What Are the Lessons Learned From the Virtual Interview Process for Oral and Maxillofacial Surgery Residency Programs Affected by COVID-19?

Purpose

With the outbreak of COVID-19, residency programs for the 2020 to 2021 OMS interview cycle were forced to quickly adapt to a new method of assessing candidates—virtual interviewing—for the first time. The purpose of this study is to describe applicants’ perspectives regarding the advantages and disadvantages of the virtual interview process through an online descriptive survey.

Methods

This cross-sectional study utilizes a descriptive survey sent to the 2020 to 2021 interview cycle applicants of the University of Illinois at Chicago Oral and Maxillofacial Surgery (UIC OMS) residency program. The survey consisted of questions employing both scaled and open-ended designs. The questions were fabricated to extrapolate applicants’ perceived advantages and disadvantages of virtual interviewing compared to their expectations of in-person interviewing by focusing on interactions, number of interviews received/attended, and overall applicant satisfaction. Descriptive statistics were computed for each variable for data analysis.

Results

In the 2020 to 2021 UIC OMS residency cycle, there were 288 applications. A total of 102 surveys were collected (response rate = 35.4%). Respondents attended more interviews during the virtual format due to accessibility (64.7%), and cost savings (63.7%). 42.2% of applicants felt they did not present themselves as well during the virtual interview as they would have in person and 46.1% felt they did not have a good understanding of the culture of the program after the interview. 49.0% of all participants do not feel that virtual interviews should continue in the future.

Conclusions

Virtual formats would allow access to a greater number of interviews; however, they lack the ability to promote effective interaction between applicants, residents, and faculty members. The results of the study show that although applicants agreed that interviews were more accessible this year, they felt that the “personal” interaction was lacking and they could not present themselves effectively with the virtual format. Ultimately, almost half (49%) of the respondents do not wish for virtual interviews to continue in the future.

Are we able to predict airway dimensional changes in isolated mandibular setback?

The goal of this study was to determine whether a relationship exists between the amount of mandibular setback and the amount of airway dimensional changes. Records and cone beam computed tomography (CBCT) of patients who had undergone isolated bilateral sagittal split osteotomy setback between January 1, 2013 and March 16, 2020 at a single institution were reviewed retrospectively. The primary outcome variable was upper airway volume dimension change, and the predictor variable was the magnitude of mandibular setback as measured by six different methods. Thirty-one patients were included in the study, with a mean mandibular setback ranging from 1.41 mm to 6.11 mm. None of the predictor variables showed an association with oropharyngeal (P = 0.54) or hypopharyngeal (P = 0.33) volume. Stepwise regression analysis failed to show any significant relationships. Similarly, there was no statistically significant association between any of the predictor variables and oropharyngeal (P = 0.44) or hypopharyngeal (P = 0.74) minimum axial area. The results showed that no correlation exists between the magnitude of mandibular setback and the amount of static airway dimensional changes; therefore, it may not be possible to predict whether obstructive sleep apnea will develop following mild to moderate mandibular setback based upon CBCT measurements.

Management of Traumatic Trigeminal and Facial Nerve Injuries

In the area of craniomaxillofacial trauma, neurosensory disturbances are encountered commonly, especially with regard to the trigeminal and facial nerve systems. This article reviews the specific microanatomy of both cranial nerves V and VII, and evaluates contemporary neurosensory testing, current imaging modalities, and available nerve injury classification systems. In addition, the article proposes treatment paradigms for management of trigeminal and facial nerve injuries, specifically with regard to the craniomaxillofacial trauma setting.

How Many Oral Surgeons Does It Take to Classify a Nerve Injury?

PURPOSE

There is inconsistency in clinical grading of peripheral trigeminal nerve (TN5) injuries that impact patient care. The study goal is to assess the current status of evaluation and classification of TN5 injuries by oral and maxillofacial surgeons (OMSs).

PATIENTS AND METHODS

A cross-sectional study design used an electronic survey to 100 selected OMSs to determine their clinical TN5 injury practice, including neurosensory testing, confidence level with current protocols, and evaluation and treatment of a hypothetical TN5 injury case. The target sample was enhanced to reduce type 2 error, assuming prior experience in the diagnosis and management of TN5 injuries.

RESULTS

The sample was composed of 90 respondents. Nerve injury classification systems used by OMSs include Seddon (44%), Sunderland (70%), and Medical Research Council Scale (31%). Neurosensory testing protocols varied considerably among survey respondents. A sample case for Medical Research Council Scale grading produced inconsistent and inaccurate results. There was no consensus on TN5 injury management, and recommendations for timely nerve repair varied from 1 month to up to 1 year after injury. Half of the respondents stated that OMSs are not adequately prepared to assess inferior alveolar/lingual nerve injuries, and most oral-maxillofacial surgery respondents evaluate fewer than 10 TN5 injuries each year. Most OMSs (92%) have had a temporary inferior alveolar/lingual nerve injury, while 54% have had a permanent injury; of which, 21% required microsurgical repair. The majority of OMSs (74%) believed that a uniform TN5 injury classification system is needed.

CONCLUSIONS

Within the oral-maxillofacial surgery target group experienced in evaluation of TN5 injuries, respondents do not feel confident in the assessment of these injuries. There is inconsistency in evaluation methods, and there is agreement that a unified classification system is needed for more efficient patient evaluation and reporting of outcomes in the literature. The Medical Research Council Scale and clinical neurosensory testing is preferred for evaluation of TN5 injuries.

The Quality of the Evidence in Craniomaxillofacial Trauma: Are We Making Progress?

PURPOSE

The purpose of this study is to evaluate the level of evidence in the craniomaxillofacial trauma literature. The secondary purpose is to determine if improvement in the quality of evidence has been made over the past 2 decades.

MATERIALS AND METHODS

This retrospective cohort study analyzed clinical articles published in select craniomaxillofacial surgery journals. Patient-focused articles were selected. The year of publication (1999, 2009, 2019) was the primary predictor variable. Secondary predictor variables included study funding status, anatomical facial region (eg maxilla, mandible, and so on), specific journal, and journal impact factor. The level of evidence was determined using the Center of Evidence-Based Medicine criteria, which served as the outcome variable. The statistical analysis included descriptive, bivariate, and regression analysis.

RESULTS

The sample consisted of 469 craniomaxillofacial trauma articles, with 13.2% being published in 1999, 44.1% in 2009, and 42.6% in 2019. The majority of the studies (77.5%) were published in 4 journals. The impact factor varied among the journals with a significant improvement in the mean impact factor from (0.89 ± 0.29) in 1999 to (1.4 ± 0.47) in 2009 and a slight decline in 2019 (1.26 ± 0.71). Mandibular fractures (31.6%) and orbital trauma (26%) were the most investigated topics. Level 4 studies accounted for 67.4% of the sample, with level 3 evidence of 4.7%, level 2 of 22.6%, and level 1 of 5.3% of the included studies. Significant progress in the level of evidence has been made from 1999 but not since that time (P = .002). It is unclear why this may be but sheds light on the need for further development of high quality studies. Finally, a higher quality of evidence is associated with journal impact factor (odds ratio  = 1.9; P < .01) and funded research (odds ratio = 4.69; P = .02).

CONCLUSIONS

While there has been some improvement in the level of evidence in the craniomaxillofacial trauma literature over the past 2 decades, the current quality remains low, and further progress is needed to support the practice of evidence-based medicine.

Does early repair of trigeminal nerve injuries influence neurosensory recovery? A systematic review and meta-analysis

This systematic review and exploratory meta-analysis of the available evidence was performed to examine whether early nerve repair of lingual nerve (LN) and inferior alveolar nerve (IAN) injuries has an effect on neurosensory recovery. A literature search was conducted to identify relevant studies meeting the inclusion criteria. Two reviewers independently evaluated the methodological quality of the included studies and the risk of bias using the ROBINS-I quality assessment tool. For the quantitative analysis, data were pooled using the Mantel-Haenszel random-effects method due to the clinical heterogeneity across the studies. Sensitivity and subgroup analyses were performed based upon the group definition of timing from injury to nerve repair, with breakpoints of 2, 3, and 6 months. A total 1236 citations were identified, with a final 13 studies included in the systematic review. A clear definition of 'early' versus 'late' repair was not reported in six studies, allowing only seven to be included in the meta-analysis. The effect of early repair on functional sensory recovery was found not to be significant in nine studies, while four studies found a significant effect of early intervention. The meta-analysis showed a combined success rate of 93.0% for the early group and 78.5% for the late group. The odds of improvement were 5.49 (95% confidence interval 1.40-21.45) in the 3-month breakpoint studies and 2.28 (95% confidence interval 1.05-4.98) in the 6-month studies. A trend towards early repair achieving better functional sensory recovery outcomes was observed, but the specific time period is unknown.

Is There a Role for Absorbable Metals in Surgery? A Systematic Review and Meta-Analysis of Mg/Mg Alloy Based Implants

Magnesium (Mg) alloys have received attention in the literature as potential biomaterials for use as absorbable implants in oral and maxillofacial and orthopedic surgery applications. This study aimed to evaluate the available clinical studies related to patients who underwent bone fixation (patients), and received conventional fixation (intervention), in comparison to absorbable metals (comparison), in terms of follow-up and complications (outcomes). A systematic review and meta-analysis were performed in accordance with the PRISMA statement and PROSPERO (CRD42020188654), PICO question, ROBINS-I, and ROB scales. The relative risk (RR) of complications and failures were calculated considering a confidence interval (CI) of 95%. Eight studies (three randomized clinical trial (RCT), one retrospective studies, two case-control studies, and two prospective studies) involving 468 patients, including 230 Mg screws and 213 Titanium (Ti) screws, were analyzed. The meta-analysis did not show any significant differences when comparing the use of Mg and Ti screws for complications (p = 0.868). The estimated complication rate was 13.3% (95% CI: 8.3% to 20.6%) for the comparison group who received an absorbable Mg screw. The use of absorbable metals is feasible for clinical applications in bone surgery with equivalent outcomes to standard metal fixation devices.

"Monoblock" Occlusal Model to Enhance Occlusal Verification During Orthognathic Surgery

Intraoperative verification of the planned occlusion is critical in ensuring the accuracy of orthognathic surgery. This step is limited to visual inspection, which can be especially challenging when the planned occlusal setup is less-than-stable. The authors introduce a cost-effective method of an accurate reproduction of the planned occlusion using additive manufacturing which can aid in intraoperative verification of positionally unstable occlusal setups. The authors present a case example, and discuss various technical considerations.

Is There a Correlation Between Comprehensive Basic Science Examination and United States Medical Licensure Examination Step 1 Performance Among Oral and Maxillofacial Surgery Residents?

PURPOSE

Oral and maxillofacial surgery (OMS) applicant Comprehensive Basic Science Examination (CBSE) scores are scrutinized by residency programs and medical schools because of their perceived predictive value for United States Medical Licensure Examination (USMLE) Step 1 performance. The purpose of this study was to answer the following question: Is there a correlation between the OMS applicant's CBSE score and his or her later USMLE Step 1 score?

MATERIALS AND METHODS

We e-mailed all current 45 dual-degree OMS residency programs to request participation in the study. Participating programs submitted residents' CBSE scores and USMLE Step 1 scores.

RESULTS

Of 45 United States-based, dual-degree OMS residency programs, 23 (51%) enrolled in the study, including data for 152 residents from 2012 to 2018. The mean CBSE score was 71 (range, 47 to 99). The mean USMLE Step 1 score was 220 (range, 177 to 266). The Pearson correlation coefficient for the relationship between the CBSE and USMLE Step 1 scores was 0.36. The overall USMLE pass rate was 97%. On the USMLE Step 1, OMS residents outperformed their translated CBSE score by an average of 15 points. Of the 50 residents (33%) with a translated CBSE score below the passing level, 94% passed the USMLE Step 1. Residents who had a translated passing CBSE score outscored residents with a translated failing score by 14 points when taking the USMLE Step 1 (225 vs 211).

CONCLUSIONS

Although no statistically significant difference in the USMLE Step 1 pass rates was found between OMS residents with a translated passing CBSE score and those with a translated failing CBSE score, a weak positive correlation was noted between CBSE and USMLE Step 1 scores. These data do not support the use of a certain cutoff CBSE score for OMS applications by OMS program directors, especially as it pertains to interview offers.

What information do patients recall from the third molar surgical consultation?

The aim of this study was to determine whether the use of a professionally prepared educational video on third molar extraction enhances comprehension and retention of general and informed consent information. A prospective cohort study of adult patients undergoing consultation followed by extraction of third molars in the Oral and Maxillofacial Surgery Clinic, University of Illinois at Chicago was completed. At the initial consultation, the subjects viewed an educational video and received specific verbal individual information about their case. A written examination (group 1) was then completed; a subgroup of the subjects (group 2) was selected randomly to complete the same examination at the next visit prior to the procedure. The primary predictor variable was utilization of the video. The primary outcome variable was comprehension of information regarding third molars, assessed by examination scores. The secondary outcome variable was retention of the information, assessed by repeat examination scores. One hundred adults (34 male, 66 female; group 1) completed the examination at least once; 54 (19 male, 35 female) completed both examinations (group 2). Correct responses ranged from 64% to 100% in group 1 and from 37% to 100% in group 2. In group 2, all questions answered incorrectly at the first visit were answered correctly at the second visit, without any additional information being provided. Patient comprehension and retention of pertinent pre-surgical information is poor, despite use of an educational video to supplement the usual verbal consultation. These results confirm those of prior studies and may have medico-legal implications regarding the informed consent process for third molar surgery.

Interceptive Dentofacial Orthopedics (Growth Modification)

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.