Does Practice Type Determine the Complexity of Patients Encountered for Orthognathic Surgery?

PURPOSE: This study sought to determine whether the type of oral and maxillofacial surgery (OMS) practice dictated the complexity of patients encountered for orthognathic surgery and to determine whether there were meaningful differences in comorbidities between patient groups. MATERIALS AND METHODS: This was a retrospective cohort study of orthognathic surgical patients operated on by surgeons at an academic medical center (AMC; OMS department at the University of Alabama-Birmingham) compared with a private practice (PP) group that also operated at the AMC auxiliary facility. Surgical procedures included in this study were Le Fort osteotomy, bilateral sagittal split osteotomy, genioplasty, and combinations of these procedures. An experienced surgeon scrutinized the medical records of the AMC and PP groups for age, gender, medical history, American Society of Anesthesiologists (ASA) classification, and indications for surgical procedures. These data were statistically compared for differences in patient complexity. RESULTS: The average age of patients in the 2 groups was similar (AMC, 29 yr; PP, 27 yr). Many more females were treated in the PP setting (male-to-female ratio, 1.06:1 in the AMC group and 1:1.6 in the PP group). The AMC group had a larger percentage of patients with medical comorbidities, a larger proportion of patients with ASA class 2 or 3, and a larger proportion of patients who underwent procedures for reasons other than malocclusion or cosmetic purposes, and these proportions were statistically relevant. Average length of surgery and average length of stay were longer in the AMC group. CONCLUSION: This retrospective cohort study suggests that OMS departments in AMCs tend to treat orthognathic surgical patients with increased comorbidities and systemic illnesses and operate on a larger percentage of patients with concomitant dentofacial issues versus more routine dentofacial skeletal and occlusion deformities.

EGCG-targeted p57/KIP2 reduces tumorigenicity of oral carcinoma cells: role of c-Jun N-terminal kinase.

The green tea polyphenol epigallocatechin-3-gallate (EGCG) regulates gene expression differentially in tumor and normal cells. In normal human primary epidermal keratinocytes (NHEK), one of the key mediators of EGCG action is p57/KIP2, a cyclin-dependent kinase (CDK) inhibitor. EGCG potently induces p57 in NHEK, but not in epithelial cancer cells. In humans, reduced expression of p57 often is associated with advanced tumors, and tumor cells with inactivated p57 undergo apoptosis when exposed to EGCG. The mechanism of p57 induction by EGCG is not well understood. Here, we show that in NHEK, EGCG-induces p57 via the p38 mitogen-activated protein kinase (MAPK) signaling pathway. In p57-negative tumor cells, JNK signaling mediates EGCG-induced apoptosis, and exogenous expression of p57 suppresses EGCG-induced apoptosis via inhibition of c-Jun N-terminal kinase (JNK). We also found that restoration of p57 expression in tumor cells significantly reduced tumorigenicity in athymic mice. These results suggest that p57 expression may be an useful indicator for the clinical course of cancers, and could be potentially useful as a target for cancer therapies.