Oral Maxillofacial Surgery Research Articles

Passing The Scalpel: A Student Initiative in Identifying and Addressing Unmet Needs in Dental Education

Becoming an oral-maxillofacial surgeon is often challenging for young trainees. The purpose of this manuscript is to explore how a student-led group, which emphasizes networking, mentorship, and academic opportunities, may impact one's journey to becoming an oral-maxillofacial surgeon. This was a cross-sectional descriptive study where a 5-question Likert-type survey was administered to students who matriculated into residency and participated in a student-led group called Passing The Scalpel (PTS). This survey evaluated the value of PTS in providing exposure, career decision-making, networking/mentorship, and camaraderie. The results were analyzed, and statistical outcomes were evaluated. There was an 80.5% response rate (n=29). Question 1 regarding first exposure to oral-maxillofacial surgery had a mean score of 2.55 (standard deviation [SD]= 1.35; χ2=15.39; P<.05). Question 2 regarding choosing oral-maxillofacial surgery as a career had a mean score of 3.66 (SD= 1.11; χ2=10.84; P<.05). Question 3 regarding offering mentorship and networking had a mean score of 4.14 (SD= 0.92; χ2=27.81; P<.05). Question 4 regarding increasing applicant camaraderie had a mean score of 4.21 (SD= 0.77; χ2=36.71; P<.05). Question 5 regarding the importance of PTS within a dental curriculum had a score of 4.48 (SD= 0.68; χ2=41.89; P<.05). PTS is an effective student-led initiative that emphasizes early exposure, networking, and mentorship opportunities and encourages students in choosing oral-maxillofacial surgery as a specialty. PTS demonstrates that student-led initiatives can fulfill unmet needs in the dental curriculum.

Effects of Impacted Lower Third Molar Extraction on Periodontal Tissue of the Adjacent Second Molar.

The extraction of impacted lower third molars (ILTM) is one of the most common procedures in oral-maxillofacial surgery. Being adjacent to lower second molars, most impacted lower third molars often lead to distal periodontal defects of adjacent second molars. Several symptoms may occur after extraction, such as periodontal pocket formation, loss of attachment, alveolar bone loss and even looseness of second molar resulting in extraction. The distal periodontal defects of second molars are affected by many factors, including periodontal conditions, age, impacted type of third molars, and intraoperative operations. At present, several studies have suggested that dentists can reduce the risk of periodontal defects of the second molar after ILTM extraction through preoperative evaluation, reasonable selection of flap design, extraction instruments and suture type, and necessary postoperative interventions. This review summarizes the research progress on the influence factors, interventions methods and some limitations of distal periodontal defects of adjacent second molar after extraction of impacted mandibular third molars, with the aim of opening up future directions for studying effects of ILTM extraction on periodontal tissue of the adjacent second molar.

Artificial Intelligence: The Future of Maxillofacial Prognosis and Diagnosis?

Artificial Intelligence: The Future of Maxillofacial Prognosis and Diagnosis?

Reflections on the Oral-Maxillofacial Surgery Residency Virtual Match

The National Matching Services (NMS) released results for the 2020-2021 oral-maxillofacial surgery residency application cycle on January 19, 2021. With the coronavirus disease 19 (COVID-19) pandemic remaining a global challenge, there is no guarantee that the virtual format of this year's application process will be a one-off occurrence. Furthermore, as programs adapted to this virtual interview process, there were many innovations that could augment traditional in-person residency interviews or complete transition to virtual interviews in the future.

Orbital Surgical Guidelines: Pediatric Considerations.

Pediatric orbital and skull base surgery comprises a wide array of tumors. An understanding of the location of the lesion, nature of the disease, and surrounding anatomy is paramount to surgical planning in these small spaces. The goals of pediatric skull base surgery are to avoid injury to the surrounding structures, minimize cosmetic deformities, and remove some or all of the tumors based on anticipated pathology and biologic cost of removal. Safe surgery on many of these tumors requires an understanding of the location of the lesion relative to the optic nerve or orbit. This is particularly challenging because the dimensions of the orbital confines change continuously as one navigates from rostral to caudal. Management of these tumors may require a multidisciplinary approach including orbital surgery, neurosurgery, otolaryngology, oral maxillofacial surgery, plastic surgery, and interventional neuroradiology.

Surgical training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery – Part I

PurposeMany technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols. MethodsThis article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice. ResultsThe results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias. ConclusionSurgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side.This first part therefore reviews, open field camera, telemedicine and 3D printing.This systematic review is registered on PROSPERO.

How Many Oral Surgeons Does It Take to Classify a Nerve Injury?

There is inconsistency in clinical grading of peripheral trigeminal nerve (TN5) injuries that impact patient care. The study goal is to assess the current status of evaluation and classification of TN5 injuries by oral and maxillofacial surgeons (OMSs). A cross-sectional study design used an electronic survey to 100 selected OMSs to determine their clinical TN5 injury practice, including neurosensory testing, confidence level with current protocols, and evaluation and treatment of a hypothetical TN5 injury case. The target sample was enhanced to reduce type 2 error, assuming prior experience in the diagnosis and management of TN5 injuries. The sample was composed of 90 respondents. Nerve injury classification systems used by OMSs include Seddon (44%), Sunderland (70%), and Medical Research Council Scale (31%). Neurosensory testing protocols varied considerably among survey respondents. A sample case for Medical Research Council Scale grading produced inconsistent and inaccurate results. There was no consensus on TN5 injury management, and recommendations for timely nerve repair varied from 1month to up to 1year after injury. Half of the respondents stated that OMSs are not adequately prepared to assess inferior alveolar/lingual nerve injuries, and most oral-maxillofacial surgery respondents evaluate fewer than 10 TN5 injuries each year. Most OMSs (92%) have had a temporary inferior alveolar/lingual nerve injury, while 54% have had a permanent injury; of which, 21% required microsurgical repair. The majority of OMSs (74%) believed that a uniform TN5 injury classification system is needed. Within the oral-maxillofacial surgery target group experienced in evaluation of TN5 injuries, respondents do not feel confident in the assessment of these injuries. There is inconsistency in evaluation methods, and there is agreement that a unified classification system is needed for more efficient patient evaluation and reporting of outcomes in the literature. The Medical Research Council Scale and clinical neurosensory testing is preferred for evaluation of TN5 injuries.

Summative assessments of web-based patient simulations of pre-clinical local anaesthesia and non-surgical extraction.

The purpose of this study was to evaluate the use of web-based patient simulations, a whole-task simulation, in oral surgery education for second-year pre-clinical dental students on learning outcomes regarding cognitive, psychomotor and professional interpersonal skills for two topics: local anaesthesia and non-surgical extractions. In 2018-19, using an experimental design in a live course, we evaluated two web-based patient simulations on student learning outcomes in an introductory course on oral maxillofacial surgery. The study was repeated across two semesters, Fall (N=109) and Spring (N=112), on two different topics, namely local anaesthesia and extractions, respectively. Learning outcomes were evaluated for each topic with two different assessment formats: a student-recorded role-play video project and a fifty-item multiple-choice test. For both topics, local anaesthesia and non-surgical extractions, students in the group, Web Sim, who used the web-based patient simulation over and above the online lesson material earned significantly higher scores in the role-play patient video project compared with the group, No Web Sim, who only used the online lesson materials. However, scores on the fifty-item multiple-choice test did not differ significantly between groups. The results suggest that the web-based patient simulation as a formative assessment type is a useful scaffolding tool for the summative student-recorded role-play patient video project due to the similarity in activity types that support clinical learning objectives.

Dislocation of the Mandible Condyle Towards the Middle Cranial Fossa: Case Report and Review of Literature

Introduction: Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare in patients with craniofacial trauma. Methods: This report documents a case of an intact mandibular condyle intrusion into the middle cranial fossa in a 17-year-old woman following a traumatic incident treated by an intraoral approach that was performed to do an open reduction by condylectomy. Results: The causative mechanism, diagnostic features and a management option for reduction and treatment of these cases by performing a multidisciplinary approach involving neurosurgery and oral maxillofacial surgery are presented in this report. Conclusion: Adequate radiographic examination, including Tomography and Magnetic Resonance, is necessary to obtain the proper diagnosis and to determine an effective management.

Dental software classification and dento-facial interdisciplinary planning platform.

Despite all advantages provided by the digital workflow, its application in clinical practice is still more focused on device manufacturing and clinical execution than on treatment planning and communication. The most challenging phases of treatment, comprehensive planning, diagnosis, risk assessment, and decision-making, are still performed without significant assistance from digital technologies. This article proposes a new dental software classification based on the digital workflow timeline, considering the moment of patient's case acceptance as key in this classification, and presents the ideal software tools for each phase. The proposed classification will help clinicians and dental laboratories to choose the most appropriate software during the treatment planning phase and integrate virtual plans with other software platforms for digitally guided execution. A dento-facial interdisciplinary planning platform virtually simulates interdisciplinary clinical procedures and assists in the decision-making process. The suggested classification assists professionals in different phases of the digital workflow and provides guidelines for improvement and development of digital technologies before treatment plan acceptance by the patient. Three-dimensional interdisciplinary simulations allow clinicians to visualize how each dental procedure influences further treatments. With this treatment planning approach, predictability of different procedures in restorative dentistry, orthodontics, implant dentistry, periodontal, and oral maxillofacial surgery is improved.

Use of Lasers in Oral Maxillofacial Surgery; a cross-sectional study done in Riyadh, Saudi Arabia

This cross-sectional survey was aimed to assess the use of Lasers in oral maxillofacial surgery. The study subjects comprised of general dentists and specialists/consultants having experience of 1-10 years, and more than 10 years. The use of Lasers in oral maxillofacial surgery was measured using 24 items questionnaire. After ensuring the reliability of the questionnaire, differences across gender, clinical position, and clinical experience were seen using a statistical measure Chi-square throug

Management of Patients in Oral Maxillofacial Surgery during the Prevention and Control Period of the New Coronavirus Pneumonia: A Retrospective Study

Management of Patients in Oral Maxillofacial Surgery during the Prevention and Control Period of the New Coronavirus Pneumonia: A Retrospective Study

Cemento-ossifiying fibroma of the maxilla: A rare case report

ABSTRACT Introduction: Benign fibro-osseous lesions of the jaw are often a problem in diagnosis and classification. Cemento ossifying fibroma is one of the odontogenic tumor fibro-osseous lesions originating from the periodontal ligament's remaining cells, which occurs in the jaw and is rarely found. These lesions are often clinically and radiographically similar to other fibro-osseous lesions of the jaw. This case report aims to discuss its clinical, radiological, and histopathological features of cemento-ossifying fibromas that are often confused with other fibro-osseous lesions. Case Report: A 53 years old man reported to the Department of Oral Maxillofacial Surgery, Hasan Sadikin General Hospital, with a chief complaint that had lumped in his right upper jaw. About four years ago, a 2x2x2 cm lump appeared around the right maxillary gum after trauma from brushing, the lump did not hurt, and the patient did not seek any treatment. Approximately three months ago, the lump was getting bigger without pain, uncomfortable because it filled the oral cavity with a clinical picture of a lump on the palate that does not bleed easily without pain, the color of the lump is the same as the surrounding tissue, and there is no ulcer. At first, the patient was diagnosed with peripheral ossifying fibroma. Histopathological examination results showed cemento ossifying fibroma. The therapy is excision. Conclusion: Cemento ossifying fibroma is fibro-osseous lesions that develop from the periodontal ligament and are composed of cementum, bone, and fibrous tissue. In this case, the result of the histopathological examination is a definitive diagnosis.

Immediate implant placement with immediate provisionalization in the maxillary esthetic zone using mixture of allograft and xenograft vs xenografts to augment the jumping gap (A Randomized Clinical Trial)

AIM: The aim of the study is to evaluate the efficacy of grafting material in the jumping gap and their effect on the marginal bone loss in upper esthetic zone by using mixture of allograft and xenograft versus xenograft. Material and methods: A total of 20 extractions sockets, with 17 patients had non-restorable maxillary teeth in the esthetic zone indicated for implant placement. They were selected from the outpatient clinic of the oral Maxillofacial surgery Department, Faculty of Dentistry, Cairo University. • Xenograft as jumping gap filling material is successful for preservation labial cortical plate in immediate implant placement in the aesthetic zone. Summary: This study was performed to evaluate marginal bone loss using mixture allograft and xenograft versus xenograft in immediate implant placement with temporization in esthetic area. Twenty implants were conducted in twenty fresh extraction sockets in 17 patients with one or more hopeless teeth indicated for extraction in the region of maxillary anterior teeth. All patients were systemically free and with reasonable oral hygiene. Conclusion: •Immediate implant with immediate temporization is a viable technique for emergence profile preservation which subsequently adds to better result regarding radiographic bony changes and pink esthetic score.

How Do Oral and Maxillofacial Surgery Residency Program Directors Feel About Their Graduating Residents' Level of Competence?

The purpose of this study was to assess program directors' impressions of how competent graduating residents are in practicing the full scope of the specialty. The investigators hypothesized that program directors' impressions of their graduating residents' ability to practice the full scope of oral and maxillofacial surgery would fall within Laskin's suggested levels. The investigators implemented a cross-sectional study. A questionnaire was designed and a link to a Partners REDCap (Nashville, TN) survey was e-mailed to 101 oral-maxillofacial surgery program directors. The questionnaire included demographics, and program director's perceived level of preparedness, level of proficiency, comfort, and experience of their graduating residents (July 2018). The response rate was 34.7%. Analyses included univariate statistics and a Wilcoxon signed-rank test. Significance was set at P<.05. There was no significant difference between orthognathic surgery and each discipline in the area of expertise category, and in some cases, a significantly higher perception of training in orthognathic surgery (P<.05). There was a significantly lower perception of training in oral medicine than each discipline in area of expertise (P<.05), suggesting a deficit in oral medicine training. Using our analyses, program directors believed that the chief residents training in orthognathic surgery was at the level of expertise. Furthermore, 97% of respondents considered orthognathic surgery an area of expertise, suggesting that training at that level is necessary. Our results show that program directors' impressions of their graduates' competence fall within the levels suggested by Laskin.

Public and Professional Perceptions of the Scope of Practice of Oral and Maxillofacial Surgeons

To investigate and compare the general public's, general dentists', and primary care physicians' level of knowledge of the scope of practice of oral and maxillofacial surgeons (OMSs). We hypothesized that there is a generalized lack of knowledge of the scope of practice of oral-maxillofacial surgery, with the general public being the least informed and the general dentists the most educated. A cross-sectional survey study was conducted via a mail-out survey that was delivered to a random sample of the general public, general dentists, and primary care physicians in Ontario, Canada. A total of 1800 participants were selected. The survey consisted of a demographic screener along with 24 clinical scenarios in which the participants could select all the specialists they thought were capable of completing the treatment. Inferential statistics were computed using a chi-square test to compare responses between the groups and identified any significant differences between subjects for each of the 24 scenarios with P value set at 0.05. Total response rate of 50.1% (n=902) was achieved. The majority of health professionals (100% dentists, 95.5% primary care physicians) have heard of oral-maxillofacial surgery, in contrast to only 73.7% of the general public (P<.001). There was a general lack of awareness of oral-maxillofacial surgery scope of practice by all groups wherein OMSs were selected less than 50% of the time in 10 (general dentists), 14 (primary care physicians), and 16 (general public) of 24 clinical scenarios. Greater than 25% of the general public are unaware of OMS. More concerning, the general public and health professionals as a whole are unfamiliar with the full scope of practice of OMSs. For enhancing access to care by qualified specialists, educational programs highlighting key aspects of oral-maxillofacial surgery should be developed and distributed to all populations.

Dental students' OMFS-related experiences and interest in OMFS careers: An exploration.

While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still underrepresented. The objectives were to assess dental students' OMFS-related personal and educational experiences and attitudes and explore which factors correlate with their interest in future OMFS careers. Data were collected from 493 dental students in 1 dental school and 206 students from 15 other US and Canadian dental schools. The students in the national sample were more likely to have experienced an OMFS procedure themselves (64.6%vs. 50.7%; P=0.001), have shadowed an OMFS in an operating room (23.2%vs. 14.9%; P=0.009) prior to coming to dental school and to be much/very much interested in an OMFS career (36.4%vs. 12%; P<0.001) than the students at the home school. While the majority of both groups rated their experiences with rotations in the OMFS department in the dental school (68%vs. 62.5%) and in the hospital (80.3%vs. 85.7%) as very interesting, the students in the national sample were more likely to agree/strongly agree that they were satisfied with their OMFS experiences (68.1%vs. 36.3%; P<0.001) and had learned a lot from the OMFS faculty (57.9%vs. 30.8%) than the students in the home school. For both groups, the degree of interest in an OMFS career correlated with having had more personal OMFS experiences (home: r=0.28; P<0.001/other: r=0.39; P<0.001), more interesting OMFS experiences in the dental school (r=0.23; P<0.05/r=0.40; P<0.001) and the hospital (0.33; P<0.05/r=0.50; P<0.001) and more positive attitudes toward OMFS faculty (r=0.26; P<0.001/r=0.37; P<0.001). Positive personal and educational OMFS experiences and positive attitudes toward OMFS faculty were associated with an interest in OMFS careers. These findings provide a basis for developing educational interventions aimed at increasing the percentage of women and residents from URM backgrounds in OMFS programs.

Checklist for the initial evaluation of oral and maxillofacial trauma.

The standardization of the maxillofacial examination using a validated checklist is highly important. A checklist can also be a valuable tool for epidemiological studies, as it provides all clinical information related to maxillofacial trauma. The aim of this study was to propose a new checklist for the initial evaluation of maxillofacial trauma. The development and validation of the new checklist were performed in four consecutive phases: (a) determination of items and development of the checklist; (b) analysis by experts; (c) pre-test; and (d) pilot study. The checklist was designed as follows: (a) Specific signs and symptoms (Part 1); (b) Specific signs and symptoms (Part 2); (c) Intraoral signs and symptoms; and (d) Imaging examination. A good level of agreement was found among the experts and no items were excluded during the validation step. The administration of the instrument to the target population revealed the lack of some important aspects of the clinical evaluation, such as halitosis, otorrhea, petechiae, eyelid ptosis, hypo/hyperacusis, and temporomandibular join sounds. These missing signs were included in the final version. This checklist is a practical guide that can be used by specialists or students in oral and maxillofacial surgery and it can contribute to the quality of health care at outpatient and oral-maxillofacial surgery services for patients with maxillofacial trauma.

Preoperative Anxiety in Oralmaxillofacial Surgery and Related Risk Factors: A Retrospective Study

Preoperative Anxiety in Oralmaxillofacial Surgery and Related Risk Factors: A Retrospective Study

Surgical Training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery – Part II

PurposeMany technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols. MethodsThis article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice. ResultsThe results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias. ConclusionSurgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side.This second part therefore reviews, social networks, serious games and virtual reality.This Systematic review is registered on PROSPERO (CRD42020181376).