Capnography Detection Using Nasal Cannula Is Superior to Modified Nasal Hood in an Open Airway System: A Randomized Controlled Trial Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Brett J. King, Andrew Megison, Zach Scogin, Brian J. Christensen Purpose The nasal cannula and modified nasal hood are methods used by oral and maxillofacial surgeons to detect expired carbon dioxide during procedural sedation in an open airway system. The purpose of this study was to compare the accuracy of the detection of expired carbon dioxide between the nasal cannula and modified nasal hood. Materials and Methods The authors designed a parallel-group randomized controlled trial to compare the nasal cannula and modified nasal hood. Patients presenting to the authors' institution for outpatient oral and maxillofacial surgery (OMS) using intravenous deep sedation or general anesthesia were randomized to have capnography detection by the modified nasal hood or the nasal cannula. The primary outcome variable was the percentage of accurately captured breaths, as determined by the average number of capnography waveforms per auscultated breath using a precordial stethoscope. The 2 groups were compared using t test. Results Fifty patients were screened for enrollment in the study. Twenty-five patients were randomized to the nasal cannula group and 25 patients were randomized to the modified nasal hood group. The proportion of accurate waveforms, recorded as a percentage of total breaths, was 95.7 ± 4.7% for the nasal cannula and 75.8 ± 14.1% for the modified nasal hood (P < .0001). Conclusions When used for capnography for procedural sedation in an open airway system for routine OMS, the nasal cannula accurately recorded more breaths than the modified nasal hood.

News and Announcements Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s):

Surgery Alone Is Effective in the Management of Pediatric Salivary Gland Acinic Cell Carcinoma Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Chong Wang, Minghui Mao, Bo Li, Kyojin Kim, Zhengxue Han, Zhien Feng Purpose The treatment strategy for salivary gland acinic cell carcinoma in pediatric patients remains controversial. This retrospective study was undertaken to analyze the role of surgery in the treatment of acinic cell carcinoma of the major salivary gland in pediatric patients. Patients and Methods In this retrospective cohort study, we reviewed the medical records of all pediatric patients with acinic cell carcinoma of the major salivary gland who were treated at Beijing Stomatological Hospital of Capital Medical University from 1998 to 2015. The predictor variable was treatment modality. The outcome variables were disease-free survival (DFS), overall survival (OS), local control, and freedom from distant metastasis. Other variables of interest were as follows: age, gender, tumor site, T category, N category, recurrence history, pathologic grade, perineural invasion, extracapsular extension, positive margin, and resection condition. The data analysis methods used were descriptive, bivariate statistics and the Cox proportional hazards regression model. Results Of the 19 patients, 7 received surgery alone and 12 received initial surgery combined with postoperative radiotherapy (RT). During the median follow-up period of 86 months, the overall estimates of DFS, OS, local control, and freedom from distant metastasis were 82.6, 93.3, 89.5, and 94.4%, respectively. Good outcomes were achieved in patients who received surgery alone (100% OS and 85.7% DFS). Initial surgery combined with postoperative RT was appropriate for patients with risk factors (91.7% OS and 83.3% DFS). Conclusions Surgery alone is appropriate for salivary gland acinic cell carcinoma in pediatric patients without risk factors, even if extracapsular excision is adopted. Preserving the invaded facial nerve during surgery is a good choice because a curative effect can be obtained when adjuvant RT is administered. Older age, high-grade pathology, incomplete resection, recurrence history, and extracapsular extension were identified as risk factors of poor prognosis.

Intraoperative Depth of Invasion Is Accurate in Early-Stage Oral Cavity Squamous Cell Carcinoma Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Justine Moe, Jonathan B. McHugh, Aaron M. Udager, Thomas M. Braun, Joseph I. Helman, Brent B. Ward Purpose Depth of invasion (DOI) is one predictor of nodal metastasis in oral cavity squamous cell carcinoma (OCSCC) and can facilitate the decision to complete an elective neck dissection (END) in early-stage disease with a clinically negative neck. The purpose of this study was to investigate the accuracy of DOI in intraoperative frozen specimens for T1N0 oral OCSCC. Materials and Methods To compare the accuracy of DOI in frozen versus permanent specimens, we completed a prospective, blinded study of 30 patients with cT1N0 OCSCC who presented between October 2016 and December 2017. Results DOI in frozen specimens was 96.8% accurate in predicting the need for END with a sensitivity of 90.9%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 95.2%. A strong correlation was found between DOIs in frozen and permanent specimens measured by head and neck (HN) pathologists (r = 0.96; 95% confidence interval [CI], 0.93 to 0.97), between HN pathologists using frozen specimens (r = 0.98; 95% CI, 0.95 to 0.99) and permanent specimens (r = 0.95; 95% CI, 0.91 to 0.98), and in DOIs in frozen specimens communicated intraoperatively versus measured by HN pathologist 1 (r = 0.93; 95% CI, 0.86 to 0.97) and HN pathologist 2 (r = 0.95; 95% CI, 0.89 to 0.98). Only 1 patient who did not undergo an END based on frozen specimens was undertreated owing to upgrading of the DOI in permanent specimens. Conclusions DOI in intraoperative frozen sections has an accuracy of 96.8% and may be reliably used as a clinical tool to determine the need for END in early-stage OCSCC.

Modified GoPro Hero 6 and 7 for Intraoperative Surgical Recording—Transformation Into a Surgeon-Perspective Professional Quality Recording System Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Laurent Ganry, Nicolas Sigaux, Kyle S. Ettinger, Salam O. Salman, Rui P. Fernandes Recent innovations in wearable action cameras with high-definition video recording enable surgeons to use cameras for their surgical procedures. In this study, the GoPro HERO 6 (and 7) Black edition camera was modified step by step to allow for a completely wireless surgeon-perspective recording with a battery life and memory capacity never previously obtained with such a high level of digital video quality. With this system, a surgeon can record for more than 14 hours 26 minutes in 1,080 pixels at 60 frames per second without breaking scrub and capture the operating surgeon's direct view of the field. By modifying the newest generation of devices, the authors successfully eliminated all shortcomings of the prior generation of GoPro cameras for surgical recording. The modified GoPro HERO6 camera produced professional recording quality for a total cost lower than US$850. This is critically important, because video-based surgical training will continue to be a primary area of development in the future and represents a novel and effective way for young generations of surgeons to attain technical excellence and knowledge in surgery.

Effect of Maxillomandibular Advancement Surgery on Pharyngeal Airway Volume and Polysomnography Data in Obstructive Sleep Apnea Patients Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Iiro Niskanen, Jukka Kurimo, Jorma Järnstedt, Sari-Leena Himanen, Mika Helminen, Timo Peltomäki Purpose To study volumetric changes in the upper airway in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and compare those findings with polysomnographic (PSG) data of the same patients. Materials and Methods The study included 20 patients with OSA (1 woman and 19 men; mean age, 48 yr; range, 31 to 59 yr). Mean values of angles formed by the sella, nasion, and B point and the sella, nasion, and A point before surgery indicated mandibular and maxillary retrognathia, respectively. All patients were treated with MMA and pre- and postoperative orthodontics. Pre- and post-treatment cone-beam computed tomograms were used to measure upper airway volume and PSG data were used to examine the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI-3 or ODI-4). In addition, Epworth Sleepiness Scale (ESS) score, General Health Questionnaire (GHQ-12) score, and amount of MMA were collected from patients' files. Results Mean maxillary and mandibular advancement was 4.6 ± 1.9 and 9.3 ± 1.7 mm, respectively. A statistically relevant increase (mean, 64.1%) in airway volume was found, with large individual variation. ODI-3 or ODI-4 and AHI values showed statistically relevant improvements from before to after surgery. ODI-3 or ODI-4 score decreased from 12.3 ± 9.8 to 4.0 ± 4.2 and AHI score decreased from 21.4 ± 13.8 to 5.8 ± 7.2. ESS scores showed improvement (lower scores) after surgery for most patients (n = 15), whereas GHQ-12 scores showed improvement (lower scores) for only 6 patients. Conclusion MMA increases upper airway volume and lessens OSA symptoms according to PSG data. MMA can be considered curative treatment for OSA; however, residual apnea as measured by the AHI can be found in many patients.

Is It Cost Effective to Add an Intraoral Scanner to an Oral and Maxillofacial Surgery Practice? Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Cory M. Resnick, Michael Doyle, Carly E. Calabrese, Karl Sanchez, Bonnie L. Padwa Purpose Intraoral scanners (IOSs), which create digital “impressions” of dental arches, have become popular for prosthetic and orthodontic applications. Adoption in oral and maxillofacial surgery (OMS) practices has been slower, likely because of high implementation costs and low-volume use. The purpose of this study was to evaluate costs for introduction of an IOS into an OMS practice. The authors hypothesized that digital impressions would be more efficient in time and cost compared with conventional impressions and that implementation costs would be offset within 1 year. Materials and Methods This was a prospective study that included patients who had digital impressions during the first year after introduction of an IOS to the practice. Conventional alginate impressions obtained at the same visit were included for comparison. Variables included time for each step in each impression process, IOS experience of the operator obtaining the impression, and associated costs. Per-arch costs for each technique were calculated using time-driven activity-based costing methodology. Results Sixty-three digital impressions and 31 conventional impressions were included. Mean total times for digital and conventional impressions were 14.1 ± 1.3 and 19.4 ± 4.0 minutes per arch, respectively. On a per-patient basis (2 arches for digital impressions and 4 arches for conventional impressions because of the inability to create duplicate stone models from each alginate impression), total impression times were 24.8 ± 2.7 minutes for digital and 67.2 ± 14.8 minutes for conventional impressions. Total calculated costs for digital and conventional impressions were $21.42 and $29.40 per arch and $37.66 and $102.10 per patient, respectively. In a practice with 2 patients for impressions per working day (500 per year), it would take 1.04 years to offset the purchase of the IOS; with 5 sets of impressions per day (1,250 per year), it would take 5 months. Conclusion Digital impressions are more efficient and cost effective than standard impressions, and implementation costs can be offset within the first year.

Which Factors Affect Length of Stay and Readmission Rate in Mandibular Distraction Osteogenesis? Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Kevin C. Lee, Sidney B. Eisig, Vincent Carrao, Sung-Kiang Chuang, Michael A. Perrino Purpose Because Robin sequence (RS) is clinically heterogeneous, there is uncertainty as to whether different presentations yield different perioperative outcomes. The purpose of this study was to evaluate factors associated with postoperative length of stay and readmission rate after mandibular distraction osteogenesis (MDO) for RS. Materials and Methods This was a 10-year retrospective cohort of patients with RS who had MDO performed from 2007 through 2017 at the Morgan Stanley Children's Hospital of the NewYork-Presbyterian/Columbia University Irving Medical Center (New York, NY). Predictor variables were the presence of multiple anomalies, airway intervention used before MDO, and feeding method used before MDO. Outcome variables were postoperative day (POD) of discharge and number of readmissions from the period of discharge to hardware removal. Patient characteristics and outcomes were compared within predictors using Fisher’s exact and 2-tailed Student’s t tests. Multiple regression models were calculated for each outcome variable using univariate predictors with P values less than or equal to .25. Results Twenty-four patients who had MDO performed at a mean age of 18.1 weeks were included in this study. On average, patients were extubated on POD 6.6 and distracted to 13.9 mm. Seven patients (29.2%) were readmitted from the period of discharge to hardware removal. Patients receiving an invasive airway intervention before MDO were significantly older at the time of the operation (55.0 vs 8.4 weeks; P = .01). In addition, these patients had a significantly higher readmission rate (80.0 vs 15.8%; P = .01) with a trend toward longer postoperative stays (45.0 vs 21.6 days; P = .06). Feeding status and presence of multiple anomalies did not appear to influence these outcomes. Conclusions Baseline airway intervention may be useful for predicting length of stay and readmission rate after MDO.

Comparison of the Planned Versus Actual Jaw Movement Using Splint-Based Virtual Surgical Planning: How Close Are We at Achieving the Planned Outcomes? Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Ashley C. Tankersley, Matthew C. Nimmich, Andrew Battan, Jason A. Griggs, Ronald Caloss Purpose Virtual surgical planning and interocclusal splints are commonly used in performing orthognathic surgery. The benefits are well known, but how close do surgeons come to achieving the planned movements? The aim of this study was to answer this question. Materials and Methods This was a retrospective cohort study of patients who underwent maxillary and mandibular osteotomies to correct their dentofacial deformity. The predictor variable consisted of the virtually planned 3-dimensional (3D) positions of the maxillary and mandibular centroids and maxillary central incisor. The outcome variable consisted of the postoperative 3D positions of these points. Absolute differences were calculated using the root mean square deviation. Other variables that could affect the outcome were assessed, which included skeletal classification, osteotomy sequence, and maxillary segmental surgery. Paired t test was used to determine the mean of the error for the outcome variable. A forward stepwise regression test was used to test for associations with the other variables. Results This study was composed of 15 patients with a mean age of 19 years. The maxillary incisor was advanced 2.5 to 8 mm. The mean of the error for the maxillary incisor in the anteroposterior dimension was −2.0 mm, which was a statistically relevant under-advancement (95% confidence interval). The anteroposterior error for the maxillary centroid was significantly higher for a 1- than for a 3-piece Le Fort osteotomy (P = .008). Eight patients had under-advancement of more than 50% of the planned movement, which could be clinically relevant. Conclusions The maxillomandibular complex was under-advanced. This could be due to surgeon-dependent variables and other factors that are not simulated with virtual planning. This could affect the desired lip and paranasal support. The surgeon needs to take this into account when planning esthetic objectives for surgery.

Clinical, Imaging, and Therapeutic Aspects of Genial Tubercle Fractures: A Systematic Review Publication date: August 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 8 Author(s): Daniel Almeida Ferreira Barbosa, Thamara Manoela Marinho Bezerra, Paulo Goberlânio Barros Silva, Alynne Vieira Menezes Pimenta, Lúcio Mitsuo Kurita, Fábio Wildson Gurgel Costa Purpose The present study reviewed the clinical, imaging, and therapeutic aspects of genial tubercle fracture (GTF). Materials and Methods A 2-phase systematic search of the literature was performed. Search strategies were developed for specific databases (PubMed, Scopus, Web of Science, Cochrane, and LILACS), including the gray literature (Open Grey and Google Scholar). The descriptors “genial tubercle,” “fractures, bone,” “mentalis,” “spinae,” and “mandible” were searched without restriction to year of publication. The CARE guideline was applied to evaluate methodologic aspects, and the Meta-Analysis of Assessment and Review Instrument was used to assess the risk of bias. The adopted level of significance was .05. Results Of 1,970 articles, 1,948 were excluded after applying the eligibility criteria. Furthermore, 2 studies were added through a manual search of the reference lists, totaling 24 articles. Occurrence of GTF was most common in women older than 61 years and men younger than 60 years (difference in age at occurrence was statistically significant; P = .019). The main clinical findings were edentulism, sublingual edema, and pain (P < .001). Previous trauma was commonly absent in women and present in men (P = .018). A cracking sound was mainly reported by women (P = .009). Isolated panoramic and occlusal radiographs were the most commonly performed examinations (P < .001). Diagnosis of sialolithiasis occurred in 37.5% of cases, and conservative treatment was performed in 76.6% of cases. Conclusion GTF was mainly observed in older women, edentulous patients, and those without previous trauma. Conventional radiography and nonsurgical treatment were frequently reported.