Maxillofacial Surgery Program Research Articles

Trends and Attitudes Regarding Head and Neck Oncologic Surgery: A Survey of United States Oral and Maxillofacial Surgery Programs

The purposes of this study were to: 1) estimate the prevalence and trends of American oral and maxillofacial surgery (OMS) programs in recruiting head and neck oncologic surgery (HNOS) -trained faculty, performing HNOS oncologic procedures and microvascular reconstruction, and presenting HNOS research at academic meetings; 2) estimate whether HNOS and microvascular reconstruction involvement varies among programs with or without a program director or chair trained in HNOS; 3) estimate whether HNOS involvement varies among those OMS programs that regularly attend and do not attend tumor board; 4) estimate whether HNOS involvement varies among those programs that have and have not presented HNOS research at an academic meeting; 5) estimate whether HNOS involvement varies among doctor of medicine-integrated and 4-year OMS programs. Investigators developed and distributed a survey to all US OMS program directors and/or chair composed of questions regarding faculty prevalence and recruitment, frequency and trends in cases, and the priority of applicants for residency with regard to HNOS. There were 18 close-ended questions, and one open-ended question. Responses were recorded in categorical, Likert, ordinal, and numerical format. Bivariate associations were calculated using Fisher exact test and logistic regression. Sixty-three of 101 surveys were returned (62.3%). Ten program directors or chair completed a fellowship in HNOS (15.9%). Programs with an HNOS-trained program director or chair were more likely to have another HNOS-trained faculty member (P = .01), performed more malignant tumor resections (P < .001), neck dissections (P < .001), and microvascular free-flap reconstructions (P = .02) than programs without program directors or chair trained in HNOS. Programs that regularly attended tumor board performed an increasing number of malignant tumor resections (P = .008); and neck dissections (P = .003) than programs that did not regularly attend their institution's tumor board. Presentations of HNOS-related research at national meetings did not differ between doctor of medicine-integrated and 4-year OMS programs (P = .7). There was no difference in the prevalence of HNOS-trained program directors and chair between doctor of medicine-integrated and 4-year programs (P = .7). This study's data and comments suggest that programs involved in HNOS have a strong involvement in expanded scope OMS and related academic activities.

Orthognathic and TMJ Surgery: Postsurgical Patient Management

Postsurgical patient management is a critical factor for high-quality patient treatment and predictable outcomes in orthognathic and temporomandibular joint (TMJ) surgery. Lack of understanding of proper patient management on the part of the surgeon and orthodontist can result in compromised or even disastrous results. Surgeons and orthodontists must have the knowledge and ability to implement postsurgical management protocols and strategies to provide the best care and outcomes possible for their orthognathic and TMJ surgery patients. Information is presented here in reference to postsurgical orthodontics, healing process, dietary considerations, activities, and potential complications to aid the clinician in understanding the postsurgical processes that patients will encounter.

History of the Baylor Oral and Maxillofacial Surgery Program, Dallas, TX

The development of Baylor University Medical Center (BUMC) has paralleled that of the Baylor College of Dentistry (BCD). The 2 institutions are physically attached but administratively separate. For many years, the 2 institutions have had a close working relationship, in particular, the shared specialty and training program of oral and maxillofacial surgery. Presented herein is the history of this program, the institutions that support it, and the many administrators and oral and maxillofacial surgeons whose support and contributions have made this program one of the best.

Trends in Head and Neck Oncologic Surgery: A Survey of United States Oral and Maxillofacial Surgery Programs

Statement of the Problem: Head and Neck oncologic surgery (HNS) is emerging as a growing sub-specialty of oral and maxillofacial surgery (OMFS). However, there are no data reporting the prevalence and importance of HNS from the department and applicant standpoint in United States OMFS programs. The purposes of this study were to: 1) Evaluate the prevalence and recruitment of HNS trained faculty and case-load; 2) estimate the prevalence and trend of HNS cases; and 3) estimate the importance of HNS among applicants, among United States OMFS programs.

アメリカ合衆国における口腔外科専門医育成プログラムの現状

アメリカ合衆国における口腔外科専門医育成プログラムの現状

Centric Relation: A Survey Study to Determine Whether a Consensus Exists Between Oral and Maxillofacial Surgeons and Orthodontists

The purpose of this study was to determine whether there is a consensus among oral and maxillofacial surgeons and orthodontists as to the definition of centric relation. A survey constructed from 5 definitions of centric relation as provided from the "Glossary of Prosthodontic Terms" was sent to the chairpersons of every oral and maxillofacial surgery and orthodontic program in the United States. Only full-time faculty members from each program were asked to respond to the survey. The different responses were analyzed statistically by chi(2) analysis and examined by use of 95% confidence intervals. We received 73 responses from the oral and maxillofacial surgeons and 64 from the orthodontists. There were 69 different programs represented in this survey. Orthodontists and surgeons had a significantly different response regarding the definition of centric relation (chi(2) = 28, df = 4, P < .0001). There was no difference between the 2 groups on the need for mounting models in centric relation for use in orthognathic surgery (chi(2) = 1, P > .6). Regarding the definition of centric occlusion, there was a significant difference between orthodontists and surgeons (chi(2) = 9.9, df = 1, P = .0070). The fourth and fifth questions had to do with centric relation/centric occlusion slide and the direction of movement. There was a significant difference between the 2 groups regarding mandibular movement (chi(2) = 28, df = 2, P < .0001). Surgeons were nearly unanimous in their opinion that the mandible would move anteriorly (88%), whereas there was more discordance among orthodontists. Within the orthodontic group, 50% indicated anterior movement and 47% indicated that either an anterior or posterior movement could occur. The surgeons were asked 1 additional question that the orthodontists were not. Forty-nine percent of the surgeons indicated that during a bilateral sagittal split osteotomy, the proximal segment should be seated vertically and posteriorly before rigid fixation. The results of this study show that there is a statistical lack of consistency among practitioners regarding an absolute definition of centric relation as it relates to orthognathic surgery. The inconsistency exists between specialties and within practitioners in each specialty.

Survey of Implant Training in Oral and Maxillofacial Surgery Residency Programs in the United States

The status of implant training in US oral and maxillofacial surgery programs has been reported previously based on data gathered from residency program directors. Since the time of those earlier surveys, however, many new technological and surgical developments have occurred in implant therapy. The purpose of this study was to evaluate the current status of implant training in oral and maxillofacial surgery residency programs in the United States. E-mail invitations were sent to 559 resident members of the American Association of Oral and Maxillofacial Surgeons asking them to participate in an online survey between January 23 and February 6, 2006. Each survey invitation was assigned a unique URL so that each resident could respond only once to the survey during the specified interval. The survey contained 17 questions assessing various aspects of training in implant placement. A total of 201 completed surveys were received by the specified deadline. The participation rate was roughly similar in residents of 4-year certificate programs and those of 6-year MD combined programs (56% vs 44%). In total, 48% of residents reported receiving less than 20 hours of didactic training in implantology per year, and 57% reported using 2 or fewer implant systems. Some 57% estimated that they would place fewer than 20 implants in the coming year, whereas 52% reported that they would place more than 50 implants during their residency. Interestingly, 98% of the residents reported that implant dentistry would be an important part of their practice, but 28% felt inadequately prepared by residency training. There is a broad range of experience in implant training in US oral and maxillofacial surgery residency programs. Almost all oral and maxillofacial surgery residents feel that implant dentistry will be an important part of their practice; however, many residents feel that their training during residency has not adequately prepared them for implant surgery. Our findings identify a potential need for additional training in implant surgery during oral and maxillofacial surgery residency.

The University of Kentucky Oral and Maxillofacial Surgery Program

r h 1 fi b g T o g g o t m m s m he University of Kentucky Oral nd Maxillofacial Surgery Program s sponsored by the College of entistry at the University of Kenucky and has as its main teaching enters the College of Dentistry, handler Medical Center, the Vetrans Administrative Hospital in exington, and the University of entucky Children’s Hospital. All f these facilities are physically atached to one another. The Univerity of Kentucky Chandler Medical enter was established in 1957 on he Lexington campus. The Uniersity of Kentucky Hospital is omprised of a 473-bed facility, hich is supported by more than 00 faculty physicians and denists, 400 resident physicians, and a taff of 3,200 health professionals. ith more than 80 specialty serices, programs, and centers, it

Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery Program

The present Oral and Maxillofacial Surgery Service at Massachusetts General Hospital (MGH) (Fig 1). began in 1867 when the Harvard Dental School, the first university-affiliated dental school in the country, was founded. Physicians at Harvard and MGH identified a need for “doctors of dental medicine” analogous to “doctors of medicine.” The new dental school occupied a building on Grove Street, adjacent to the MGH, recently vacated by the Harvard Medical School. It was within this building that the Dental Infirmary of the MGH, the parent of the present Department of Oral and Maxillofacial Surgery, was established. Six dentists and a dental surgeon were appointed to the staff, and it is noteworthy that they treated 4,000 patients a year.

Massachusetts general hospital/Harvard medical school MD oral and maxillofacial surgery program: a 30-year review

Purpose The first resident enrolled in the Massachusetts General Hospital/Harvard MD Oral and Maxillofacial Surgery (MD/OMFS) program graduated from Harvard Medical School (HMS) in 1972. The purpose of this report is to provide a summary of the first 30 years of the program and to outline plans for its future. Materials and methods This was a retrospective cohort study and the sample was composed of the residents enrolled in the MD/OMFS program between 1971 and 2000. Study variables included the dental school from which the resident graduated, successful completion of the MD/OMFS program, performance on parts I and II of the United States Medical Licensing Examination/National Board of Medical Examinations (USMLE/NBME), HMS grades, and career trajectories (full- or part-time academic or private practice). Appropriate descriptive and bivariate statistics were computed for all study variables. Results During the study interval, 56 residents entered the MD/OMFS program and graduated from HMS. All members of the cohort, regardless of the dental school from which they graduated, performed well as evidenced by USMLE/NBME scores and medical school grades. Ninety-four percent of eligible graduates have completed the American Board of Oral and Maxillofacial Surgery examination. The pass rate was 100%. Thirty-four graduates are involved in full- or part-time academic practice. Four trainees completed medical school but did not complete the OMFS program. Conclusion The overwhelming majority of trainees completed the program, became board certified, and currently practice OMFS or a related specialty. A disproportionate number entered academic careers.

Is there a correlation between performance on dental and medical board examinations?

Purpose: The purpose of this study was to determine whether a correlation exists between passing the United States Medical Licensing Examination (USMLE) Step 1 (USMLE) on the first attempt and performance on National Board Dental Examination Part I (NBDE). Materials and Methods: Questionnaires were sent to program directors of 52 dual-degree oral and maxillofacial surgery programs. The information requested concerned residents of each program from 1990 to 2000 and included NBDE scores and number of attempts each resident took to pass the USMLE Step 1. Also included was the number of years of medical school each program required, as well as time given to USMLE Step 1 study preparation. The data were analyzed to determine if a relationship exists between NBDE Part I score and pass rate on the USMLE Step 1 on the first attempt. Data presented are the mean ± SD. Results: Questionnaires were received from 26 of 52 (50%) dual-degree oral and maxillofacial surgery programs regarding 426 residents. The overall average of NBDE Part 1 was 92.55 ± 3.62 (range, 83 to 99). The average NBDE Part I score for those candidates who passed the USMLE Step 1 on the first attempt was 93.75 ± 3.02, and for those who did not pass the USMLE Step 1 on the first attempt, it was 89.12 ± 2.93. The average NBDE Part I score is significantly higher for those subjects who passed the USMLE Step 1 on the first attempt (P <.001). A candidate with an NBDE Part I score of 95 to 99 is 75 times more likely to pass the USMLE Step 1 on the first attempt than is a candidate with a score of less than 90. A marginal association was found with study preparation time and amount of medical school completed during residency. Conclusions: A significant correlation exists between NBDE Part I score and pass rate on the USMLE Step 1 examination. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:701-706, 2003

Applicants' opinions about the selection process for Oral and Maxillofacial Surgery Programs

Purpose: This study was conducted to investigate the characteristics of and opinions about the selection process of applicants to residency programs in oral and maxillofacial surgery (OMS) in the year 2000. The current investigation paralleled a survey completed in the 1970s, with additional questions to assess contemporary curriculum and surgical training evolution. Differences from the previous (1976) survey, a profile of applicants in 2000, and characteristics of OMS residency programs that applicants view as attractive are discussed. Subjects and Methods: Questionnaires were sent to 307 applicants to OMS residency programs registered in the dental matching program. To provide a more direct comparison of the study completed in 1977, the current questionnaire used the original survey as a model. It was divided into 6 sections: general information, information from the formal application and letters of recommendation, the interview, the selection process, the characteristics applicants were seeking in a program, and a retrospective review of programs visited. Results: In this study, 118 responses were received, representing 38% of the total. Respondents were predominately men (86%) and single, and attended dental school in all regions of the United States and the world. Respondents listed geographic location (65%) and national reputation (58%) as important factors for selecting programs to which to apply. Many respondents felt that a previous dental internship (85%), national board scores (83%), and class rank (79%) would be considered important in screening applicants for interview. A program's reputation, personalities of residents and attending staff, and clinical material were ranked as important factors contributing to program selection. Fifty-three of the 79 successful applicants reported that they were matched with their first-choice institution. Sixty percent of programs were considered worthy of revisiting by the respondents. Conclusions: Respondents in 2000 had more knowledge of the selection process before interviewing and submitted 2 times the number of applications than applicants in 1977. When selecting programs to which to apply, current applicants were less influenced by geographic location and the recommendations of other dentists. Applicants were attracted to programs that they perceive to have a good reputation and abundant clinical material. Residencies that convey a friendly atmosphere, favorable interpersonal skills of enrolled residents, and appealing personalities of the faculty were more attractive to candidates. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:608-614, 2003

A double standard in double degree

A double standard in double degree

Women in oral and maxillofacial surgery: Factors affecting career choices, attitudes, and practice characteristics

Purpose: This study analyzed the factors that attract women to the field of oral and maxillofacial surgery, their attitudes toward various aspects of the specialty, current practice patterns, and biases that may have been or are still being encountered. Methods: Surveys were mailed to practicing female oral and maxillofacial surgeons, to oral and maxillofacial surgery residency programs to be distributed to their female residents, and to male and female dental students. Results: A total of 107 surveys were sent to practicing female surgeons and 105 to oral and maxillofacial surgery programs. There was a return rate of 71% and 70%, respectively. Practicing female oral and maxillofacial surgeons tended to be young, Caucasian, and married. Fifty-nine percent were boarded, and 47% owned their own practices. Four of 76 had interrupted their residencies, and 18 had interrupted their practices at some point. More than 64% of practicing female oral and maxillofacial surgeons believed that there was a bias against women in this field. Female residents showed an overwhelming satisfaction with their career choice, but nearly half of them alluded to the need for dedication, a restriction of social life, or a concern for entering an maledominated field. For students, the time commitment during residency and while in practice, and compromised family and social life, were the most commonly mentioned deterrents to entering oral and maxillofacial surgery, and lifestyle and the excitement of the field were its major attractions. Conclusion: Despite some biases in the field, women are practicing oral and maxillofacial surgery full time and are combining their career with full family lives. Among dental students, the time commitment and social compromise are the largest deterrents to entering the specialty of oral and maxillofacial surgery.

Survey of clinic fees and clinic revenue–summary report, 1993–94

Figure 4 shows the mean unadjusted revenue-per-student by program type. Advanced Education General Dentistry programs had the highest revenue-per-student this year and in two of the three previous years. Oral and Maxillofacial Surgery programs generated the second highest mean amount of clinic revenue-per-student, followed by General Practice Residencies, Orthodontic programs, and Prosthodontic programs. Pediatric Dentistry, Endodontics, and Periodontics programs also had similar mean revenues-per-student. The smallest revenues-per-student were generated by D.D.S./D.M.D. and dental hygiene programs. These data should be interpreted with care. A review of the information for each program shows that there are significant variations in these data from school to school. These variations could be caused by different accounting procedures as well as differences in program size and location. Consequently, these data are best viewed in general terms.

Outcome assessment in oral and maxillofacial surgery advanced education programs

Outcome assessments are becoming a standard by which predoctoral and postdoctoral advanced dental educational programs are being evaluated internally and externally. This article presents an overview of the process of development of an outcome assessment document for oral and maxillofacial surgery residency programs and provides an example of its value in the evaluation of two different types of oral and maxillofacial surgery programs.

The mandibular subperiosteal implant denture: A fourteen-year study

A n analysis of 74 of the 80 patients undergoing or having experienced mandibular subperiosteal implant denture (MSID) therapy at the University of Southern California, School of Dentistry was conducted to evaluate the 1Cyear follow-up results. The design and prosthodontic procedures used have been reported by Bodine et al’s2 and the initial report on the MSID was given at 5 years by Bodine et al3 The fabrication of the mandibular subperiosteal implant framework and superstructure attachment was performed by Buttress and Associates Laboratory of Los Angeles, California. All implant frameworks were cast by using Vitallium (Austenal Dental, Inc., Chicago, Ill.) alloy. The MSID therapy was administered by dentists receiving instruction in the Advanced Prosthodontic Education Program and the Oral and Maxillofacial Surgery Program at the University of Southern California. Recalls are performed at the sixth month after insertion of the MSID and annually thereafter for evaluation with treatment as needed for problems that are noted. As the study continues these problems deal with normal denture wear and various difficulties with the implant itself. This study evaluated the clinical manifestations of paresthesia, incision line separation, implant framework exposure, inflammation, and reaction to vertical force along the abutments. The responses were subjected to analysis by number of occurrences and frequency on an IBM 3081 computer system for each category, recall, and specific post.

Drug abuse in oral and maxillofacial training programs

Concern about drug dependence in other medical specialties involving constant exposure to anesthetic and sedative drugs prompted a survey of oral and maxillofacial surgery programs. One hundred sixteen programs were surveyed; 78.5% responded, and 51% of the responding programs reported at least one suspected incident of drug dependence. Twenty-six confirmed cases were reported. Meperidine and fentanyl were the most frequently abused substances. Behavioral changes and information supplied by co-workers were the most frequent reasons for confrontation of residents suspected of drug abuse by superiors. Detailed follow-up information was often sketchy and unavailable. Drug abuse may be more common than usually thought in oral and maxillofacial surgery programs and on the same level as that observed in anesthesia training programs.

The Performance of Patient Histories and Physical Evaluations by Oral and Maxillofacial Surgeons

F or some years there has been an on­ going dialogue in a large number of in­ stitutions about the propriety and effi­ cacy of the obtaining of patient his­ tories and performance of physical evaluations by oral and maxillofacial surgeons. Some institutions have en­ thusiastically supported the concept, but official approval by some has been withheld based on a misunderstand­ ing of what training the oral and maxillofacial surgeon has, confusion in state laws, absence of approval by accrediting agencies, and questions about why it is necessary. The rationale for “why” is clear to those who have reviewed the issue. It is necessary for the oral and maxillo­ facial surgeon to do his or her own his­ tory taking and perform physical evaluations because it is an essential feature of planning for a surgical pro­ cedure; anticipating preand postop­ erative problems; making hospitaliza­ tion less costly; protecting the healthy patient from the inconvenience of a redundant examination by a physi­ cian; enabling medical and surgical house staff to use their time more effi­ ciently; and preparing the oral and maxillofacial trainees to perform effec­ tively and competently, so that when they leave the parent institution they can provide appropriate care to the pa­ tients whom they will see in an ambu­ latory setting. The oral and maxillofacial surgeon is trained almost exclusively in a hos­ pital environment for three or four years after graduation from an accredi­ ted dental school. As a health provider in a surgical discipline, the oral and maxillofacial surgeon must be well trained in the physical evaluation of the patients before surgery. In addi­ tion, skill in physical evaluation is re­ quired for the administration of seda­ tive and anesthetic agents to ambula­ tory patients. The question that arises is under what circumstances is it appropriate for the oral and maxillofacial surgeon to perform his own history taking and physical evaluation? There is, surpris­ ingly, no published answer directed specifically to this question. A 1975 survey1,2 of 133 approved oral surgery residencies showed great variability in the extent of physical diagnosis taught in training programs, varying from no training (15 to 133 responding institu­ tions) to as much as 120 lecture hours and 90 hours of clinical teaching, or up to five clinical rotations including medicine, general surgery, and anes­ thesiology. In 99 of 118 programs that included teaching physical diagnosis, the oral surgeon did his own history taking and physical examination, but 80 of these programs required a physi­ cian’s countersignature.3 A t the M e d ic a l C o lle g e of Virginia I Virginia Commonwealth University Hospital Division of Oral and Maxillofacial Surgery program, trainees have a 45-hour didactic course in physical diagnosis; seven months of c lin ica l rotations in medicine, surgical oncology, neuro­ surgery, and emergency room; plus four months in anesthesiology. These residents have been performing their own patient evaluations without a physician’s countersignature since 1972 without any problems. This paper takes a critical look at this prac­ tice.