Certification by the American Board of Oral and Maxillofacial Surgery: Residency to Retirement.

The American Board of Oral and Maxillofacial Surgery (ABOMS) has been serving the specialty since 1946. The ABOMS frequently reviews its strategic plan, mission, and vision. The board administers 4 examinations (the Oral and Maxillofacial Surgery In-service Training Examination, the Qualifying Examination, the Oral Certifying Examination, and Certificates of Added Qualifications in Head and Neck Oncologic and Reconstructive Surgery and Pediatric Craniomaxillofacial Surgery) and also oversees the Certification Maintenance process for diplomates. The members of the Examination Committee and directors are volunteers who create, validate, and deliver examination content for the various examinations by the ABOMS.

Validation of a diagnostic protocol used to identify intimate partner violence in the emergency department setting.

PURPOSE: To assess the internal validity of a diagnostic protocol developed to facilitate the identification of women with intimate partner violence (IPV)-related injuries. MATERIALS AND METHODS: Using a cross-sectional study design, we enrolled a sample of female subjects presenting to the emergency department for treatment of injuries with non-verifiable etiologies. The study sample was divided randomly into index and validation sets. The index set was used to develop the diagnostic protocol, and the validation set was used to assess the protocol's internal validity. The predictor study variable was risk for IPV-related injury (ie, high or low). The outcome variable was self-report of injury etiology (IPV or other etiology). Appropriate univariate, bivariate, and multivariate statistics were computed, including estimates of sensitivity, specificity, and relative risk. Goodness of fit of the diagnostic protocol was estimated with the Hosmer-Lemeshow statistic. For all analyses, P < or = .05 was considered statistically significant. RESULTS: The index and validation samples were composed of 200 and 100 women, respectively. In the index sample, subjects categorized at high risk of IPV-related injuries were statistically associated with an increased risk for self-report of IPV-related injury (relative risk, 25.2; 95% confidence interval, 10.6-59.5 [P < .05]; sensitivity, 90.2%; specificity, 96.4%; positive predictive value, 90.1%; negative predictive value, 96.4%). The agreement between the predicted and actual observations showed excellent agreement in the index and validation samples (P = .999, Hosmer-Lemeshow chi(2)). CONCLUSION: The proposed diagnostic protocol effectively stratifies risk for IPV-related injuries with good internal validity.

Markers for intimate partner violence in the emergency department setting.

PURPOSE: Intimate partner violence (IPV) is a serious, under-reported public health problem in the United States. Pilot studies suggested that injury location, that is, head, neck, or face, was a sensitive but nonspecific marker for IPV-related injuries. This study's goal was to determine whether adding a second element to the diagnostic protocol-response to an IPV-screening questionnaire-improved the specificity of the protocol. MATERIALS AND METHODS: We used a cross-sectional study design and a sample composed of women presenting to the emergency department for evaluation and management of injuries of non-verifiable etiology. The predictor study variables were injury location (head, neck, or face vs other), responses to a verbal questionnaire (Partner Violence Screen or Woman Abuse Screening Tool), and the combination of both elements. By combining both elements, the probability for IPV-related injury was classified as high or low. The outcome variable was self-report of injury etiology (IPV or other etiology). Appropriate univariate and bivariate statistics were computed, including estimates of sensitivity, specificity, positive and negative predictive values, and relative risk. RESULTS: The sample was composed of 300 women with a mean age of 36.5 years. The frequency of self-reported IPV-related injury was 32.3%. The sensitivities and specificities for injury location and the questionnaires combined ranged from 86.5% to 91.8% and 93.1% to 96.1%, respectively. CONCLUSIONS: The study findings suggest that combining information regarding injury location and the results of a screening questionnaire was a better predictor of a woman's likelihood to report IPV-related injuries than either modality alone.

Comparison of patient and surgeon assessments of pain in oral and maxillofacial surgery.

Pain perception is a physical sensation interpreted in the light of experience and is influenced by a great number of interacting factors. Clinicians are constantly required to combine subjective and objective information to determine optimal treatment of pain. In this study, the authors prospectively compare patients' subjective complaints of pain using the visual analog scale to the surgeons' assessment of pain using standard history and physical examination findings.

Complications of third molar surgery.

This article addresses the incidence of specific complications and, where possible, offers a preventive or management strategy. Injuries of the inferior alveolar and lingual nerves are significant issues that are discussed separately in this text. Surgical removal of third molars is often associated with postoperative pain, swelling, and trismus. Factors thought to influence the incidence of complications after third molar removal include age, gender, medical history, oral contraceptives, presence of pericoronitis, poor oral hygiene, smoking, type of impaction, relationship of third molar to the inferior alveolar nerve, surgical time, surgical technique, surgeon experience, use of perioperative antibiotics, use of topical antiseptics, use of intra-socket medications, and anesthetic technique. Complications that are discussed further include alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.

Stability of orthognathic surgery and distraction osteogenesis: options and alternatives.

Relapse in orthognathic surgery is multifactorial and can be attributed to posttreatment growth, condylar changes, lack of rigid fixation, and muscle pull and function. Consideration of these factors can aide the surgeon in the decision-making process with regards to treatment options and alternatives. This article reviews the stability of various orthognathic movements using traditional osteotomies and fixation, and compares them to what is currently in the literature regarding distraction osteogenesis.

The fabrication and use of an extraoral surgical guide for implant placement coincident with soft tissue matrix expansion grafts: a clinical report.

During soft tissue matrix expansion (tent pole) graft (STMEG) surgery, the traditional intraoral surgical guide for dental implant placement cannot be used because the surgery is initiated and maintained outside the oral cavity. The essential records established from an intraoral surgical guide must be transferred to an extraoral surgical guide. This clinical report describes the fabrication and use of an extraoral surgical guide employed during STMEG surgery.

A protocol to diagnose intimate partner violence in the emergency department.

BACKGROUND: To better identify women at risk for intimate partner violence (IPV), we developed a diagnostic protocol composed of injury location and response to a verbal questionnaire to identify women at high risk for reporting an IPV-related injury etiology. The purpose of this study was to test the external validity of the protocol when applied at two institutions that differ considerably in terms of geography and socioeconomic measures. METHODS: A cross-sectional design was used at two demographically and geographically different hospitals, designated H1 and H2. The sample was composed of adult females age >or=18 years presenting to the emergency department (ED) for evaluation and management of nonverifiable traumatic injuries. The predictor variable was risk for reporting an IPV-related injury. Risk was categorized per the protocol as high or low. High-risk subjects had visible head, neck, or face (HNF) injuries and positive responses to the questionnaires. Low-risk subject had non-HNF injuries or negative responses to the screening questionnaires. The outcome variable was self-reported injury etiology classified as IPV-related or other. Descriptive and bivariate statistics and standard measurements for a diagnostic test were computed. RESULTS: The sample was composed of 400 subjects, with 200 subjects enrolled at each institution. Self-reported IPV was 34% and 9.5% at H1 and H2, respectively. The protocol classified 33% (H1) and 18% (H2) of subjects as high risk. Sensitivities were 90% (H1) and 74% (H2). Specificities were 96% (H1) and 88% (H2). Subjects classified per protocol as high-risk had an 18-fold (p < 0.01, H1) and 13-fold (p < 0.01, H2) increased risk for reporting IPV-related injuries. CONCLUSIONS: Despite significant geographic and socioeconomic differences between the two hospitals, the results suggest that our protocol may be applicable in disparate clinical settings.

Diagnosis and treatment of patients with trigeminal neuralgia.

BACKGROUND: The authors review the literature regarding the etiology, diagnosis and treatment of trigeminal neuralgia, or TN. They also describe a patient with the disease. TYPES OF STUDIES REVIEWED: A MEDLINE search was conducted to identify articles published within the last 10 years regarding current thinking on the etiology, diagnosis and treatment of TN. The authors also reviewed historic articles to gather information about the initial discovery and descriptions of this condition. RESULTS: The authors identified more than 50 articles on the topic. Generally, there was concordance regarding the diagnosis of this condition; however, some questions and controversy exist regarding the pathogenesis and treatment modality of choice. The authors relied on the most representative and complete articles for this review article. CLINICAL IMPLICATIONS: TN is the most common form of neuralgia, and patients often visit several clinicians with complaints of pain. Clinicians must recognize this condition and diagnose it correctly for patients to receive proper referral and therapy for this relatively treatable condition.