To what extent do oral and maxillofacial surgery residents suffer from imposter syndrome?

OBJECTIVE: This study aims to evaluate the frequency and severity of imposter syndrome (IS) in oral and maxillofacial surgery (OMS) residents and identify factors associated with higher Clance Imposter Phenomenon Survey (CIPS) scores. STUDY DESIGN: A cross-sectional study was performed with a survey including CIPS, demographic, and training program structure questions distributed to all OMS training programs and residents in the United States. The primary predictor variable was gender, and the main outcome variable was the CIPS score. Statistical analyses were performed using linear regression in R v4.3.1; statistical significance was set to P value < .05. RESULTS: A total of 175 OMS residents responded. The average CIPS score was 59.8 (IQR 52, 70). Statistically significant differences were found between average male and female resident scores (56.5 vs 66.9; P < .001) and male and female single-degree residents (54.3 vs 73.1; P < .001), but not for dual-degree residents (58.8 vs 63.9; P = .35). CONCLUSIONS: The average male resident experiences moderate IS, whereas the average female resident experiences frequent IS. Loss of significance between male and female dual-degree resident scores may be due to the completion of a doctoral degree, an internship, and/or dental board exams upon entering medical school, leading to more favorable accomplishment comparisons among medical school peers.

A retrospective study of orthognathic surgery reimbursement and volume changes at an American academic medical center over a 13-year period.

OBJECTIVE: This study aimed to measure the association between orthognathic surgeon reimbursement and surgical volume over time. STUDY DESIGN: A retrospective cohort study of patients who underwent orthognathic surgery from January 1, 2010, to December 23, 2022, at an academic medical center was performed. Five patients per year were randomly selected and evaluated for insurance type and associated costs to create representative averages. Pearson correlation analysis was performed to test associations over 13 years with 2-tailed significance reported and statistical significance set at P < .05. RESULTS: A total of 618 patients who underwent 942 procedures were included. The average procedure charge was $6,153.76, and the average total surgeon collection was $1,535.75 per procedure. When monetary values were adjusted to reflect 2010 purchasing power, there was a negative correlation between the average charge per procedure and the year (r[11] = -0.59, P = .04). The year was not significantly correlated with the average amount collected (r[11] = -0.09, P = .78) or average insurance reimbursement (r[11] = -0.52, P = .07). CONCLUSIONS: Collections by surgeons did not change significantly over 13 years and were not correlated with the volume of procedures performed. Increased collections were correlated with increased patient costs. The stagnation of surgeon collection is concerning in the face of increased monetary inflation during this period. Increased volume of surgeries per year was correlated with decreases in patient cost and total collections.

The Use and Outcomes of 3D Printing in Pediatric Craniofacial Surgery: A Systematic Review.

Three-dimensional (3D) printing has demonstrated efficacy in multiple surgical specialties. As accessibility improves, its use in specific fields deserves further attention. We conducted a systematic review of the implementation and outcomes of 3D printing in pediatric craniofacial surgery, as none has been performed. A systematic review was conducted according to Cochrane and PRISMA guidelines. PubMed, Embase, Cochrane library, and Clinicaltrials.gov were queried with combinations of the terms: "3D printing," "craniofacial," "surgery," and "pediatric." Original human studies containing patients <18 years old implementing 3D printing to aid in craniofacial surgery were included. Study selection, grading, and data extraction were performed independently by multiple authors. After screening 120 articles, 7 (3 case series and 4 case reports) were included, published from 2017 to 2022. All studies addressed patients with different disease processes including craniosynostosis, cleft lip/palate, and mandibular hypoplasia. 3D printing was used to create mock surgical models in 2 studies, intraoperative cutting guides/molds (CGs) in 6 studies, and cranioplasty implants in 2 studies. Two case series determined the accuracy of the CGs was acceptable within historical comparison, while 4 articles included subjective statements on improved accuracy. Five studies noted reduced operating time, 2 noted reduced intraoperative blood loss, and 1 felt the use of 3D printed materials was responsible for shorter hospitalization duration. No adverse events were reported. Despite the limitations of the current literature, all studies concluded that the use of 3D printing in pediatric craniofacial surgery was beneficial. Definitive conclusions cannot be made until further controlled research is performed.

Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution.

BACKGROUND: Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied. PURPOSE: This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI). STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records. PREDICTOR VARIABLE: The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density. MAIN OUTCOME VARIABLE(S): The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable. COVARIATE(S): Covariates included sex, age, and race. ANALYSES: Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05. RESULTS: Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR) = 0.91; 95% confidence interval (CI) 0.78 to 1.05; P = .18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR = 0.91; 95% (CI) 0.86 to 0.97; P = .004), and higher population density (IRR = 0.87; 95% CI 0.79 to 0.94; P < .001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients. CONCLUSIONS AND RELEVANCE: Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.

Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes.

Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm 2 versus 15.3 cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.

Current Methods of Maxillofacial Tissue Engineering.

For several decades, the multidisciplinary field of tissue engineering has striven to improve conventional methods of dental, oral, and craniofacial rehabilitation for millions of people annually. Several bone tissue engineering strategies are now readily available in the clinic. Enrichment of autologous products, growth factors, and combination approaches are discussed as ways to enhance the surgeon's traditional armamentarium. Lastly, cutting-edge research such as customized 3-dimensional printed bone scaffolds, tissue engineering strategies for volumetric muscle loss, and temporomandibular joint disc and condyle engineering are briefly discussed as future applications.

Massive Self-Induced Subcutaneous Cervicofacial, Pneumomediastinum, and Pneumopericardium Emphysema Sequelae to a Nondisplaced Maxillary Wall Fracture: A Case Report and Literature Review.

Iatrogenic cervicofacial subcutaneous emphysema is a well-reported entity in the field of dentistry and oral and maxillofacial surgery, especially with the use of air-driven headpieces. Cervicofacial subcutaneous emphysema sequelae after maxillofacial trauma, however, has been reported less and the self-induced variant is even rarer. We report a case of massive cervicofacial subcutaneous emphysema, pneumomediastinum, and pneumopericardium in a healthy 16-year-old boy after blunt trauma to the face, which caused a nondisplaced anterior maxillary wall fracture. The findings from the present case report will validate the common phrase "no nose blowing or holding your sneezes" that clinicians tell patients after maxillofacial trauma and sinus surgery.

Mechanical properties of resin-ceramic CAD-CAM materials after accelerated aging.

STATEMENT OF PROBLEM: The development of polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) milling bocks and the limited availability of independent studies on these materials make it pertinent to evaluate changes in their mechanical properties after simulated aging to identify strengths and limitations. PURPOSE: The purpose of this in vitro study was to measure the effect of thermocycling on the flexural properties of ceramic, resin, and resin-ceramic CAD-CAM materials. MATERIAL AND METHODS: Studied materials included Lava Ultimate Restorative (LVU; 3M ESPE), Enamic (ENA; VITA Zahnfabrik), Vitablocs Mark II (VM2; VITA Zahnfabrik), and Paradigm MZ100 (MZ1; 3M ESPE). Polished 4×1.2×14 mm bars (n=45 per material) were prepared from standard-size milling blocks. The 2 distilled water baths of the thermocycling apparatus were set to 5°C and 55°C, with a specimen immersion time of 15 seconds and transfer time of 4 seconds. Fifteen specimens from each material group were subjected to a 3-point flexural test at 3 different thermocycling intervals: 0 (control), 5000, and 10 000 cycles. The flexural test was performed over a 12-mm span with a crosshead speed of 0.5 mm/min. Data were subjected to multiple analyses of variance and the Tukey HSD post hoc tests (α=.05). RESULTS: Mean flexural strength values for 0, 5000, and 10 000 cycles were 133, 130, and 128 MPa for VM2; 175, 139, and 134 MPa for LVU; 154, 144, and 138 MPa for MZ1; and 149, 136, and 132 MPa for ENA. Mean flexural modulus values were 51, 52, and 54 GPa for VM2; 14, 13, and 13 GPa for LVU; 16, 15, and 15 GPa for MZ1; and 31, 30, and 31 GPa for ENA. Mean modulus of resilience values were 0.17, 0.16, and 0.15 MPa for VM2; 10.1, 0.76, and 0.72 MPa for LVU; 0.77, 0.69, and 0.62 MPa for MZ1; and 0.42, 0.31, and 0.28 MPa for ENA. A significant difference was found among the materials in the mean change of flexural strength (P<.001) and modulus of resilience (P<.05) after thermocycling. No significant difference was found among the materials in the mean change of flexural modulus after thermocycling (P=.113). CONCLUSIONS: The mean flexural strength of resin-ceramics is significantly different from that of the feldspathic ceramic control at 0 and 5000 cycles, but not at 10 000 cycles. The mean modulus of resilience of resin-ceramics varies significantly after thermocycling, unlike the feldspathic ceramic control. Conversely, the mean flexural modulus of tested materials did not vary significantly after thermocycling.

In vitro and in vivo characterization of pentaerythritol triacrylate-co-trimethylolpropane nanocomposite scaffolds as potential bone augments and grafts.

A thiol-acrylate-based copolymer synthesized via an amine-catalyzed Michael addition was studied in vitro and in vivo to assess its potential as an in situ polymerizing graft or augment in bone defect repair. The blends of hydroxyapatite (HA) with pentaerythritol triacrylate-co-trimethylolpropane (PETA), cast as solids or gas foamed as porous scaffolds, were evaluated in an effort to create a biodegradable osteogenic material for use as a bone-void-filling augment. Osteogenesis experiments were conducted with human adipose-derived mesenchymal stromal cells (hASCs) to determine the ability of the material to serve as an osteoinductive substrate. Poly(ɛ-caprolactone) (PCL) composites PCL:HA (80:20) (wt/wt%) served as the control scaffold, while the experimental scaffolds included PETA:HA (100:0), (85:15), (80:20), and (75:25) composites (wt/wt%). The results indicate that PETA:HA (80:20) foam composites had higher mechanical strength than the corresponding porous PCL:HA (80:20) scaffolds made by thermo-precipitation method, and in the case of foamed composites, increasing HA content directly correlated with increased yield strength. For cytotoxicity and osteogenesis experiments, hASCs cultured for 21 days on PETA:HA scaffolds in stromal medium displayed the greatest number of live cells compared with PCL:HA composites. Moreover, hASCs cultured on foamed PETA:HA (80:20) scaffolds resulted in the greatest mineralization, increased alkaline phosphatase (ALP) expression, and the highest osteocalcin (OCN) expression after 21 days. Overall, the PETA:HA (80:20) and PETA:HA (85:15) scaffolds, with 66.38% and 72.02% porosity, respectively, had higher mechanical strength and cytocompatibility compared with the PCL:HA control. The results of the 6-week in vivo biocompatibility study using a posterior lumbar spinal fusion model demonstrate that PETA:HA can be foamed in vivo without serious adverse effects at the surgical site. Additionally, it was demonstrated that cells migrate into the interconnected pore volume and are found within centers of ossification.