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The purpose of this study was to estimate the frequency of retained ballistic fragment (RBF) removal and to identify factors associated with an increased risk for RBF removal. To date, there are no studies focused on identifying factors associated with removal of RBFs localized to the maxillofacial region.Using a retrospective cohort study design, the authors enrolled a sample composed of patients with RBFs localized to the maxillofacial region. The predictor variables included bullet size, location, involvement of bone, involvement of sinus, antibiotics, multiple antibiotics, and multiple locations. The primary outcome variable was RBF retrieval. The secondary outcome variables were timing of operative retrieval, fragment site infection, and migration of RBF. Appropriate uni- and bivariate statistics were computed and logistic regression modeling was used.The sample was composed of 20 patients (mean age, 30 yr; 80% male) and 55% (11 patients) required or desired object removal overall. The number of projectiles ranged from 1 to 19 (total, 48) in the 20 patients. The logistic model identified larger size, final location of bone, final location of soft tissue, and final location of sinus as having a higher probability of removal that was statistically significant (P .05); however, size was the only variable with a substantial odds ratio (OR; 1.96; P .05). There was no evidence of migration and a low rate (2.3%) of infection was noted at subsequent follow-up radiography and clinical examination.Size was the only statistically significant predictor variable with a substantial OR (1.96; 95% confidence interval, 1.31-3.40; P .05). There was a low risk of infection even when considering oral pharyngeal contamination and low risk of migration. Further studies could focus on prudent antibiotic use and larger patient populations.

Surgical residency education has undergone a paradigm shift, with more emphasis being placed on the value of simulation as a core educational tool. As a result, the Halstedian education model of ‘‘see one, do one, teach one’’ is no longer the preferred method of initial procedural and cognitive training. Patient care involves a more experienced and confident interaction with the resident, likely resulting in enhanced patient care and safety. This requires a change for residents and faculty alike. Although there is considerable literature describing the use of simulation in general surgery and anesthesia residency education, there is scant information specifically on its use in oral and maxillofacial surgery (OMS) residency training. Programs need to balance the reality of clinical duties with the importance of patient safety and proficiency-based trainingthatsimulation canprovide. Simulation provides the ability to tailor specific educationalgoalstofittheneedsofaprogram’sstrengthsand resources and ensures that residents gain experience in high-risk, low-volume procedures and to make the learning conducive to all levels of learners within the residency. 1 The process of implementing simulation education involves a change in philosophy with regard to current residency education. This new philosophy requires that the learner, not the patient, be the educational focus and itensuresthat errorsare used asteaching points. 2 Further, it fosters competency based on validatedmeasurements. 2 TheOMSresidencyprogram at Christiana Care is developing and implementing simulation with the institution’s Virtual Education and Simulation Training Center into the core curriculum of residency training. Six core areas of residency training were identified: surgical skills, physical diagnosis, ethics and professionalism, Advanced Cardiovascular Life Support (ACLS), anesthesia, and patient management. Simulation models are being developed that cover these core areas. Currently, scant information is available in the literature on implementing simulation into OMS residency education; thus, we present an initial novel approach toward residency education. In the implementation of this pilot program, sessions were developed and scheduled over the course of the academic year: 1) management of difficult airways, 2) local skin flaps (Fig 1), 3) laparoscopic fundamentals for arthroscopy of the temporomandibular joint, 4) objective structured assessment of technical skills for formative assessment of laceration closure, 3 5) delib