Orthognathic Surgery in Patients with Syndromic Craniosynostosis.

Patients with syndromic and nonsyndromic synostosis may have end-stage skeletal discrepancies involving the lower midface and mandible, with associated malocclusion. While orthognathic surgical procedures in this population can be reliably executed, the surgeon must be aware of the unique morphologic characteristics that accompany the primary diagnoses as well as the technical challenges associated with performing Le Fort I osteotomies in patients who have undergone prior subcranial midface distraction.

Do Oral and Maxillofacial Surgeons Prescribe More Opioids After Third Molar Removal for Patients with Substance Use History?

PURPOSE: Oral and maxillofacial surgeons (OMSs) must manage postoperative pain control for patients who take illicit substances. The purpose of this study was to measure and compare the amount of opioid prescribing between patients with and without self-reported substance use history (SUH) by OMSs after third molar (M3) removal. MATERIALS AND METHODS: The investigators implemented a retrospective cohort study and enrolled a sample of subjects who had M3 removal between January 1, 2019 through December 31, 2019. The primary predictor variable was SUH coded as yes (SUH+) or no (SUH-). The primary and secondary outcome variables were prescribed morphine milligram equivalents (MMEs) and number of postoperative visits due to inadequate pain control (IPC), respectively. Other variables were age, gender, payor, provider, anesthesia, and procedure specific. Descriptive, bivariate, and multiple linear regression models were computed. RESULTS: The sample included 1,112 subjects with a mean age of 25 ± 9 years; 61.2% were female. Of the 1,112 subjects, 198 (17.8%) reported a SUH. Mean MMEs were 70.9 ± 27.9 and 63.4 ± 28.8 in the SUH+ and SUH- groups, respectively (P ≤ .001). An adjusted linear regression model showed a non-significant association between SUH and MMEs prescribed (P = .50). The study showed a non-significant increase (P = .15) in the proportion of patients with IPC in the SUH- group (4.1%) versus the SUH+ group (2.0%). CONCLUSIONS: The results suggest that 10% more opioids were prescribed for postoperative pain after M3 removal for patients with SUH, though after adjustment, the amount may not be clinically significant. Postoperative pain management after M3 removal in patients with SUH, on average, can be managed in a similar manner as for patients without SUH.

Are Oral and Maxillofacial Surgeons Prescribing Fewer Opioids and More Non-Narcotic Analgesics for Postoperative Pain After Third Molar Removal?

PURPOSE: In response to the national opioid epidemic crisis, the purpose of this study was to measure changes in opioid and non-narcotic analgesia (NNA) prescribing practices over time after third molar (M3) removal. MATERIALS AND METHODS: A retrospective double cohort study was utilized enrolling 2 samples of patients who had M3s removed during 2 different 3-month intervals. The primary predictor variable was prescribing practice, divided into cohorts: 1) previous prescribing practice (PPP) occurring early during the evolving opioid epidemic (2014); and 2) current prescribing practice (CPP) (2018). The outcome measures were morphine milligram equivalents (MMEs), NNA prescriptions, and refill MMEs for inadequate pain control (IPC). Other variables were age, gender, payor, provider, anesthesia, procedure, and number of M3s removed. Descriptive, bivariate, and multiple linear and logistic regression models were computed. RESULTS: The sample included 330 subjects with a mean age of 23.1 ± 8.1 years; 42.4% were male. Of the 330 subjects, 147 were in the PPP cohort (44.5%) and 183 in CPP cohort (55.5%). Mean MMEs were 130.1 ± 42.4 and 68.5 ± 32.0 in the PPP and CPP cohorts, respectively (P ≤ .001). An adjusted linear regression model showed differences in MMEs prescribed persisted (P ≤ .001). The frequency of postoperative NNA prescriptions written increased from 2.7 to 71.6% (P ≤ .001). An adjusted logistic regression model also revealed that NNA prescriptions had significantly increased (odds ratio, 242.00; P ≤ .001). No difference was found in the frequency of refills for IPC (P = .13) or mean refill MME prescriptions between the cohorts (P = .48). CONCLUSIONS: Within our academic practice, fewer opioids and more NNAs are being prescribed for postoperative pain after M3 removal without an increase in IPC. Increased awareness through prescribing regulations, non-narcotic research findings, and organizational guidelines could have contributed to these changes.

Is Gender Associated With Success in Academic Oral and Maxillofacial Surgery?

PURPOSE: Several studies of surgical specialties have shown disparities in measures of research productivity and academic rank between female and male surgeons. The purpose of this work was to measure the role of surgeon gender in academic success in oral and maxillofacial surgery. MATERIALS AND METHODS: We performed a cross-sectional study of full-time academic oral and maxillofacial surgeons (OMSs) in the United States as of June 2017. The primary study variable was surgeon gender (male or female). The primary outcome variable was research productivity assessed using 2 different parameters: 1) h index (number of publications h with at least h citations each) and 2) academic rank. The other study variables were demographic characteristics potentially related to the outcome measures. Descriptive, bivariate, and regression statistics were computed. RESULTS: The study sample comprised 306 full-time academic OMSs, 53 (17.3%) of whom were women. On average, female OMSs had shorter academic careers (mean time since completion of training, 11.0 ± 8.2 years for female OMSs vs 22.0 ± 14.1 years for male OMSs; P < .001). There were no other significant differences between male and female OMSs regarding the secondary measures (P ≥ .23). Male OMSs had a higher mean h index than female OMSs (7.1 ± 8.6 vs 5.1 ± 7.9, P = .01). Academic rank was statistically significantly different between female and male OMSs, with a greater proportion of higher ranks seen in male OMSs (P = .001). After adjustment for career length and other confounders or effect modifiers, gender was not an independent predictor of the h index or academic rank (P ≥ .22). CONCLUSIONS: Although female surgeons represent a minority of full-time academic OMSs, academic success measured using research productivity and academic rank was not associated with gender.

Is Formal Research Training Associated With Academic Success in Oral and Maxillofacial Surgery?

PURPOSE: Pursuing promotion in academic rank and seeking funded research opportunities are core elements of academic practice. Our purpose was to assess whether formal research training influences academic rank or National Institutes of Health (NIH) funding among full-time academic oral and maxillofacial surgeons (OMSs). MATERIALS AND METHODS: We performed a cross-sectional study of full-time academic OMSs in the United States. The primary predictor variable was completion of formal research training, defined as a research fellowship or advanced non-clinical doctoral research degree (PhD, DMSc, DPH, DPhil, ScD). The outcomes measures were current academic rank and successful acquisition of NIH funding (yes vs no). Other study variables included MD degree, clinical fellowship training, years since training completion, and Hirsch index (H-index), a measure of academic productivity. We computed the descriptive, bivariate, and multiple regression models and set P ≤ .05 as significant. RESULTS: A total of 299 full-time academic OMSs were included in the study sample. Of the 299 OMSs, 41 (13.7%) had had formal research training. Surgeons with formal research training had a greater mean interval since completion of training (P = 0.01) and had a greater mean H-index (P = 0.02). Formal research training was not associated with academic rank (P = .10) but was associated with an increased likelihood of receiving NIH funding (P < .001). In a multiple logistic regression model, after adjusting for years since completing training and H-index, formal research training was associated with an increased likelihood of obtaining NIH funding (odds ratio, 3.22; 95% confidence interval, 1.15 to 9.00; P = .03). CONCLUSIONS: Among academic OMSs, those with formal research training had greater success with obtaining NIH funding. However, formal research training did not appear to influence an OMS's current academic rank.