What is in a name? Oral and maxillofacial surgeon versus oral surgeon.

PURPOSE: In 1975, the American Society of Oral Surgeons officially changed its name to the American Association of Oral and Maxillofacial Surgeons. This change was intended to address the specialty's expanding surgical scope. However, today, many health care professionals continue to use the term oral surgeon. This study was undertaken to determine if students' perception of the oral and maxillofacial surgeon's (OMS) surgical scope would change when oral and maxillofacial surgeon was used instead of oral surgeon. MATERIAL AND METHODS: This cross-sectional study surveyed undergraduate and dental students' choice of specialist to treat 21 different conditions. The independent variable was the specialty term (oral and maxillofacial surgeon vs oral surgeon). The dependent variables were specialists chosen for the procedure (ear, nose, and throat surgeon; plastic surgeon; OMS or oral surgeon; periodontist; other). The test of proportions (z test) with the Yates correction was performed for data analysis. RESULTS: Of the 280 senior dental students who were surveyed, 258 surveys were included in the study. Dental students' perception of the OMS's surgical scope increased significantly from 51% to 55% when oral and maxillofacial surgeon was used instead of oral surgeon. Of the 530 undergraduate upper division science students who were surveyed, 488 surveys were included in the study. Undergraduate upper division science students' perception of the OMS's surgical scope increased significantly from 23% to 31% when oral and maxillofacial surgeon was used as an option instead of oral surgeon. CONCLUSION: The use of oral and maxillofacial surgeon increased students' perception of the OMS's surgical scope. This study also suggested that students were not fully aware of the magnitude of the OMS's scope of practice. The current dichotomy and inconsistent use of the specialty's official term adds to the confusion and to misunderstanding. Therefore, OMSs should universally refer to themselves as oral and maxillofacial surgeons and help educate others of their scope.

Infection following deep brain stimulator implantation performed in the conventional versus magnetic resonance imaging-equipped operating room.

OBJECT: Risk factors for deep brain stimulator (DBS) infection are poorly defined. Because DBS implants are not frequently performed in the MR imaging-equipped operating room (OR), no specific data about infection of DBS implants performed in the MR imaging environment are available in the literature. In this study the authors focus on the incidence of infection in patients undergoing surgery in the conventional versus MR imaging-equipped OR. METHODS: To identify cases of DBS-associated infection, the authors performed a retrospective cohort study with nested case-control analysis of all patients undergoing DBS implantation at the University of California Los Angeles Medical Center. Cases of DBS infection were identified using standardized clinical and microbiological criteria. RESULTS: Between January 1998 and September 2003, 228 DBSs were implanted. Forty-seven operations (20.6%) were performed in the conventional OR and 181 (79.4%) in the MR imaging-equipped OR. There was definite infection in 13 cases (5.7%) and possible infection in 7 cases (3%), for an overall infection rate of 8.7% (20 of 228 cases). There was no significant difference in infection rates in the conventional (7 [14.89%] of 47) versus MR imaging-equipped OR (13 [7.18%] of 181) (p = 0.7). Staphylococcus aureus was isolated in 62% of cases. Twelve of 13 confirmed cases underwent complete hardware removal. On case-control analysis, younger age (< or = 58.5 years) was a significant predictor of DBS infection (odds ratio 3.4, p = 0.027) CONCLUSIONS: Infection is a serious complication of DBS implantation and commonly requires device removal for cure. The authors found that DBS implantation can be safely performed in MR imaging-equipped suites, possibly allowing improved lead placement. Young age was associated with an increased risk of DBS infection.

Novalis Shaped Beam Radiosurgery of arteriovenous malformations.

OBJECT: The authors studied outcomes and complications in patients who harbored arteriovenous malformations (AVMs) and underwent stereotactic radiosurgery involving the Novalis shaped beam unit. METHODS: Between January 1998 and January 2002, 83 patients were treated with radiosurgery at University of California, Los Angeles. The mean patient age was 37.8 years. Forty-four patients completed follow up. There were 24 women. Sixteen patients underwent repeated radiosurgery. Embolization was performed in 13 patients and radiosurgery alone in 31. The mean follow-up period after embolization was 54.4+/-21.9 months and 37.4+/-14.6 months for radiosurgery alone. The mean peripheral dose was 15 Gy (range 12-18 Gy). The mean preradiosurgery lesion volume was 9.7+/-11.9 ml for radiosurgery alone and 16.2+/-11.3 ml for embolization. The AVMs in 13 patients (29.8%) were Spetzler-Martin Grade II, 12 (27.5%) were Grade III, eight (18.2%) Grade IV, and five (11.3%) were Grade V and VI each. Spetzler-Martin grade, volume, and peripheral dose were analyzed in consideration to outcome. A positive trend (p = 0.086) was observed between Spetzler-Martin grade and obliteration rate. Volume per se did not predict obliteration (p = 0.48). A peripheral dose of 18 Gy was shown to be the most important predictor for occlusion (p = 0.007). The overall obliteration rate was 52.5%. A transient complication was noticed in one case (2.3%) and but no permanent deficits due to radiosurgery have been detected so far. Three patients (6.8%) bled after radiosurgery. CONCLUSIONS: The range of the prescribed peripheral dose was narrow. An association between the mean peripheral dose of 15 Gy, high conformality, and homogeneous dose distribution permitted no permanent complications. Volume per se did not correlate with outcome. The next step will be to increase the peripheral dose shaping the beam and to achieve higher obliteration rates without increasing complications.