Aquatic Activity-Related Craniofacial Injuries Presenting to United States Emergency Departments, 2010 to 2019.

PURPOSE: Aquatic activities are some of the most widely enjoyed sports and recreational activities in the United States. This study aimed to analyze the risks and types of craniofacial injuries associated with various aquatic activities. METHODS: We retrospectively analyzed aquatic activity-related craniofacial injuries between 2010 and 2019 using the National Electronic Injury Surveillance System database. Aquatic activities included swimming, diving, surfing, water skiing, and water tubing. Risks and types of craniofacial injuries were analyzed according to the types of aquatic activities, age, and sex. RESULTS: Among 48,112 patients with aquatic activity-related injuries, 9,529 (19.8%) had craniofacial injuries. In decreasing order of frequency, the causes of craniofacial injuries were swimming (79.6%), diving (7.5%), surfing (5.9%), water skiing (3.6%), and water tubing (3.5%). The proportion of craniofacial injuries among all injuries was higher in males than in females (22.8 vs 16.3%, P < .001), and decreased with age: 27.7% in 0 to 5 years, 21.5% in 6 to 11 years, 20.5% in 12 to 17 years, and 15.2% in ≥18 years (P < .001). Additionally, the proportion of craniofacial injuries was highest in diving (38.7%), and lowest in swimming (18.1%, P < .001). The male-to-female ratio in the proportion of patients with craniofacial injuries was highest in swimming at 1.42, and close to unity (0.97-1.13) in other activities. The most common type of craniofacial injury was laceration (43.5%), followed by concussion/internal organ injury (38.9%), contusion/abrasion (11.3%), and fracture (3%). Among all craniofacial injuries, the proportion of craniofacial fractures was highest in water tubing (8.5%) and lowest in swimming (2.2%, P < .001). CONCLUSIONS: Craniofacial injuries are a frequent cause of morbidity related to aquatic activities. Substantial variability exists in the risk and pattern of craniofacial injuries depending on the type of activity, age, and sex. These findings may aid in instituting educational programs and preventive measures against aquatic activity-related craniofacial injuries.

The expression of apoptotic proteins and matrix metalloproteinases in odontogenic myxomas.

PURPOSE: The odontogenic myxoma is a rare benign tumor affecting the jaws. We hypothesize that odontogenic myxomas have dysregulated antiapoptotic mechanisms to assist in neoplastic growth. We believe that antiapoptotic proteins of the Bcl-2 family are over expressed and that tumor cells must generate some form of matrix proteinase. The aim of this study was to evaluate odontogenic myxomas for the expression of cell cycle protein Ki-67, apoptosis-regulating proteins Bcl-2, Bcl-XL, Bak, and Bax, and matrix metalloproteinases MMP-2, MMP-3, and MMP-9. MATERIALS AND METHODS: Odontogenic myxomas submitted to oral pathology between 1974 and 1998 were evaluated. Twenty-six paraffin-embedded tissue sections were used in a standard immunohistochemistry protocol and incubated with one of the following antibodies: Bcl-2, Bcl-XL, Bak, Bax, or Ki-67. The sections were then incubated with anti-immunoglobulin conjugated to peroxidase-labeled dextran polymer in a Tris-HCl buffer. Counts of positive (staining) cells were completed in 5 high-power fields for each specimen. Each slide was reviewed by 2 investigators, and final data were pooled and averaged. RESULTS: Specimen slides showed an increase in cells staining positively for anti-apoptotic proteins Bcl-2 and Bcl-X. An average of 6.5% of specimen cells were positive for Bcl-2 and 10.4% for Bcl-X. Control tissue showed only 1.1% of cells to be positive for Bcl-2 and 1.2% for Bcl-X. Less than 1% of both specimen and control cells stained positively for Ki-67. Proapoptotic proteins (Bak and Bax) were not detected in tumor cells. Ninety percent of tumor cells stained positively for MMP-2 compared with 10% of controls. Specimen and controls were negative for MMP-3 and MMP-9. CONCLUSION: Odontogenic myxoma tumor cells did not show an increase in cell division. Less than 1% of tumor and control cells were positive for Ki-67. Odontogenic myxoma tumor cells showed increased expression of antiapoptotic proteins (Bcl-2 and Bcl-X) and the matrix metalloproteinase MMP-2. This study suggests that 2 mechanisms of disease progression used by the odontogenic myxoma are the production of antiapoptotic proteins and the secretion of matrix metalloproteinases.