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Purpose: Underlying psychiatric conditions are thought to influence the presentation, management, and outcomes of facially injured patients. Our study sought to determine if psychiatric diagnoses were associated with the decision to repair facial fractures during the index hospitalization., Methods: This was a cross-sectional review of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of a facial fracture were included in the study. The primary study predictor was the presence of a documented psychiatric illness. Covariates included patient age, insurance, injury mechanism, primary fracture location, other concomitant injuries, and Injury Severity Score. The study outcome was facial fracture treatment status (reduction or no reduction). A multiple logistic regression model was created to identify and measure independent factor associations for fracture treatment., Results: The final sample included 59,378 patients of whom 10,485 (17.7%) had a documented psychiatric illness. Most of these diagnoses involved substance use (62.5%). Patients with psychiatric illness had significantly higher rates of extra-nasal primary fracture location (56.2 vs 47.1%, P < .01) and a greater mean Injury Severity Score (5.0 vs 3.8, P < .01). In the unadjusted analysis, patients with psychiatric illness had higher rates of fracture repair during their index hospitalization (RR = 2.42, P < .01). After adjusting for covariates in the multiple logistic regression model, psychiatric illness became negatively associated with fracture repair (OR = 0.82, P < .01)., Conclusions: Patients with psychiatric illness experienced higher rates of hospitalization and suffered more severe patterns of injury but had lower odds of fracture repair during their index hospitalization after controlling for injury characteristics., (Copyright © 2021 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting., Materials and Methods: This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6 months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or 2., Results: The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilateral repairs, and 17.4% were retreatments. The cumulative success rate was 89.5%. There were no differences in success between materials (rhBMP: 90.3%; AICBG: 89.1%; P = .85). Patients presenting for retreatment were more likely to receive rhBMP-2 than AICBG (48.6 vs 3.8%, P < .01). After controlling for other significant confounders, the rhBMP-2 group required less personnel (P < .01) and operating room time (P < .01). Only 1 patient in the rhBMP-2 group was admitted, whereas all AICBG patients were admitted a minimum of 1 night., Conclusions: Compared with AICBG, rhBMP-2 produced a similar height of bone but required less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: 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: This is a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in this study if they 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% involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries 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 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 scooter injuries had more than triple the admission rate compared to nonmotorized injuries (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double the 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 may pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Because Robin sequence (RS) is clinically heterogeneous, there is uncertainty as to whether different presentations yield different perioperative outcomes. The purpose of this study was to evaluate factors associated with postoperative length of stay and readmission rate after mandibular distraction osteogenesis (MDO) for RS., Materials and Methods: This was a 10-year retrospective cohort of patients with RS who had MDO performed from 2007 through 2017 at the Morgan Stanley Children's Hospital of the NewYork-Presbyterian/Columbia University Irving Medical Center (New York, NY). Predictor variables were the presence of multiple anomalies, airway intervention used before MDO, and feeding method used before MDO. Outcome variables were postoperative day (POD) of discharge and number of readmissions from the period of discharge to hardware removal. Patient characteristics and outcomes were compared within predictors using Fisher's exact and 2-tailed Student's t tests. Multiple regression models were calculated for each outcome variable using univariate predictors with P values less than or equal to .25., Results: Twenty-four patients who had MDO performed at a mean age of 18.1 weeks were included in this study. On average, patients were extubated on POD 6.6 and distracted to 13.9 mm. Seven patients (29.2%) were readmitted from the period of discharge to hardware removal. Patients receiving an invasive airway intervention before MDO were significantly older at the time of the operation (55.0 vs 8.4 weeks; P = .01). In addition, these patients had a significantly higher readmission rate (80.0 vs 15.8%; P = .01) with a trend toward longer postoperative stays (45.0 vs 21.6 days; P = .06). Feeding status and presence of multiple anomalies did not appear to influence these outcomes., Conclusions: Baseline airway intervention may be useful for predicting length of stay and readmission rate after MDO., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The aims were to report the characteristics of Le Fort fractures and to quantify the associated hospital costs., Materials and Methods: From October 2015 to December 2016, the National Inpatient Sample was searched for patients admitted with a primary diagnosis of a Le Fort fracture. Predictor variables were drawn from demographic, admission, and injury characteristics. The outcome variable was hospital cost. Summary statistics were calculated and compared among Le Fort patterns. Univariate comparisons and multivariate regression analyses were conducted to determine predictors associated with cost., Results: A total of 519 patients were identified in this cohort. Associated injuries included skull fractures (28%), intracranial hemorrhage (13%), cervical spine injury (9.8%), and concussion (9.1%). Seventy-three percent of patients received open reduction and internal fixation (ORIF) for their facial fractures during their admission, 13% received a tracheostomy, and 10% were mechanically ventilated for at least 1 day. The ventilation (P < .01) and tracheostomy (P < .01) rates increased with Le Fort complexity, as did length of stay (LOS; P < .01), costs (P < .01), and charges (P < .01). The mean costs of treating Le Fort I, II, and III fractures were $25,836, $28,415, and $47,333, respectively. Increased cost was independently associated with younger age, male gender, African-American ethnicity, Le Fort II and III patterns, motor vehicle accident etiology, mechanical ventilation requirement, tracheostomy, ORIF, transfer to an outside facility, and increased LOS., Conclusions: The prevalence of head injuries and the need for respiratory support substantially increased with Le Fort complexity. Hospital costs were not markedly influenced by the diagnosis and management of associated injuries. Instead, costs were predominantly driven by fracture complexity and the need for necessary procedures, such as ORIF, tracheostomy, and mechanical ventilation., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to characterize the sources, amounts, and nature of general industry payments to oral and maxillofacial surgeons (OMSs)., Materials and Methods: The Open Payments database was searched from August 2013 to December 2017 for all general payments made to OMSs. For each payment, data were recorded regarding the date, value, paying organization, and nature of the payment. Analyses of variance were performed to compare payment amount per surgeon, number of payments per surgeon, and amount per payment across payment years., Results: Overall, there were 112,448 payments totaling $28,644,063.20. Although, on average each year, 69% of OMSs received at least 1 payment, the top 10% of earners accounted for 89% ($25,607,781) of all payments. Each OMS received a median total of $93.75 (interquartile range, $33 to $263) and an average of $1,109.68 (SD, $14,297; range, $2-$2,250,345) per year. The mean payment value was $254.73 (SD, $2,727; range, $0.01-$548,126) compared with a median of $28.90 (interquartile range, $15-$82). Most payments were in the form of food and beverage (72%); however, the most dollars were spent on consulting fees ($5,594,087; 20%). From 2014 to 2016, significant decreases occurred in the payment amounts (P < .01) and number of payments (P < .01) per surgeon, as well as the value of each payment (P < .01)., Conclusions: Although OMSs receive a substantial amount of industry payments, the overall figure is driven by a small percentage of top earners. Most individual payments were of nominal value, and their effect on clinical practice remains to be seen., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the readability and quality of online patient educational materials (PEMs) for orthognathic surgery., Materials and Methods: Two internet searches were performed using the search terms orthognathic surgery and jaw surgery. The presence of content related to the risks, benefits, procedure, and postoperative care was recorded. Readability was measured using 4 validated scales: Flesch-Kincaid grade level, Gunning Fog index, Coleman-Liau index, and Simple Measure of Gobbledygook index. Materials were readable if they were written at or below an eighth-grade reading level as recommended by the American Medical Association (AMA) and the National Institutes of Health (NIH). Quality was assessed using 2 metrics: the DISCERN instrument and the Journal of the American Medical Association benchmark criteria. A DISCERN score of 50 was set as the lower limit of acceptable quality. Mann-Whitney U and Fisher exact tests were used to compare the readability, quality, and presence of content between private practice and non-private practice PEMs., Results: Fifty websites were included in the study after removing duplicates and applying exclusion criteria. On average, PEMs were written at a 13.4-grade level (range, 7.8 to 17.3). Nearly every website (n = 49; 98%) mentioned the benefits of surgery; however, very few websites discussed the surgical procedure (n = 12; 24%), postoperative care (n = 10; 20%), and risks or complications (n = 6; 12%). The mean DISCERN score was 25.5 of 80 (range, 18 to 63), and only 2 websites achieved DISCERN scores of acceptable quality. Private practice websites reported less content related to the surgical procedure (P = .03) and had lower DISCERN scores (P = .02)., Conclusions: As a whole, online PEMs for orthognathic surgery failed to meet AMA and NIH readability recommendations and yielded poor quality scores. Increasing the presence of content related to treatment risks and postoperative care will help improve the quality of PEMs., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Prospective applicants use residency program websites (PWs) to evaluate programs when deciding where to apply, interview, and rank. The purpose of this study was to evaluate the content of oral and maxillofacial surgery (OMS) PWs., Materials and Methods: This is a cross-sectional study of all OMS programs accredited by the Commission on Dental Accreditation. PWs were identified through the American Association of Oral and Maxillofacial Surgeons Program Directory (AAOMS-PD) and a secondary internet search. The predictor variables were program characteristics (federal service, medical school curriculum, program size, and viability of AAOMS-PD link). The outcome variables were 22 content items related to resident recruitment and resident education and 4 content items related to medical school commitment. Content was recorded as present or absent without judgment on the quality or accuracy. Descriptive statistics were calculated for all outcome variables, and Student t tests were used to compare program characteristics with the amount of content reported., Results: Ninety-six of 101 programs had dedicated PWs. On average, programs included 39% (range, 0 to 77%) of the recruitment and education items assessed. Most programs did not address crucial aspects of training, such as faculty research interests (22%), resident selection criteria (22%), alumni rosters (19%), surgical case load (13%), and dedicated scholarly time (8.8%). Less than half the 6-year programs discussed a tuition responsibility (44%) or tuition assistance (21%). Four-year programs provided significantly less recruitment content (P < .01) and 4-year (P < .01) and federal (P < .01) programs reported significantly less resident education content., Conclusions: As a whole, OMS PWs are under-reporting content related to resident recruitment and resident education. Program directors should update their PWs to provide adequate information for prospective applicants., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

After discectomy, interpositional implants (IPIs) are believed to provide temporomandibular joint stability and protect against degenerative joint space remodeling. Alloplastic IPIs gained popularity in the late 1970s because the practice showed early success without donor site morbidity. Unfortunately, these implants were subject to substantial fragmentation resulting in an exuberant foreign body giant cell response that progressively eroded adjacent structures. Most of these alloplastic implants were removed in the years following their recall by the US Food and Drug Administration in 1991, however some remained in circulation. This report describes a case of a failed Proplast/Teflon IPI 27 years after its placement. This case highlights the considerations for managing a patient with a Proplast/Teflon IPI and serves to remind providers that, although increasingly rare, these implants are still present and subject to delayed failure., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery., Materials and Methods: A single-center, prospective, randomized, double-blind, crossover trial was conducted. The study population consisted of 20 nonsmoking patients referred to the Department of Oral and Maxillofacial Surgery of Columbia University College of Dental Medicine for extraction of all 4 TMs. Each patient received nicotine nasal spray or placebo spray before TM surgery. At a subsequent visit the contralateral TMs were removed with prior administration of the alternate treatment. For an hour postoperatively, subjects reported information on pain and nausea, and hemodynamic variables were recorded at 15-minute intervals. Telephone follow-up was recorded for 5 days postoperatively, where patients reported information on pain, nausea, and use of hydrocodone/acetaminophen as rescue analgesia., Results: Nicotine treatment was associated with a highly significant decrease in pain reported during the 5 days after TM surgery. There was no difference in the amount of hydrocodone/acetaminophen used or amount of nausea reported. There was a small but significant increase in heart rate after nicotine treatment compared with placebo during the first hour after surgery. There was no difference in blood pressure between groups., Conclusion: Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This study evaluates the temporal sequence and growth factor release from platelet-rich plasma (PRP) combined with different bone substitutes (BS), to identify an optimal substrate for extended growth factor retention., Materials and Methods: PRP was clotted with bovine thrombin or thrombin receptor activator peptide-6 (TRAP). In addition, PRP was clotted using Allogro (Ceramed, Lakewood, CO), BioGlass (Mo-Sci, Rolla, MN), or BioOss (Osteohealth, Shirley, NY). The effects of media exchange and BS on platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF beta) release were quantified via enzyme-linked immunosorbent assay., Results: At day 1, the thrombin group released 36% more PDGF than the TRAP group and 80% more than the BS groups. At 7 days, PDGF release was the greatest for the TRAP group. PDGF release was minimal for all groups at day 14, with BS groups retaining 60% more PDGF than thrombin clots. Similarly, the thrombin group released the greatest amount of TGF beta (81.4% of the total), whereas TRAP and BS groups released significantly less TGF beta at day 1. Compared with thrombin, TRAP retained 39.2% more TGF beta, whereas BS groups retained even greater levels (Allogro, 54.3%; BioOss, 45.8%; BioGlass, 67.0%). No significant difference in TGF beta release was observed among the substitutes after day 1. The BS groups continued to retain TGF beta after 14 days, whereas all TGF beta in the thrombin clots was depleted., Conclusions: PRP preparation with thrombin results in a large, immediate release of growth factors that could be lost into the interstitium in vivo. TRAP-BS may prove more efficacious than thrombin in sustaining growth factor levels critical for the cascade of events leading to bone formation.

Purpose: This study proposes an alternative preparation method of platelet-rich plasma (PRP). Specifically, we compare the use of thrombin receptor agonist peptide-6 (TRAP) and bovine thrombin as a clotting agent in the preparation of PRP., Materials and Methods: PRP was prepared by centrifugation and clotted with thrombin or TRAP. In vitro clotting times were monitored as a function of TRAP concentration, and clot retraction was determined by measuring clot diameter over time. Following the optimization of TRAP concentration, experiments were repeated with the addition of several commercially available bone substitutes. The release of PRP-relevant growth factors as a function of PRP preparation was also determined., Results: The most rapid polymerization of PRP takes place with the addition of thrombin, followed by TRAP/Allogro (Ceramed, Lakewood, CO), TRAP/BioGlass (Mo-Sci, Rolla, MN), TRAP/BioOss (Osteohealth, Shirley, NY), and TRAP alone. Thrombin caused considerable clot retraction (43%), whereas TRAP alone resulted in only 15% retraction. TRAP/Allogro, TRAP/BioOss, and TRAP/BioGlass all exhibited minimal retraction (8%)., Conclusions: The use of TRAP to activate clot formation in the preparation of PRP may be a safe alternative to bovine thrombin. It results in an excellent working time and significantly less clot retraction than the currently available methods of PRP production.

Surgery of the cranial base presents significant challenges for the surgeon and patient alike. The goal of ablative surgery-to obtain disease-free margins-contrasts with the patient's functional and esthetic needs. This comes into sharp juxtaposition in cranial base surgery. The technical and technologic advances of the last two decades have made surgical treatment of cranial base lesions possible. This article reviews the pathology, anatomy, and lateral and midline approaches to the cranial base.

Purpose: Augmentation of the alveolar ridge before implant placement is frequently performed. The purpose of this study was to compare the amount and quality of bone formation under Micro Titanium Augmentation Mesh (M-TAM) when used alone for guided tissue regeneration or in combination with a porous hydroxyapatite (HA) bone graft substitute., Materials and Methods: Nine adult female dogs underwent extraction of premolars and molars and had a knife-edge ridge created. Three months later, the ridges were augmented with either M-TAM alone or M-TAM with a nonresorbable porous HA (Interpore 200; Interpore Cross International, Irvine, CA). Six months after augmentation, the dogs were killed, and the mandibles were harvested and imaged using 3-dimensional computed axial tomography. Statistical analysis was performed from the data obtained from the scans. The mandibles were then fixed, sectioned, and examined by light microscopy., Results: Dehiscence occurred in 22 of 32 experimental sites. Seven of these 22 dehisced sites showed increased ridge width. Ridge width increased in both the HA and non-HA groups. The HA group showed a greater increase in ridge width., Conclusion: A high rate of dehiscence was observed in this animal study using M-TAM for guided tissue regeneration. In animals that did not dehisce, increased width was greater when nonresorbable porous HA was used as a bone graft substitute., (Copyright 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:347-353, 2003)

Purpose: This article discusses the use of the 2-piece Le Fort I osteotomy to gain access to the cranial base and the authors' experiences with this technique., Methods: Medical records of patients who required surgical access to the cranial base were retrospectively reviewed, and demographic data, procedures done, postoperative results, and complications were recorded., Results: Nine patients underwent a 2-piece Le Fort I osteotomy. Complications included development of a pseudoaneurysm of the internal carotid artery in 1 patient, 2 cerebrospinal fluid leaks, both of which resolved, and 1 patient who lost 2 teeth and some associated bone., Conclusion: The 2-piece Le Fort I osteotomy provides excellent access to the clival region of the cranial base with minimal complications.

Purpose: This study was performed to compare the dimensions of the nasopharynx, oropharnynx, and hypopharynx of persons with hyperdivergent and normodivergent facial types, and to determine whether any variations exist., Patients and Methods: Lateral cephalometric records of a population with a normodivergent facial pattern (n = 23) and a group with a hyperdivergent facial pattern (n = 27) as evidenced by increased mandibular plane angle were used to compare the soft tissue airway dimensions. Statistical analysis consisted of Student's t-tests, Wilcoxon rank sums, and chi2. Statistical significance was set .05., Results: Overall the hyperdivergent group had a narrower anteroposterior pharyngeal dimension than the normodivergent control group. This narrowing was specifically noted in the nasopharynx at the level of the hard palate and in the oropharynx at the level of the tip of the soft palate and the mandible. In addition, the posterior pharyngeal wall had a thinning at the level of the inferior border of the third cervical vertebrae, and there was a more obtuse palatal angle. The tongue was also positioned more inferiorly and posteriorly in the hyperdivergent group, as evidenced by the increased distance between the hyoid bone and the mandibular plane and the increased distance between the soft palate tip and the epiglottis. The hyperdivergent group had more retruded maxillary and mandibular apical bases and a higher Class II skeletal discrepancy., Conclusions: The narrower anteroposterior dimension of the airway in hyperdivergent patients may be attributable to skeletal features common to such patients, that is, retrusion of the maxilla and the mandible and vertical maxillary excess. Other features, such as an obtuse soft palate and low-set hyoid, also may be contributory factors. The relatively thin posterior pharyngeal wall observed in hyperdivergent patients might be a compensatory mechanism.

The purpose of this investigation was to compare two sedation techniques for use in outpatient third molar surgery. Forty ASA class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, sublimaze (.0007 mg/kg [corrected] intravenous bolus), and midazolam (.5 mg/min) titrated to effect. Using an incremental bolus technique, group A then received methohexital, while group B received propofol. Both groups maintained stable mean arterial pressure, oxygen saturation, and end-tidal CO2 throughout the perioperative period. However, group A had a dramatic increase in heart rate (26.7% versus 13.9% for group B [P < .05]). Better postoperative psychomotor performance (P < .05) as measured by the Trieger Dot analysis was demonstrated by patients who received propofol. It was concluded that propofol is superior to methohexital for intravenous sedation.