Maxillofacial Research Articles

Does Positioning During Oral and Maxillofacial Surgery Operations Influence the Development of Upper Extremity Peripheral Neuropathy?

BackgroundControversy exists regarding the role of specific etiology and mitigating factors in perioperative upper extremity peripheral neuropathy (PUN) development during oral and maxillofacial surgery (OMS) procedures. PurposeThe purpose of this study was to measure the association between upper extremity positioning and developing PUN in oral and maxillofacial surgery operations. Study design, setting, sampleThe investigators implemented a retrospective cohort study. Patients referred to the Department of Oral and Maxillofacial Surgery at Jefferson Health who underwent orthognathic, telegnathic, or free flap surgery from April 2017 through December 2021 were identified. Exclusion criteria were age less than 13, revision surgery, ablative case without free flap reconstruction, incomplete medical record, pre-existing neuropathy, and upper extremity position other than tucked or abducted. Predictor variableThe predictor variable was upper extremity (UE) position during surgery, which had two levels-- tucked or abducted. Outcome variableThe outcome variable was self-reported development of PUN, defined as new sensory and/ or motor deficit in a non-operated extremity diagnosed within 48 hours of surgery. CovariatesDemographic covariates included age, gender, and race. Perioperative covariates included American Society of Anesthesiologists (ASA) physical status and body mass index (BMI). The operative covariate was general anesthesia (GA) duration. AnalysesDescriptive statistics were calculated. Shapiro-Wilk test was used to assess normality of the sample. Categorical variables were analyzed with Fisher’s exact test. Continuous variables were analyzed with Mann-Whitney U test. Significance was defined at P<0.05. ResultsOf the 432 patients identified, 342 met inclusion criteria. Median (IQR) ages for the abducted and tucked cohorts were 40 (31) and 34 (28) years, respectively (P<0.01). Males comprised 55.4% (n=41) and 54.1% (n=145) of abducted and tucked groups, respectively (P=0.9). PUN frequency was 6.8% (n=5) for abducted subjects and 3.7% (n=10) for tucked subjects (relative risk 1.8, 95%CI [0.7,5.1]; P=0.33). PUN was associated with gender (P=0.01), ASA status (P=0.03), BMI (P=0.01), and GA duration (P<0.01) on bivariate analysis. When adjusting for covariates, only GA duration (P<0.01) and BMI (P=0.03) were associated with PUN development Conclusion and relevanceThe findings suggest that PUN development during OMS procedures was not associated with upper extremity position.

400 Gramme on Skull Base and Face: Complete Removal and Reconstruction

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Huge craniofacial tumors represent a surgical challenge not only for high risk of intraoperative damage of the brain and sense organs of the face, but also for esthetical issues which may occur postoperatively. This surgery is riskier when these processes are represented by massive compact bone such as osteomas. &amp;lt;i&amp;gt;Case presentation&amp;lt;/i&amp;gt;: A young patient with huge disfiguring osteoma of anterior skull base extended to sphenoidal, frontal, maxillary sinuses as well as in orbits benefit for a complete removal with craniofacial reconstruction through a surgical teamwork including neurosurgeon, maxillofacial surgeon and ophthalmologist; with an overt satisfactory cosmetic result. Preoperative planning is reported as well as the intraoperative procedure and the postoperative reconstruction and follow up. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Craniofacial osteoma represents a surgical and cometic challenge for their resection. This resection is tailored through sophisticated devices such as preoperative 3D (3 dimension) printed model, intraoperative neuronavigation, and the use on custom-made bone. In place where this reported patient is managed, these tools are unavailable. Thus, priority should be given to teamwork with accurate preoperative planning and manually confectioned cranioplasty. Endoscopic approach for these processes gained more and more indication in the resection of these craniofacial and skull base osteomas. Since this device require a learning curve, laboratory training for is proper using as well as in microneurosurgery techniques is highly recommended. A hope is encountered though the humanitarian implication of some organization and universities.

Efficacy of Three-Dimensional Printing in the Management of Frontal Bone Trauma

Abstract Objectives Craniomaxillofacial (CMF) trauma surgery is difficult because of its unique architecture and vast range of injuries in the head and neck area. This study sought to determine the potential of employing preoperative three-dimensional (3D)-printed models to improve frontal fracture healing outcomes. Methods This prospective cohort clinical trial involved 20 patients who were surgically fitted and had a frontal bone fracture, as evidenced by computed tomography. The patients were separated into two groups: Group A: patients with frontal bone trauma reduced using 3D printing; and Group B: patients with frontal bone trauma reduced without 3D printing. Results Compared to Group B, Group A had a considerably shorter operational time (p &lt; 0.001). The esthetic results, complications, and functional outcomes were not significantly different between the two groups. All patients in Groups A and B underwent accurate radiographic evaluations (correct placement of the titanium mesh). Conclusion 3D printing in preoperative planning improves frontal fracture repair with respect to operative length but does not reduce intraoperative blood loss or improve postoperative function compared with normal management.

Platelet-Rich Plasma in Oral and Maxillofacial Surgery: A Comprehensive Literature Review.

Platelet-rich plasma (PRP) is well recognized and frequently used therapeutic tool for surgeons in oral and maxillofacial surgery (OMFS). It is become popular due to its regenerative potential of autologous blood components that enhance tissue repair while improving overall surgical outcomes. we decided to discuss historical evolution of PRP and OMFS, preparation methods and biological mechanisms, OMFS applications, more precisely, efficacy of PRP in OMFS. PRP was originated from early explorations in wound healing research and now it has made continuous refinement and is being used in widespread application across diverse medical specialities. In OMFS, PRP is prepared through centrifugation methods where PRP is concentrate platelets and other important growth factors that are essential for tissue regeneration, or improving bone density and regrowth. Clinical applications span from bone and soft tissue augmentation to the management of temporomandibular joint disorders and maxillofacial pathology. Various pieces of evidence promise promising outcomes, but the efficacy of PRP in enhancing bone regeneration remains debated among researchers and physicians, which necessitates further research and comprehensive validation. Complications of PRP administration are rare but may include infection, nerve damage, tissue calcification, or even blindness in some cases, which emphasizes careful patient selection and monitoring is evident. PRP future in OMFS is promising for more personalized therapies and standardized protocols. More discoveries will be made through mixed or combination treatments with PRP and it will expand applications, technological advancements, and efficacy in long-term outcome.

CURRENT APPROACHES TO MANAGING MICROTIA

Microtia, a developmental anomaly of the external ear resulting in a deformed auricle, affects 1 to 5 individuals per 10,000. Literature suggests a male predominance, with nearly 2.5 times more male patients affected than females. Additionally, there is a notable right-sided predilection, leading to pronounced asymmetry, observed in approximately 83% of cases. Surgical reconstruction is the primary treatment for microtia, albeit a technically demanding procedure with challenges in achieving optimal aesthetic outcomes. Reconstruction typically involves autologous costal cartilage, known for its effectiveness but requiring advanced surgical skills. Complications, including pneumothorax, postoperative pain, chest wall deformity, and pathological scarring, are common with this approach. In recent years, surgeons have increasingly adopted modern techniques utilizing porous high-density polyethylene implants for reconstruction. This approach is gaining popularity due to the challenges associated with achieving satisfactory cosmetic results using autologous costal cartilage reconstruction. Based on the bibliosemantic and analytical methods employed to analyze the literature, we posit that this topic necessitates further investigation and a multidisciplinary approach. The involvement of otolaryngologists and maxillofacial surgeons is imperative for the comprehensive treatment of this pathology.

Assessment of anxiety in patient’s undergone surgical extraction and root canal treatment – A comparative study

: To quantitate and compare the anxiety level associated with patients who have undergone surgical extraction of teeth and root canal treatment.: This study was conducted on 100 patients who reported to the Department of Oral and Maxillofacial Surgery (50) requiring surgical extraction of teeth and Department of Conservative Dentistry and Endodontics (50) requiring root canal treatment. Patients were randomly enrolled for the study and were given a questionnaire after the completion treatment (extraction and root canal treatment). The anxiety levels were evaluated based on the scores of the Corah's Dental Anxiety Scale. : The results of the present study showed that the dental anxiety was higher among subjects who have undergone surgical extraction of teeth when compared to the patients undergone root canal treatment. : In conclusion, maxillofacial surgeons should consider that patients initially visit dental office for treatment of surgical extraction of teeth with severe anxiety which could be due to conditioning or learned responses which these patients might have experienced or first visit. Thus a prior awareness of the patient's predisposition to dental anxiety may be of value, enabling to take appropriate measures pre-operatively. Thus our aim is to give anxiety free dental treatment to the patients and better postoperative recovery.

Comorbidities and final outcome of post COVID-19 associated oral mucormycosis patients: a cross-sectional study

BackgroundMucormycosis is an invasive and possibly fatal fungal infection that frequently affects the mouth. Co-infection in post COVID-19 patients is an emerging concern, owing to their complex nature and higher mortality. Therefore, this study aimed to report the underlying risk factors, clinical characteristics, presentation, and final outcome of COVID-19 associated oral mucormycosis cases.ResultsThis study included 51 patients with oral mucormycosis 28 (55%) males and 23 (45%) females. Twenty-three patients (45%) presented with deep necrotic ulcer, 16 patients (31%) presented with superficial ulcer, and 12 patients (23%) of them presented with fistula. The overall survival rate was 51% (26 patients recovered). On the other hand, mortality rate was 49% (25 patients), of which 68% suffered from uncontrolled diabetes mellitus.ConclusionsThe mortality rate of COVID-19 associated mucormycosis cases with oral manifestations was found to be quite high mostly due to delayed diagnosis and lack of timely treatment. Thus, increasing the awareness of dentists and maxillofacial surgeons is crucial for the early diagnosis of oral mucormycosis which is vital to improve prognosis of this serious infection. This is of high importance in view of the escalating numbers of mucormycosis cases being recorded worldwide.

РОЛЬ МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИХ МЕТОДОВ ИССЛЕДОВАНИЙ В ЭТИОПАТОГЕНЕЗЕ ОСТЕОМИЕЛИТА ЧЕЛЮСТЕЙ

The subject of the study is the importance of molecular genetic research methods in the study of the etiopathogenesis of osteomyelitis of the jaws. The purpose of the work is to provide up-to-date information to researchers, dental surgeons, and maxillofacial surgeons on the possibilities of molecular genetic research in identifying bacterial pathogens in osteomyelitis of the jaws, as well as to reflect genetic markers of pathogenicity factors for a number of the main causative agents of the disease. Methodology. International scientific databases PubMed, ScienceDirect, Scopus, Cochrane Collaboration, Elsevier, as well as electronic catalogs eLIBRARY.RU and CyberLeninka.ru were used. Results. A review of publications demonstrated that S. aureus and S. Epidermidis dominate the etiological spectrum of causative agents of bone tissue infections. The participation of these microorganisms is determined by a whole range of pathogenicity factors. Toxins and Panton-Valentine leukocidin (PVL) genes play a major role in the pathogenesis of osteomyelitis and disease progression. It has been shown that the pathogenic bacteria Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans are capable of inducing differentiated production of cytokines. The most attention has been attracted to E. faecium, which exhibits multidrug resistance to a wide range of antibiotics. The proportion of infections mediated by S. epidermidis and S. Saprophyticus is, on average, about 25% of cases. The proportion of representatives of gram-negative flora Escherichia, Klebsiella, Enterobacter, Citrobacter, Proteus, Providencia, Serratia reaches 23% of cases. Pathogenic nosocomial strains of P. aeruginosa are also involved in the formation of chronic inflammation in osteomyelitis. According to the results of published studies, more than a third of cases of chronic osteomyelitis are mediated by microbial associations, which are dominated by S. aureus, S. epidermidis and, less commonly, E. faecalis. Conclusions. The use of PCR analysis to identify the causative agents of osteomyelitis and gene amplification using specific primers has a huge advantage over routine microbiological tests, being an informative method for studying the pathogenicity factors of the main pathogens. The high importance of molecular genetic methods in the study of the etiopathogenesis of osteomyelitis of the jaws requires their widespread use in the clinic of surgical dentistry and maxillofacial surgery to successfully solve complex problems in the rehabilitation of patients with this disease.

Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a regional Australian oncology and reconstructive service: benchmarking the data to audit clinical outcomes in emerging, regional, and small-volume centres

The traditional model of centralisation of care, whilst having many advantages, also requires adaptation and upscaling to meet the requirements of both regional areas and the increasing urban sprawl. However, to ensure comparable outcomes with current major centres, this transition, when required, must be delivered in a safe and effective manner. Our project, which utilised the British Association of Oral and Maxillofacial Surgeons (BAOMS) recently published outcome data from the Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) project to benchmark data prospectively collected from a small-volume, emerging centre in Northern Queensland, was the first of its kind in terms of validation studies. As expected, the small volume of our centre impacted the ability to derive powerful statistical models and comparators, an intrinsic limitation for small-volume centres whilst they are developing services. However, during this evolution project, the use of comparison metrics allowed for the detection of alert and alarm levels, which are invaluable to ensure patient safety and quality of outcome.Our paper demonstrated that, irrespective of size or volume, the utilisation of quality assurance metrics (national or international) provides for the safe and transparent upscaling of head and neck services in emerging, regional, and small-volume centres.

ChatGPT May Help Inform Patients in Dental Implantology.

Patients may have high expectations regarding dental implants based on the source of their information, which can lead to challenges in clinical communication. This study aims to evaluate the quality of responses provided by Chat Generative Pretrained Transformer (ChatGPT, OpenAI), an artificial intelligence (AI) program, to patient questions in the field of dental implantology. This study was prospectively designed as a cross-sectional study. Frequently asked questions by patients about general information on dental implantology (Part 1) and dental implant brands (Part 2) were posed to the ChatGPT program. Responses were independently assessed by oral and maxillofacial surgeons (Group 1; n &#61; 10), periodontologists (Group 2; n &#61; 10), prosthodontists (Group 3; n &#61; 10), and general dentists (Group 4; n &#61; 10) using the Global Quality Scale (GQS, scored from 1 [low quality] to 5 [high quality]). There was a total of 60 questions, with 30 questions in each part. Participants in the study were evenly distributed by gender (50% female, 50% male) with a mean age of 32.6 ± 4.07 years. The mean years of experience were 8.5 ± 3.12 years. There were no significant differences in mean age, gender, and years of experience among the groups (P > .05). The overall mean GQS score was 3.87 ± 0.29. Part 1 had a mean score of 3.9 ± 0.35, and Part 2 had a mean score of 3.85 ± 0.29, with no statistically significant difference (P > .05). The AI platform may contribute to the additional education of patients in the field of dental implantology and aid in understanding treatment procedures. However, it is concerning that ChatGPT may exhibit bias regarding dental implant brands, which could impact patient guidance.

Interdisciplinary Management of Orbital Diseases

Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.

Validation of the pink esthetic score/white esthetic score at single tooth-supported prostheses in the esthetic zone: A randomized clinical trial.

To validate the reproducibility and inter/intra-observer variability of the Pink Esthetic Score/White Esthetic Score (PES/WES) of single tooth-supported prostheses in the maxillary esthetic zone (13-23). Forty-five patients were randomly assigned to one of the three treatment options (15 patients per group) receiving each one a different crown type: Porcelain fused to metal (PFM), monolithic zirconia, and lithium disilicate. Eight observers from each of four different specialties (Prosthodontists, Orthodontists, Periodontists, and Oral Surgeons) were recruited and assessed twice and four weeks apart (i.e., T1 and T2) 45 photographs of the single tooth-supported prosthesis using PES/WES and compared them with contralateral teeth. According to the ANOVA and post hoc tests, the zirconia crown type obtained the highest mean score by all observers, with a mean value of 16.70 ± 2.94. The prosthodontists and oral surgeons assigned the lowest mean score to PFM crowns, 13.03 ± 3.47 and 13.80 ± 3.17, respectively. Notably, the prosthodontists awarded the highest scores, specifically 17.50 ± 2.81 for the zirconia crowns. Intraobserver agreement was calculated utilizing the paired t-test. Pairwise comparisons between observers of different specialties revealed significant intraobserver agreement. Interclass correlation coefficient (ICC) scores were statistically significant among four specialties. No difference was detected concerning the interobserver agreement. The PES/WES index remains consistent across various observers from different specializations, yielding uniform results in the overall esthetic evaluation. Consequently, in light of the presented preliminary positive results, its use might also be considered for the esthetic assessment of single-tooth-supported prostheses. The PES/WES index may be employed clinically to evaluate single tooth-supported prostheses as it emerged as a reproducible esthetic scoring system.

Bridging the knowledge–Practice gap: Insights from a survey of Belgian dental professionals on diagnosis and supportive oral cancer treatment in comparison with international guidelines

ObjectiveEarly detection significantly improves the prognosis of oral cancer patients, contingent upon the knowledge of dental professionals. This study aimed to assess and compare the knowledge, practices and perceptions regarding oral cancer among dental professionals in Belgium. Materials and methodsA cross-sectional survey was distributed via Qualtrics to general dentists, dental specialists, dental hygienists, and oral and maxillofacial surgeons. The self-administered questionnaire comprised three sections: demographics (4 questions), knowledge (9 questions) and clinical practices (19 questions) related to oral cancer detection and treatment. Descriptive statistics were employed for data analysis, with Chi-square tests assessing responses by specialization, gender, years of experience and number of oral cancer patients treated. ResultsA total of 262 questionnaires were completed, with the majority of respondents being general dentists (61%) followed by dental specialists (25%), oral hygienists (8%) and oral and maxillofacial surgeons (6%). 70% of the respondents reported treating fewer than four oral cancer patients throughout their careers. 5 out of the 9 knowledge questions achieved over 50% correct responses, with an average correct answer rate of 54%. Oral and maxillofacial surgeons and dental professionals who have treated more than four oral cancer patients, demonstrated significantly higher scores on multiple knowledge questions. Responses to clinically oriented questions showed less diversity across professions, and generally aligning with guidelines from professional oncological societies. ConclusionThis survey highlights the need for enhanced education on oral cancer among Belgian dental professionals. Knowledge levels were notably higher among more experienced respondents. The development and implementation of comprehensive guidelines tailored to dentists and oral hygienists for oral cancer prevention and patient care are warranted to optimize clinical practice standards.

Periodontists and oral surgeons' peri-implantitis-related education, knowledge, attitudes, and professional behavior: A national survey.

Each year, approximately 5 million dental implants are placed in the United States and one out of three patients is likely to experience peri-implantitis (PI). The objectives were to compare the PI-related education, knowledge, attitudes, and professional behavior of periodontists and oral maxillofacial surgeons (OMS), and to explore relationships between these constructs of interest. A total of 389 periodontists and 161 OMS responded to a web-based survey. Descriptive and inferential statistical analyses (independent sample t-tests, chi-square tests, and correlational analyses) were conducted. On average, periodontists reported a higher percentage of time spent in residency on implant surgery (21.02% vs. 7.27%; p<0.001), better education about PI (5-point scale with 1=not at all well: means: 2.86 vs. 2.59; p<0.001), and better knowledge of risk factors (4.07 vs. 3.86; p<0.001) than OMS. Periodontists argued that oral hygiene-related treatment (4.45 vs. 4.22; p=0.001) and regeneration-focused treatments such as guided tissue regeneration (3.62 vs. 3.20; p<0.001) contributed more to successfully treating PI and used these treatments more in their practices (4.86 vs. 4.56; p<0.001/3.06 vs. 2.68; p<0.001) than OMS. They also considered PI as a more serious problem than OMS (4.55 vs. 3.80; p<0.001). The better the respondents' PI-related knowledge was, the more they considered PI as a serious problem (r=0.19; p<0.001). The more cases they treated per month, the more they considered PI as a serious problem (r=0.19; p<0.001). The results of the present study highlight the lack of standardization in the specialty training of periodontists and OMS. Best practice guidelines for the diagnosis and treatment of PI are needed to optimize graduate education about this important topic.

What Is the Incidence of Anesthesia-Related Adverse Events in Oral and Maxillofacial Surgery Offices? A Review of 61,237 Sedation Cases From a Large Private Practice Consortium

BackgroundThe safety of the anesthesia team model performed in oral and maxillofacial surgery (OMS) offices has been criticized by professional and mainstream media. PurposeThis study aims to assess the incidence of adverse anesthetic events (AE) associated with the OMS anesthesia team model and identify risk factors associated with AEs. Study design, setting, sampleThis was a retrospective cohort study utilizing a patient database from Paradigm Oral Health®, Lincoln, Nebraska, a managed service organization (MSO). Subjects included were 14 and older, undergoing open-airway intravenous anesthesia for ambulatory OMS procedures using the OMS anesthesia team model at multiple private practices in the MSO network between June 30th, 2010, and September 30th, 2022. Exclusion criteria included patients younger than 14 or patients with incomplete medical records. Predictor variablePrimary predictor variables were age, sex, American Society of Anesthesiologists physical status classification system (ASA) score, type of surgical procedure performed, and the types of medications administered during sedation. Main outcome variableThe presence of an AE. The definition of an AE was modeled on the World Society of Intravenous Anesthesia (SIVA) definition. All AEs were identified through surrogate markers which were identified through chart review. One example of an AE is ventricular fibrillation, which necessitates application of medications, here the medication is the surrogate marker. CovariatesNone. AnalysesThe data were analyzed using t-tests and χ2 tests. P values ≤.05 were considered statistically significant. ResultsIncluded in the study were 61,237 sedation cases (53.87% female and 46.13% male), for 56,076 unique patients ranging from 14 to 98 years of age (mean 33.26 ± 18.35). An AE incidence of 3 per 100,000 per year (25 total events) was observed. Neither age, sex, ASA score, nor type of surgical procedure exhibited statistically significant associations with AEs. A statistically significant association was found between AEs and fentanyl (P = 0.0008). Conclusions and RelevanceThis investigation shows a smaller incidence of AEs than previous studies of the OMS anesthesia team model.

Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review.

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.

Accuracy of Artificial Intelligence-Based Virtual Assistants in Responding to Frequently Asked Questions Related to Orthognathic Surgery

BackgroundDespite increasing interest in how conversational agents might improve healthcare delivery and information dissemination, there is limited research assessing the quality of health information provided by these technologies, especially in orthognathic surgery (OGS). PurposeThis study aimed to measure and compare the quality of four virtual assistants (VA) in addressing the frequently asked questions about OGS. Study design, setting, and sampleThis in-silico cross-sectional study, assessed the responses of a sample of four VAs through a standardized set of 10 questionnaires related to OGS. Independent variableThe independent variables were the four VAs. The four VAs tested were VA1: Alexa (Seattle, Washington), VA2: Google Assistant (Google Mountain View, California), VA3: Siri (Cupertino, California), and VA4: Bing (San Diego, California). Main outcome variablesThe primary outcome variable was the quality of the answers generated by the four VAs. Four investigators (two orthodontists and two oral surgeons) assessed the quality of response of the four VAs through a standardized set of 10 questionnaires using a five-point modified Likert scale, with the lowest score (1) signifying the highest quality. The main outcome variables measured were the combined mean scores of the responses from each VA, and the secondary outcome assessed was the variability in responses among the different investigators. CovariatesNone AnalysisOne-way analysis of variance (ANOVA) was done to compare the average scores per question. One-way ANOVA followed by Tukey's post-hoc analyses was done to compare the combined mean scores among the VAs and the combined mean scores of all questions were evaluated to determine variability if any amongst different VA’s responses to the investigators. ResultsAmong the four VAs, VA4 (1.32 ± 0.57) had significantly the lowest (best) score, followed by VA2 (1.55±0.78), VA1 (2.67±1.49), and VA3 (3.52±0.50) (p-value<0.001). There were no significant differences in how the VAs: VA3 (p-value = 0.46), VA4 (p-value = 0.45), and VA2 (p-value = 0.44) responded to each of the investigators except VA1 (p-value = 0.003). ConclusionsThe VAs responded to the queries related to OGS, with VA4 displaying the best quality response, followed by VA2, VA1, and VA3. Technology companies and clinical organizations should partner for an intelligent VA with evidence-based responses specifically curated to educate patients.

Assessing the knowledge and awareness of US oncologists regarding the specialty of oral medicine

ObjectivesThis cross-sectional study aimed to assess the awareness among United States (US) oncologists about oral medicine (OM) as a specialty of dentistry, and their collaboration with OM providers. MethodsAn online survey was conducted, inviting 1350 US oncologists, with data collected on demographics, practice background, comfort level with diagnosing and treating oral conditions, referral practices for oral conditions, and more. ResultsOf the invited 1350 oncologists, 192 responded (14% response rate). Among respondents, 46% were familiar with the OM specialty. Of these, 73% had previously sought consultation from OM specialists. The primary reasons for referral included dental clearance before initiating chemotherapy (38.5%), dental clearance before initiating radiotherapy (37%), and managing oral ulcers and oral potentially malignant disorders equally (32.2%). Regarding referrals to providers outside of OM, oncologists primarily referred patients with oral lesions to otolaryngologists (64.6%), followed by oral and maxillofacial surgeons (55.2%) and general dentists (45.3%). ConclusionOur study showed that over half of US oncologists were unfamiliar with the OM specialty. However, the referral rate to OM providers was high among oncologists who had prior OM knowledge. It is advisable to enhance the collaboration between OM and oncology specialists to ensure optimal care for patients with cancer.

A Stage-Wise Residual Attention Generation Adversarial Network for Mandibular Defect Repairing and Reconstruction.

Surgical reconstruction of mandibular defects is a clinical routine manner for the rehabilitation of patients with deformities. The mandible plays a crucial role in maintaining the facial contour and ensuring the speech and mastication functions. The repairing and reconstruction of mandible defects is a significant yet challenging task in oral-maxillofacial surgery. Currently, the mainly available methods are traditional digitalized design methods that suffer from substantial artificial operations, limited applicability and high reconstruction error rates. An automated, precise, and individualized method is imperative for maxillofacial surgeons. In this paper, we propose a Stage-wise Residual Attention Generative Adversarial Network (SRA-GAN) for mandibular defect reconstruction. Specifically, we design a stage-wise residual attention mechanism for generator to enhance the extraction capability of mandibular remote spatial information, making it adaptable to various defects. For the discriminator, we propose a multi-field perceptual network, consisting of two parallel discriminators with different perceptual fields, to reduce the cumulative reconstruction errors. Furthermore, we design a self-encoder perceptual loss function to ensure the correctness of mandibular anatomical structures. The experimental results on a novel custom-built mandibular defect dataset demonstrate that our method has a promising prospect in clinical application, achieving the best Dice Similarity Coefficient (DSC) of 94.238% and 95% Hausdorff Distance (HD95) of 4.787.

A 5-year comprehensive evaluation of maxillofacial injuries in polytrauma patients at a tertiary hospital - an epidemiological study.

To report and analyze the pattern of maxillofacial injuries in trauma victims and to define the role of a maxillofacial surgeon in an emergency trauma care team. Trauma patients reported and reporting to the casualty of a tertiaryhospital with facial injuries and other suspected concomitant injuries in the body were included in this study. The complete medical and radiographic records of each patient were reviewed and data was collected in a standard proforma in this 5-year clinical study (3 year of retrospective and 2 year of prospective study). The complete data related to the facial injuries and associated systemic trauma was recorded and statistical analysis conducted. A total of 18,369 patients with trauma were admitted to the hospital from May 2018 to April 2023. Out of these, 11,277 (61.4%) were males and 7,092 (38.6%) were females. Seventy percent of the reported cases with trauma were in the age group of 14-40 years. The incidence of trauma during the monsoon season was highest (n = 7,927, 43%). The commonest etiological factor leading to trauma was road traffic accident (n = 4,510, 40%). Among facial injuries, the mandibular fractures (n = 1,821, 41%) were predominant. The management of polytrauma patients should be undertaken by a team of specialists which should include a maxillofacial surgeon as facial injuries were common. This data is essential in developing and assessing the preventative strategies aimed at decreasing the frequency of facial and other injuries.