Orthognathic Surgery in Goldenhar Syndrome With a Rare Course of the IAN.

Although there are multiple variations of accessory foramina described in the literature, to our knowledge there is only 1 report of an isolated mandibular foramen and inferior alveolar neurovascular bundle that courses through the lateral ramus, particularly in those with branchial arch syndromes. Goldenhar syndrome, of the oculo-auriculo-vertebral spectrum, is a rare congenital condition, which most characteristically presents with hemifacial microsomia. Depending on the severity of hemifacial microsomia, there are predictable treatment modalities to correct the consequent facial asymmetry. We report on a patient with Goldenhar syndrome who was found to have a unique course of the inferior alveolar nerve during orthognathic surgery work-up and treatment.

The Role of Endotracheal Tube in Medication-Related Osteonecrosis of the Jaw - A Case Report.

Rationale: Various traumatic risk factors have been correlated to the development of medication-related osteonecrosis of the jaw (MRONJ), with long-term use of antiresorptive or antiangiogenic medications. No previous cases of MRONJ secondary to endotracheal intubation have been reported in the oral and maxillofacial surgery literature. Patient Concerns: This case report describes a patient on long-term oral bisphosphonate therapy who presented with a nonhealing ulcer and exposed bony island along her right mandibular torus after undergoing general anaesthesia. Diagnosis: The lesion was diagnosed to be MRONJ secondary to pressure necrosis from postendotracheal intubation. These findings are suggested to be the result of poor control of the endotracheal tube while managing the airway. Treatment and Outcomes: After treatment with antibiotics and mouth rinses, the necrotic bone spontaneously dislodged with complete mucosalisation of the exposed site within 2 weeks. Take-away Lessons: Given the severe impact of MRONJ, it is imperative to recognise and minimise all controllable risk factors associated with its development.

Keeping tabs: Reducing postoperative opioid prescriptions for patients after breast surgical procedures.

BACKGROUND: As the opioid crisis continues, it is critical that health care providers ensure they are not overprescribing opioid medications. At our institution (Walter Reed National Military Medical Center, Bethesda, MD), postoperative patients after breast surgeries are discharged with variable amounts of opioid medications. However, many patients report minimal opioid use. The objectives of this study were to characterize postoperative opioid usage and prescribing practices for patients undergoing various breast surgeries and to recommend the number of opioid pills for discharge for each procedure. METHODS: This was a prospective, single-institution study of all patients undergoing breast surgery from October 2018 to 2019. All patients were enrolled in our institution's enhanced recovery after surgery protocol. Patients were given questionnaires at their 2-week postoperative clinic appointment that evaluated perioperative pain and use of pain medications. The electronic medical record was reviewed to obtain additional information. Appropriate parametric and nonparametric tests were used for analysis. RESULTS: A total of 190 breast surgery patients completed the survey. We observed no significant differences in pain scores except between re-excision and mastectomy. Of these patients, 99% were prescribed opioids; however, only 53% of patients used them. Of those patients who were prescribed opioids, on average, all were prescribed more pills than were used. CONCLUSION: Our study demonstrates that it is possible to discharge all breast surgery patients with fewer than 10 opioid pills, except for special circumstances. This is the first study to provide a set of specific recommended discharge medications. Utilization of an enhanced recovery after surgery protocol with standardized discharge opioids can be used successfully to reduce the number of opioids prescribed to patients.