Maxillofacial Surgery Training Programs Research Articles

Should we recruit trainees into the Oral and Maxillofacial Surgery pathway at the beginning of the second degree to ensure the long term viability of the specialty?

There has been a sustained decline in the number of trainees applying for entry into the Oral and Maxillofacial Surgery (OMFS) training program, which has sparked further debate on the issue of OMFS training and the future of the specialty in the United Kingdom. Here I discuss the option of recruiting the trainees into the program at the beginning of their second degree to streamline the training, and to improve the recruitment drive to ensure long term viability of the specialty.

A survey assessing the early effects of COVID-19 pandemic on oral and maxillofacial surgery training programs

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons because of an increased risk of exposure to the virus during surgical procedures involving the aerodigestive tract. The objective of this survey was to evaluate how the COVID-19 pandemic affected oral and maxillofacial surgery (OMFS) training programs during the early phase of the pandemic.Study DesignDuring the period April 3 to May 6, 2020, a cross-sectional survey was sent to the program directors of 95 of the 101 accredited OMFS training programs in the United States. The 35-question survey, designed by using Qualtrics software, aimed to elicit information about the impact of the COVID-19 pandemic on OMFS residency programs and the resulting specific modifications made to clinical care, PPE, and resident training/wellness.ResultsThe survey response rate from OMFS program directors was 35% (33 of 95), with most responses from the states with a high incidence of COVID-19. All OMFS programs (100%) implemented guidelines to suspend elective and nonurgent surgical procedures and limited ambulatory clinic visits by third week of March, with the average date being March 16, 2020 (date range March 8–23). The programs used telemedicine (40%) and modified in-person visit (51%) protocols for dental and maxillofacial emergency triage to minimize the risk of exposure of HCP to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Shortage of personal protective equipment (PPE) was experienced by 51% of the programs. Almost two-thirds (63%) of the respondents recommended the use of a filtered respirator (i.e., N95 respirator) with full-face shield and stated that it was their preferred PPE, whereas 21% recommended the use of powered air-purifying respirators (PAPRs) during OMFS procedures. Only (73%) of the programs had resources for resident wellness and stress reduction. Virtual didactic training sessions conducted on digital platforms, most commonly Zoom, formed a major part of education for all programs.ConclusionsAll programs promptly responded to the pandemic by making appropriate changes, including suspending elective surgery and limiting patient care to emergent and urgent services. OMFS training programs should give more consideration to providing residents with adequate stress reduction resources to maintain their well-being and training and to minimize exposure risk during an evolving global epidemic.

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program

Disparity in didactic education among oral and maxillofacial surgery (OMS) training programs has driven a national conversation regarding the need for a standardized OMS curriculum, which has been recently amplified by the drastic interruption of OMS training programs during the coronavirus disease 2019 (COVID-19) pandemic. In the present report, we have described the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program, a multi-institutional educational curriculum developed in response to the pandemic and aimed toward OMS resident education.

Dual-degree Oral and Maxillofacial Surgery Training in the United States: “Back to the Future”

In the present report, we trace the history of education and training of oral and maxillofacial surgeons as it has evolved from the mid-19th century to the present. We consider the effects of the discovery of ether anesthesia, the separation of medicine and dentistry, and other milestones such as antisepsis (Lister), antibiotics (Fleming) and surgical progress during wartime. The main emphasis, however, is on the background, development, and implementation of current dual-degree oral and maxillofacial surgery training programs, the first 5 programs, the pioneer advocates for this training, and progress and challenges for the future.

The Use of Virtual Surgical Planning in Orthognathic Surgery in Oral and Maxillofacial Surgery Training Programs

The purpose of this study is to evaluate the current utilization of virtual surgical planning (VSP) for orthognathic surgery in academic oral and maxillofacial surgery training programs in the United States.

Outcomes With Moderate and Deep Sedation in an Oral and Maxillofacial Surgery Training Program

The purpose of the present study was to determine the complication rate associated with the administration of intravenous (IV) sedation in an oral and maxillofacial surgery (OMS) residency training program. We performed a prospective cohort study that enrolled patients who had received IV sedation for various oral surgery procedures in the clinic setting of an oral and maxillofacial surgery residency training program. The composition of the anesthesia team included residents who had completed their anesthesia rotation, ranging from postgraduate year (PGY)-1 to PGY-4. Each trainee chose their own anesthetic technique and completed a form that included demographic data, types and amounts of anesthetic used, and any intraoperative or postoperative complications encountered. All sedations were performed by a single provider with oversight by an attending oral and maxillofacial surgeon. The demographic and medication data were used as predictor variables. The outcome variables included any reported complications. The Fisher exact test was used to compare the complication rate by subgroup. The study included 1005 patients treated during an 18-month period. The overall complication rate was 2.29%. The most common complication reported was postoperative nausea (n=10; 0.99%), with 1 patient experiencing emesis. Other complications included laryngospasm (n=1), prolonged recovery (n=3), failed sedation because of agitation (n=1), intraoperative hypertension (n=1), postoperative hypertension (n=1), ST elevation (n=1), IV infiltration (n=2), syncope during IV access (n=1), and respiratory depression (n=2). No deaths or no adverse events requiring escalation of the level of care occurred. Ketamine use resulted in a greater rate of postoperative nausea (1.21%), and propofol was associated with a lower rate of postoperative nausea (0.68%). Male patients experienced a greater rate of complications compared with female patients overall (2.4 vs 2.2%). However, the female patients had a greater rate of postoperative nausea and vomiting (0.96 vs 1.19%). Of those who had reported a previous history of postoperative nausea and/or vomiting (PONV), 50% experienced symptoms after sedation. The average length of the procedure was longer in the group that had experienced complications compared with those who had not (37.5 vs 31.6minutes). None of these reported differences were statistically significant. The results of the present study have demonstrated that the modern IV sedation anesthesia technique used in OMS training programs is safe and the complication rate is low. Postoperative nausea was the most common complication. Ketamine can increase the risk of PONV, and propofol can reduce the risk of PONV. However, larger studies are required for conclusive findings. A history of PONV is a good predictor of PONV. The length of the procedure might increase the risk of complications.

Teaching in Oral and Maxillofacial Surgery Training Programs: A Resident Perspective

Teaching in Oral and Maxillofacial Surgery Training Programs: A Resident Perspective

Outcomes with Ambulatory Anesthesia Delivered in an Oral and Maxillofacial Surgery Training Program

Oral and maxillofacial surgeons in the United States have the ability to provide anesthesia, including conscious to deep sedation, while simultaneously performing the surgical procedure in a clinic setting. These skill sets are taught during residency, where residents learn a variety of sedation techniques by performing sedation.

Outcomes with ambulatory anaesthesia delivered in an oral and maxillofacial surgery training program

Outcomes with ambulatory anaesthesia delivered in an oral and maxillofacial surgery training program

Prevalence of Substance Abuse Among Oral and Maxillofacial Surgery Residents From 2006 to 2015

Substance abuse in oral and maxillofacial surgery (OMS) training programs is an important and under-represented topic in the literature. This study's purpose was to assess the prevalence of substance abuse in OMS training programs in the United States during a 10-year period and to determine the substances most abused by OMS residents. A cross-sectional survey study was conducted by sending an online questionnaire to program directors and chairpersons of all OMS graduate training programs accredited by the Commission on Dental Accreditation. The content- and validity-tested survey asked respondents to report on substance abuse cases at their program from 2006 to 2015. Auxiliary questions asked opinions on substance abuse. To analyze the data, percentages were calculated, including the estimated prevalence of abuse; results were presented as bar charts. Forty-six of the 101 OMS training programs (45.5%) responded. Sixteen of the responding 46 programs (34.8%) reported at least 1 suspected or encountered incident of substance abuse. The 2 most abused substances were alcohol and narcotics. During the decade studied, the prevalence of resident substance abuse was estimated to be 1.2%. The estimated prevalence of resident substance abuse has gone unchanged since Rosenberg's initial study in 1986 (J Oral Maxillofac Surg 44:458, 1986). With the introduction of new drugs and despite more stringent protocols, substance abuse continues to be a germane issue for OMS requiring ongoing attention clinically and in the literature.

How Many Temporomandibular Joint Total Joint Alloplastic Implants Will Be Placed in the United States in 2030?

The purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint (TMJ) total joint replacements (TJRs) that will be performed in the United States through the year2030. The program directors of all 101 Commission on Dental Accreditation-accredited oral and maxillofacial surgery training programs in the United States were surveyed online by use of a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015-March 2015). The questionnaire included 19 questions related to each program's TMJ disorder and TMJ TJR curricula, as well as clinical experience. In addition, members of the American Society of Temporomandibular Joint Surgeons were surveyed online using Redcap and via direct survey forms. Moreover, requests for the total number of TMJ TJR devices produced and implanted during the same period were made to the 3 manufacturers of Food and Drug Administration-approved TMJ TJR devices in the United States. The response rate among program directors was 52.5%, and the total number of TMJ TJR devices implanted in oral and maxillofacial surgery programs in 2005 was 412. This total increased by 38% to 572 in 2014. Statistically, this projects an increase of 58% over the next 16years to 902 TMJ TJR operations by 2030 (95% prediction limits, 768 and 1,037). The total number of TMJ TJR devices distributed by one manufacturer increased from 430 in the year 2000 to 1,004 in 2014 (133%). By use of these data, statistically over the next 16years, the number of TMJ TJR devices distributed by this company is projected to be 1,658 (95% prediction limits, 1,380 and 1,935). The data presented in this study show an increasing demand for the use of TMJ TJR devices in the management of end-stage TMJ disorders to the year2030.

Cone-Beam Computed Tomography Education and Exposure in Oral and Maxillofacial Surgery Training Programs in the United States

The purpose of this study was to estimate the penetration of cone-beam computed tomography (CBCT) in oral and maxillofacial surgery (OMS) residency programs in the United States. In addition, this study was designed to assess the education and training, relevance, and image interpretation responsibility of CBCT as experienced by OMS residents. The authors performed a cross-sectional study of all 102 US-based OMS program directors (PDs) from January 1, 2014 through April 30, 2014. Study variables included questions about 4 key factors in CBCT in OMS programs: access, education and training, relevance, and image interpretation responsibility. Data analysis was a product of the percentage of positive responses to each question. Fifty-four PDs participated in the study. The results showed that 87% of responding OMS programs have access to CBCT and that CBCT is used primarily for dental implant-related procedures. OMS residents are actively involved in CBCT use in their residency. OMS residents' access to CBCT is increasing, and their education, training, and image interpretation responsibility is increasing.

Training Satisfaction Versus Dissatisfaction Among Chief Residents in Oral and Maxillofacial Surgery—A Pilot Survey

To survey chief residents in accredited oral and maxillofacial surgery (OMS) training programs to assess their satisfaction with their surgical training and analyze their career plans after residency. A 19-question anonymous survey was electronically mailed to 212 individuals identified as graduating chief residents in accredited OMS training programs. Ninety-four individuals (44%) completed the survey. Of these 85 were men (90.4%) and 9 were women (9.6%). Average age was 32 years. Forty-seven respondents (50%) completed the 4-year traditional OMS programs, 37 respondents (39.4%) completed the 6-year MD integrated programs, 9 respondents (9.6%) completed the 4-year MD option programs, and 1 listed "other" as a program type. Fifty-two individuals (55.3%) planned a full-time private practice career, 5 (5.3%) planned a full-time academic career, 3 (3.2%) planned a military career, 27 (28.7%) planned a combined private practice and academic career, and 7 (7.4%) planned to complete a fellowship after residency. Seventy-nine of all respondents (84%) were satisfied with their OMS training program, whereas 15 (16%) were not. Most participants of this survey were satisfied with their training program and OMS as a career. However, it is important to note that less than half (44%) of chief residents who received this survey completed it. This short survey is a pilot survey; a more involved evaluation of OMS resident satisfaction is planned, further assessing satisfaction and burnout during residency.

Poster 42: Visualizing Cleft Defects and Cleft Lip Repair in Three Dimensions: A Prototype Surgical Model for Resident Education

Approximately 1 in 700 births worldwide results in children with cleft lip and/or cleft palate. This translates to millions of infants worldwide with feeding problems, children with speech disorders and adults outcast because of their facial deformity. In developing nations with increased incidence of clefts, the demand for this specialized patient care is greater than in developed countries. However, the care of cleft patients may be a distant priority in healthcare systems that struggle to meet its society's basic needs. Compounding this problem is a shortage of surgeons skilled in cleft surgeries. Few oral and maxillofacial surgery training programs in the United States have a strong emphasis in the treatment of primary cleft repair. The lack of training in the treatment of primary cleft lip repair may be due to the complexity of the surgery itself for the novice surgeon or resident. Clearly there is a niche for a cleft model where developing surgeons can practice their skills before entering the operative environment. Improved educational tools for anatomic understanding and surgical simulation of the cleft patient are needed to facilitate surgical training. A recent search of the English scientific literature on non-computerized teaching models for maxillofacial or facial plastic surgery afforded only one article, whereas a search on computer-based cleft lip repair simulation afforded 6 articles. No literature was noted for hands-on cleft lip surgical models for resident teaching purposes. To address this need for resident teaching tools, we have developed a teaching model of a cleft child's craniofacial structures to simulate cleft lip surgery. A CT scan-based stereolithic model of a 7-year-old female cleft patient serves as the “craniofacial skeleton.” A soft tissue representation of the cleft patient's midface is created out of pink wax. The wax model is flasked and burned out, following maxillofacial prosthesis fabrication principles. After wax burnout, a skin-like silicone elastomer material is injected into the resultant “model negative” void and is allowed to cure. The “skeleton” cast duplicate is overlaid with the “soft tissue” representation to complete the cleft surgical simulator. Mentoring faculty members will use the cleft surgical simulators to teach oral and maxillofacial surgery residents cleft anatomy and cleft repair. Teaching sessions will consist of resident seminars, followed by hands-on surgical simulation exercises utilizing the cleft models. We will assess the efficacy and educational impact of the cleft models by administrating surveys before and after the teaching and hands-on sessions. In progress. We propose that the cleft lip surgical model will serve as an excellent tool for visualizing cleft hard tissue and soft tissue defects in 3 dimensions. It will also serve as a reference guide for marking out soft tissue anatomical points and a surgical model for executing lip incisions and the reapproximation of flaps.

Safety of Deep Sedation in an Urban Oral and Maxillofacial Surgery Training Program

To study the safety of deep sedation in an urban-based oral maxillofacial surgery training program. Charts of patients undergoing an intravenous sedation from January 2005 through December 2009 were reviewed. Data recorded included age, gender, type of procedures performed, and intravenous medications. Patients were divided in 2 groups depending on whether they received a general anesthetic agent (propofol or ketamine) or not. Anesthesia complications and failures were recorded and categorized. In total, 1,167 intravenous sedations were recorded. Eight patients developed adverse reactions, 3 of which required further evaluation in the emergency department. In addition, 7 intravenous sedations needed to be aborted because of patient agitation and combativeness. No deaths or long-term morbidities were reported. The safety of deep sedation in an urban-based oral maxillofacial training program is similar to office-based anesthesia. Sedations failures may be attributed to paradoxical benzodiazepine reactions.

University of Michigan Oral and Maxillofacial Surgery Training Program

One year before the 1918 founding of the American Society of Oral Surgeons and Exodontists, Chalmers J. Lyons, at the request of Cyrenius Darling, MD, Chief of Surgery at the University of Michigan Hospital and Dean of the College of Dentistry, founded an oral surgery training program at the University of Michigan Hospital. It was one of the two first training programs in the United States formed that year and is currently the oldest running US oral and maxillofacial surgery (OMS) training program. Since then, the University of Michigan has been at the forefront of the scope of practice and training in OMS in the United States and beyond (Fig 1). Dr Lyons was a central figure in the development of oral surgery at the University of Michigan and establishing its clinical focus. In 1915 Chalmers J. Lyons was appointed instructor of oral surgery at the University of Michigan College of Dentistry and consultant dentist to University Hospital. With the establishment of the training program, he served as chairman until 1935 (Fig 2). Dr Al Kany, a 1916 graduate of the University of Michigan College of Dentistry, became the first trainee in the 1-year program. By 1922, the length of training was increased to 2 years, and in 1923 a third year was added along with a master of science in oral surgery. In addition to performing exodontia and repairing facial fractures, Dr Lyons had a great interest in cleft lip and palate surgery, having been a student of Dr Truman Brophy in Chicago and Dr Cyrenius Darling, a general surgeon at the University of Michigan. His considerable skill in this arena helped him establish

Attitudes and Opinions of Residency Directors and Residents About the Importance of Research in Oral and Maxillofacial Surgery Residencies

The purpose of this study was to determine the current status of research done by residents in oral and maxillofacial surgery training programs and the attitudes and opinions of the program directors and residents regarding the need and benefits of such activity. Separate questionnaires were developed for program directors and residents. These were sent through the Inquisite System to the 101 program directors in the United States and they were requested to fill them out and to ask their residents to do the same. Forty-four of the program directors (43%) and 277 of the 951 residents responded (29%). Only 75% of the program directors indicated that their residents participated in research. The projects generally could be selected by the program director or the resident. Only 36% of the programs provided scheduled research time, and in these programs it was usually 3 months or less. Residents generally believed the scheduled research time was inadequate. Most program directors and residents believed that research experience was important for those considering an academic career but that it was not important for those entering private practice. The failure of all residency programs to provide actual research experience for their trainees has resulted in a decrease in the contributions that such programs have traditionally made to the literature and the advancement of the speciality. It is important that steps be taken to reverse this trend.

University of the Pacific/Highland Hospital Oral and Maxillofacial Surgery Training Program

The Roaring Twenties was a time of great economic and technologic expansion in the United States, particularly in California. Oakland, California, was the site of many manufacturing industries, including shipbuilding, aircraft, and automotive. Once known as the “Detroit of the West,” Oakland was host to 3 major automobile factories churning out sedans, coupes, convertibles, and roadsters.1,2

Free-flap failures and complications in an American oral and maxillofacial surgery unit

Free tissue transfer is a reliable surgical technique that enables primary reconstruction following ablative surgery. Widely practised in many European units, acceptance into mainstream oral and maxillofacial surgery in the USA has been slow. The authors reviewed free flap practice patterns and outcomes in a US oral and maxillofacial surgery training program with specific emphasis on failures and complications to illustrate obstacles encountered during the initial phase of practice implementation. The demographic and clinical data of 71 consecutive patients who underwent microvascular reconstruction over 3 years (2002-2005) were reviewed. The study group included 48 males and 23 females who underwent 72 free tissue transfer procedures. Fourteen patients required operative exploration in the perioperative period. Six patients were explored for clinically compromised flaps. Thrombotic events occurred in 4 patients; 1 flap was successfully salvaged. There were 4 flap failures and 9 complications related to the donor site. Two perioperative deaths occurred from non-flap-related complications. Prolonged hospital stay and ICU utilization was observed in patients with surgical complications. Complications in this study did not affect the overall success rates of free-flaps. Salvage rates from thrombotic events were unaffected despite rigid flap monitoring protocols.

Parameters for Treatment of Cocaine-Positive Patients

The purpose of this study was to identify the parameters by which oral and maxillofacial surgeons and anesthesiologists make decisions as to the safety for proceeding with surgery and anesthesia in cocaine-positive patients and to determine a national consensus of opinion, if possible. Questionnaires were mailed to all known oral and maxillofacial surgery training programs and anesthesiology training programs in the United States (n = 241). Programs were queried as to screening, testing, parameters, and outcomes. Of the 241 questionnaires mailed, 114 (47%) were returned. Identification on the returns was optional; therefore, it was impossible to determine the total from each discipline. Only 16% of the programs had a formalized policy for cocaine screening prior to surgery and anesthesia. There was significant variability in the length of delay/time lapse before proceeding with anesthesia and surgery in the face of cocaine positivity. Based on the returned questionnaires and literature searches, the authors propose that patients who test positive for cocaine in their urine may undergo necessary surgical and anesthetic care, after an 8-hour period of discontinuing of cocaine, if the individual is hemodynamically stable.