperative META. Perioperative strategies against META should consider DOISNORE questionnaire and focused screening among patients with heart failure and hypercapnia., Citation: Namen AM, Forest D, Saha AK, et al. DOISNORE50: a perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. A learning health system approach to sleep questionnaire development and screening. J Clin Sleep Med . 2022;18(8):1909-1919., (© 2022 American Academy of Sleep Medicine.)