Purpose The purpose of this study was to assess the outcomes after preoperative virtual surgical planning (VSP) for inferior alveolar nerve (IAN) reconstruction in ablative mandibular surgery. ...Materials and Methods We performed a retrospective evaluation of consecutive surgical cases using standard VSP for hard tissue resection and reconstructive surgery in addition to IAN VSP performed simultaneously during surgery. Cases were assessed regarding the planning time, additional costs involved, surgeon's subjective impression of the process, accuracy of the prediction during surgery, and operative time during surgery compared with cases performed without VSP. Results The study sample was composed of 5 cases of mandibular resection for benign disease, with bony, soft tissue, and neural reconstruction with the use of VSP. The addition of IAN reconstruction to the VSP session added no additional expense to the planning session but resulted in an additional 22.5 minutes (±7.5 minutes) for the webinar session. From a subjective standpoint, IAN VSP provided the surgeon with a discreet plan for surgery. From an objective standpoint, IAN VSP provided the exact length and diameter of nerve graft required for surgery, facilitated the surgeon's ability to visualize the actual nerve graft procedure, and limited the additional time required for simultaneous nerve reconstruction. Conclusions Despite perceived prejudice against simultaneous IAN reconstruction with complex mandibular resection and reconstruction, the use of IAN VSP may facilitate the actual surgical procedure and result in considerably improved patient outcomes without considerable additional time or cost associated with this protocol.
Purpose Mandibular retrognathia may cause upper airway obstruction in the pediatric patient due to tongue collapse and physical obstruction in the hypopharyngeal region. Mandibular distraction ...osteogenesis (DO) may be a useful treatment option to avoid tracheostomy. This study reviews 35 patients who underwent DO as treatment for concomitant jaw discrepancy and corrective airway management. Patients and Methods Thirty-five consecutive patients, 20 male and 15 female, with airway obstruction were evaluated retrospectively using clinic and hospital records. The mean age was 3.5 months (range, 36 weeks' gestation to 4 years). The group consisted of patients with Pierre Robin sequence, Stickler syndrome, Opitz's syndrome, Down syndrome with obstructive sleep apnea, Goldenhar's syndrome, Treacher Collins syndrome, and mandibular retrognathia. All patients had obstruction limited to the upper airway related to severe retrognathia and posterior tongue-base displacement confirmed with direct laryngoscopy. All patients underwent mandibular DO to avoid or remove a tracheostomy and allow development of speech and normal feeding. Each patient underwent bilateral mandibular corticotomies and placement of 2 percutaneous Kirchner wires and extraoral distraction devices. Following a 0-day latency, DO was performed at 3 to 5 mm per day (mean: 4 mm per day) for a mean total of 22.5 mm (range, 15-32 mm). The mean consolidation period was 28 days (range, 20-42 days). Preoperative radiographs (lateral cephalometric radiograph and/or CT scan) were obtained in all cases preoperatively and at least 3 months postoperatively for analysis. Results All patients experienced resolution of obstructive upper airway symptoms during the DO process. No patient required tracheostomy, and pre-existing tracheostomy devices were decannulated before DO completion. Apnea monitors failed to trigger in any patient postdistraction, and sleep studies were normal. The mean follow-up period was 9 months (range, 4-18 months). Radiographic analysis revealed the mean increase in posterior airway space was 12 mm. The mean decrease in overjet was 12 mm. Mandibular length increased a mean of 15 mm, and the sella-nasion-B point angle increased a mean of 16 degrees. DO complications included premature consolidation requiring manual refracture, hypertrophic scarring, device replacement, apertognathia with resolution within 8 to 12 weeks following device removal, and intraoral pin exposure. There were no cases of pin site infections or development of temporomandibular ankylosis. Conclusion Mandibular distraction osteogenesis is a viable option for the pediatric patient with upper airway obstruction due to mandibular deficiency to avoid a tracheostomy or other surgical intervention. Mandibular DO treats the etiology of the disease process and may allow for future growth.
Purpose Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine ...the outcomes of immediate reconstruction of long-span defects (≥50 mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts. Materials and Methods A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50 mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period. Results Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7 years (range, 18 to 61 yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7 months (range, 10 to 27.5 months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0). Conclusions Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5 cm) is a viable and predictable option to achieve useful functional sensory recovery.
Purpose To evaluate the effect of platelet-rich plasma (PRP) on bone healing in an osteotomized defect of the rabbit mandible. Materials and Methods Twelve adult female New Zealand White rabbits were ...randomized to 1 of 2 treatment groups: group A had an osteotomy with the addition of a bone graft, and group B had an osteotomy without a bone graft. Regardless of treatment group, 1 side in each rabbit was randomly selected to receive PRP as an internal control. Bilateral 1.0- × 0.5-cm mandibular inferior border osteotomies were performed in each animal, 0.5 cm anterior to the antegonial notch to create mandibular defects. The osteotomy sites were evaluated by histologic and radiographic analyses for bone healing at 1, 2, and 3 months after surgery. Results A 4-point ordinal scale was used to compare healing, based on radiographic density, radiographic height, and histologic height of new bone formation. Group A rabbits showed significantly shorter healing times compared with group B rabbits. A pairwise analysis indicated that the addition of PRP did not increase the overall score of any measured parameter, at any interval ( P > .9). Conclusions In the rabbit osteotomy model, bone grafting (group A) significantly improved healing in comparison with no bone grafting (group B). In defects of the mandible, an increased radiographic and histologic bone density and height were seen at 1-, 2-, and 3-month intervals in the bone graft group; however, the addition of PRP did not appear to provide any statistically significant benefit to healing in either group.
Abstract Purpose To determine why women chose to enter an academic career in oral and maxillofacial surgery (OMS). Materials and Methods An online questionnaire was developed and emailed to female ...?OMS surgeons to assess the reasons why women choose to pursue an academic career, the perceived positive and negative features of academia for women, and proposed measures to increase the percentage of women choosing to specialize in OMS and pursue an academic career. Results 31 female OMS surgeons completed the questionnaire; one additional participant accessed the survey but did not respond to any of the questions. There were 25 full-time academics and 6 part-time academics (50% time commitment or more). 72% of the responders were married, and of those 72% were married prior to entering academics. 47%% of the women had children, all during their academic tenure. Among the full time academicians with children, only 2 (7.7%) reported moderate difficulty finding the time for childbirth and maternity leave, while 3 out of the 5 part time academics with children, reported moderate or significant difficulty with childbirth and maternity leave. Factors associated with choosing and enjoying an academic career are involvement in resident-student teaching (78%), followed by colleague camaraderie and collaboration (65.6%), research potential (50%), time flexibility and not having to deal with excessive “business” practice issues (33%). The main reason for considering leaving an academic OMS career and/or amongst the least enjoyable aspects of being in academics were the potential for a higher income in private practice (56%). Less significant reasons for considering leaving an academic OMS career were a more flexible work schedule in the private sector and less institutional red tape (37.5%), independence/being in control, and more family time (22%), Engaging residents and students by female OMS, better mentorship from academic OMS and increase in the number of women serving in leadership positions in organized OMS, were identified as the most important measures to increase female involvement in academic OMS. Conclusion This study shows that among the major motivating factors for choosing an academic career are: the involvement in resident-student teaching and colleague camaraderie and collaboration. Additional important factors for making this career choice were the research potential in academia, time flexibility and not having to deal with excessive “business” practice issues. The reasons that deter women from entering OMS as a specialty and choosing a full-time academic OMS career are not significantly related to childbirth and family life. The main reason for potentially considering leaving an academic OMS career and/or among the least enjoyable aspects of being in academics, were the potential for a higher income in private practice. Other reasons for potentially considering leaving an academic OMS career indicated by this study were the lack of institutional red tape as well as independence/being in control, and more family time. It appears that engaging female residents and students by female OMS, better mentorship by (both male and female) academic OMS and increasing the number of female surgeons who can serve as role models, may be beneficial in increasing the number of female OMS interested in an academic career.
Abstract Anxiety in the pediatric patient population is a problem for outpatient anesthesia because of poor patient compliance during the initiation of the anesthetic technique. A variety of ...techniques have been used in the outpatient surgery and emergency department settings to improve cooperation in the pediatric age group or those with developmental and cognitive delay. These adjunctive techniques include the growing popularity of the use of eutectic mixtures of local anesthetic cream, nitrous oxide, oral premedication, and intramuscular injections. A highly effective technique to use during intravenous catheter insertion is the use of a refrigerant spray, ethyl chloride, to cause a transient local hypoesthesia of the skin at the venipuncture site. This technique is not associated with any significant contraindications or adverse reactions, and it should be considered for both pediatric and adult patients in the oral and maxillofacial surgery practice.
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