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Dammling C, Gilmartin EM, Abramowicz S, Kinard B. Indications for Antibiotic Prophylaxis for Dentoalveolar Procedures. Dent Clin North Am 2024; 68:99-111. [PMID: 37951640 DOI: 10.1016/j.cden.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Antibiotic prophylaxis is the use of antibiotics perioperatively to prevent infections at the surgical site or distant locations. The decision to provide prophylaxis must balance risks of antibiotic resistance, adverse drug reactions, and increased health care costs with the benefit of decreasing infection. This determination has been studied extensively in patients with specific cardiac conditions and prosthetic joints. Prophylactic antibiotics in healthy patients have been shown to reduce the frequency of alveolar osteitis and decrease the failure rates of dental implants.
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Affiliation(s)
- Chad Dammling
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA.
| | - Evan M Gilmartin
- School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL 35233, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1365 Clifton Road, Building B, Suite 2300, Atlanta 30322, Georgia, USA
| | - Brian Kinard
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA
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Caspers S, Abramowicz S, Pasteels B, Postelmans L. Smoking and short-term response to intravitreal anti-Vascular Endothelial Growth Factor injections in neovascular age-related macular degeneration. J Fr Ophtalmol 2024; 47:103955. [PMID: 37838498 DOI: 10.1016/j.jfo.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE To evaluate the role of smoking status on the response to three monthly intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections in treatment-naive neovascular AMD (nAMD) patients. METHODS We conducted a single-center, retrospective, case-control cohort study in Belgium. RESULTS Intravitreal treatment (IVT) was performed in 147 eyes of 131 patients, including 92 females (70%). Mean age at the time of the first IVT was 79±9 years. Seventeen patients (13%) were actively smoking at the time of the anti-VEGF IVT. On average, active smokers were 11 years younger than non-smokers when starting IVT treatment. They also showed more frequent subretinal fluid than non-smokers (94% vs. 65%). Mann-Whitney analyses comparing change in central macular thickness and change in logarithm of the minimum angle of resolution visual acuity between active smokers and non-smokers showed no significant difference in treatment response between both groups. Likewise, no significant difference was found when comparing treatment response between patients with less than 10 pack-years (PY) (including never-smokers) and patients with over 10 PY. In a binary logistic regression model, male patients responded worse to anti-VEGF IVT than their female counterparts, with an odds ratio (OR) of 0.27 for good response. This was the only statistically significant predictor of treatment response. CONCLUSION Our study failed to demonstrate an effect of smoking on the short-term treatment response to anti-VEGF in nAMD.
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Affiliation(s)
- S Caspers
- Service d'ophtalmologie, CHU Brugmann, université libre de Bruxelles, place Van Gehuchten 4, 1020 Brussels, Belgium.
| | - S Abramowicz
- Service d'ophtalmologie, CHU Brugmann, université libre de Bruxelles, place Van Gehuchten 4, 1020 Brussels, Belgium
| | - B Pasteels
- Service d'ophtalmologie, CHU Brugmann, université libre de Bruxelles, place Van Gehuchten 4, 1020 Brussels, Belgium
| | - L Postelmans
- Service d'ophtalmologie, CHU Brugmann, université libre de Bruxelles, place Van Gehuchten 4, 1020 Brussels, Belgium
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Taylor JQ, Hopkins E, Yang R, Abramowicz S. Epidemiology and Etiology of Facial Injuries in Children. Oral Maxillofac Surg Clin North Am 2023; 35:515-519. [PMID: 37302950 DOI: 10.1016/j.coms.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.
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Affiliation(s)
- Jeffrey Quinn Taylor
- Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA.
| | - Elizabeth Hopkins
- Johns Hopkins Children's Center Specialists, 6420 Rockledge Drive, Suite 2300, Bethesda, MD 20817, USA
| | - Robin Yang
- Johns Hopkins Children's Center Specialists, 6420 Rockledge Drive, Suite 2300, Bethesda, MD 20817, USA
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, NE, Building B, Suite 2300, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 2105 Uppergate Drive, Atlanta, GA 30307, USA
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Amin D, Marwan H, Rowan B, Abramowicz S, Zaid W. The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region. J Craniofac Surg 2023; 34:2317-2320. [PMID: 37665070 DOI: 10.1097/scs.0000000000009699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma. MATERIALS AND METHODS This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated. RESULTS Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d). CONCLUSION Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.
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Affiliation(s)
- Dina Amin
- Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY
| | - Hisham Marwan
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Faculty, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brian Rowan
- Department of Oral and Maxillofacial Surgery, School of Dentistry Louisiana State University Health Science Center, New Orleans, LA
| | - Shelly Abramowicz
- Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Waleed Zaid
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA
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Amin D, Manhan AJ, Pak-Harvey E, Roser SM, Smith RN, Abramowicz S. Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck? J Oral Maxillofac Surg 2023; 81:1383-1390. [PMID: 37572693 DOI: 10.1016/j.joms.2023.07.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S) The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES Patient, injury, and hospital-related covariates were collected. ANALYSES Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Rochester Medical School, Rochester, NY.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Ezra Pak-Harvey
- Medical Student, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University Residency Program Director, Chef of service Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Emory University School of Medicine Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Kamalakar A, Tobin B, Kaimari S, Toma AI, Moriarity I, Gautam S, Bhattaram P, Abramowicz S, Drissi H, García AJ, Wood LB, Goudy SL. Delivery of A Jagged1-PEG-MAL hydrogel with Pediatric Human Bone Cells Regenerates Critically-Sized Craniofacial Bone Defects. bioRxiv 2023:2023.10.06.561291. [PMID: 37873448 PMCID: PMC10592619 DOI: 10.1101/2023.10.06.561291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Treatments for congenital and acquired craniofacial (CF) bone abnormalities are limited and expensive. Current reconstructive methods include surgical correction of injuries, short-term bone stabilization, and long-term use of bone grafting solutions, including implantation of (i) allografts which are prone to implant failure or infection, (ii) autografts which are limited in supply. Current bone regenerative approaches have consistently relied on BMP-2 application with or without addition of stem cells. BMP2 treatment can lead to severe bony overgrowth or uncontrolled inflammation, which can accelerate further bone loss. Bone marrow-derived mesenchymal stem cell-based treatments, which do not have the side effects of BMP2, are not currently FDA approved, and are time and resource intensive. There is a critical need for novel bone regenerative therapies to treat CF bone loss that have minimal side effects, are easily available, and are affordable. In this study we investigated novel bone regenerative therapies downstream of JAGGED1 (JAG1). We previously demonstrated that JAG1 induces murine cranial neural crest (CNC) cells towards osteoblast commitment via a NOTCH non-canonical pathway involving JAK2-STAT5 (1) and that JAG1 delivery with CNC cells elicits bone regeneration in vivo. In this study, we hypothesized that delivery of JAG1 and induction of its downstream NOTCH non-canonical signaling in pediatric human osteoblasts constitute an effective bone regenerative treatment in an in vivo murine bone loss model of a critically-sized cranial defect. Using this CF defect model in vivo, we delivered JAG1 with pediatric human bone-derived osteoblast-like (HBO) cells to demonstrate the osteo-inductive properties of JAG1 in human cells and in vitro we utilized the HBO cells to identify the downstream non-canonical JAG1 signaling intermediates as effective bone regenerative treatments. In vitro, we identified an important mechanism by which JAG1 induces pediatric osteoblast commitment and bone formation involving the phosphorylation of p70 S6K. This discovery enables potential new treatment avenues involving the delivery of tethered JAG1 and the downstream activators of p70 S6K as powerful bone regenerative therapies in pediatric CF bone loss.
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Affiliation(s)
- Archana Kamalakar
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
| | - Brendan Tobin
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- School of Chemistry and Biomolecular Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Sundus Kaimari
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Afra I. Toma
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Irica Moriarity
- Neuroscience Program in College of Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Surabhi Gautam
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Pallavi Bhattaram
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
- The Atlanta Veterans Affairs Medical Center Atlanta, GA, USA
| | - Shelly Abramowicz
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University, Atlanta, GA, USA
| | - Hicham Drissi
- Department of Cell biology, Emory University, Atlanta, GA, USA
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
- The Atlanta Veterans Affairs Medical Center Atlanta, GA, USA
| | - Andrés J. García
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Levi B. Wood
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Steven L. Goudy
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Department of Pediatric Otolaryngology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Torbey J, Adler M, Abramowicz S, Willermain F. [Acute bilateral angle closure glaucoma and choroidal effusion associated with daratumumab administration for the treatment of multiple myeloma]. J Fr Ophtalmol 2023; 46:552-553. [PMID: 37061383 DOI: 10.1016/j.jfo.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 04/17/2023]
Affiliation(s)
- J Torbey
- Département d'ophtalmologie, CHU Saint-Pierre et Brugmann, université libre de Bruxelles, Bruxelles, Belgique
| | - M Adler
- Département d'ophtalmologie, CHU Saint-Pierre et Brugmann, université libre de Bruxelles, Bruxelles, Belgique
| | - S Abramowicz
- Département d'ophtalmologie, CHU Saint-Pierre et Brugmann, université libre de Bruxelles, Bruxelles, Belgique
| | - F Willermain
- Département d'ophtalmologie, CHU Saint-Pierre et Brugmann, université libre de Bruxelles, Bruxelles, Belgique.
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Amin D, Manhan AJ, Stern E, Smith RN, Abramowicz S. Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck. J Oral Maxillofac Surg 2023; 81:292-298. [PMID: 36481275 DOI: 10.1016/j.joms.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Elinor Stern
- Medical Student, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Department of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor in Oral and Maxillofacial Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Emory University, School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Satishchandran S, Umorin M, Manhan AJ, Abramowicz S, Amin D. Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life? J Oral Maxillofac Surg 2023; 81:184-193. [PMID: 36375512 DOI: 10.1016/j.joms.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.
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Affiliation(s)
- Sruthi Satishchandran
- Resident, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mikhail Umorin
- Assistant Professor, Department of Biomedical Sciences, School of Dentistry, Texas A & M University, Dallas, TX
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
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Taylor JQ, Krieger R, Blanco R, Austin TM, Abramowicz S. Pediatric Dog Bites to the Face May Have Been Less Severe During COVID-19 Pandemic: A Retrospective Cohort Study. J Oral Maxillofac Surg 2023; 81:575-582. [PMID: 36646135 PMCID: PMC9838755 DOI: 10.1016/j.joms.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Pediatric dog bite injuries are one of the most common nonfatal injuries. During the COVID-19 pandemic, children stayed at home more than pre-pandemic. The effect of the pandemic on severity of dog bites to the face in children has not been examined. The objective of this study was to determine the frequency and severity of dog bite injuries to the face in children during the first year of the COVID-19 pandemic when compared to the previous year. MATERIALS AND METHODS A retrospective cohort study was conducted for children with dog bite injuries to the head and neck region who presented to the emergency department at Children's Healthcare of Atlanta from March 2019 to March 2021. The predictor variable was the time of injury, and this was divided into pre-lockdown [control group (March 15, 2019, to March 15, 2020), ie pre-L] and lockdown (March 15, 2019, to March 15, 2020), ie post-L. The outcome variable was severity of dog bite defined as one or more of the following: 1) patient required sedation or general anesthesia for repair, 2) 3 or more regions in the head and neck were involved, and/or 3) surgical consultation took place. The investigators used a two-sample t-test, multivariable linear regression models, and modified analysis of variance and multivariate ANOVA tests to analyze the data (P-value < .05 determined significance). RESULTS 712 children (370 males) with an average age of 6 years old (range, 7 months-18 years) fit the inclusion criteria. There were 381 cases in the pre-L and 331 in the post-L period. There were more cases on average per month pre-L (31.8 cases/month) than post-L (27.6 cases/month) (P-value = .26). There were 183 pre-L surgical consults compared to 75 post-L (48 vs 22.8% of cases, respectively; P-value ≤ .001). There were 52 pre-L cases that had 3 or more sites in the head and neck compared to 28 during the post-L period (P-value = .032). CONCLUSIONS During the COVID-19 pandemic, there may have been a decrease in the severity of dog bite injuries. This trend may demonstrate a consequence that is not a direct result of the virus.
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Affiliation(s)
- Jeffrey Q. Taylor
- Resident in Training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA,Address correspondence and reprint requests to DrTaylor: Oral and Maxillofacial Surgery, Building B, Suite 2300, 1365 Clifton Road, Atlanta, GA 30322
| | - Rachel Krieger
- Resident in Training, Pediatrics, Emory Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Reena Blanco
- Assistant Professor in Emergency Medicine, Emory University School of Medicine, Associate Medical Director of Emergency Department, Children's Healthcare of Atlanta, Atlanta, GA
| | - Thomas M. Austin
- Associate Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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11
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Amin D, Manhan AJ, Zeidan AJ, Evans DP, Abramowicz S, Smith RN. Do Gender Differences Exist Among Victims of Head and Neck Injuries due to Intimate Partner Violence? J Oral Maxillofac Surg 2023; 81:49-55. [PMID: 36351477 DOI: 10.1016/j.joms.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women. MATERIALS AND METHODS This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03). CONCLUSION Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Associate Chief Oral and Maxillofacial Surgery Service, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Amy J Zeidan
- Assistant Professor, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Dabney P Evans
- Assistant Professor, Hubert Department of Global Health & Director, Center for Humanitarian Emergencies, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University, School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
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12
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Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, Koos B, Verna C, Nordal EB, Granquist EJ, Halbig JM, Kristensen KD, Kaban LB, Arvidsson LZ, Spiegel L, Stoll ML, Lerman MA, Glerup M, Defabianis P, Frid P, Alstergren P, Cron RQ, Ringold S, Nørholt SE, Peltomaki T, Larheim TA, Herlin T, Peacock ZS, Kellenberger CJ, Twilt M. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75:4-14. [PMID: 36041065 PMCID: PMC10100353 DOI: 10.1002/art.42338] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.
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Affiliation(s)
| | - Cory M. Resnick
- Department of Plastic and Oral SurgeryBoston Children's HospitalBostonMassachusetts
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and PediatricsEmory University School of MedicineAtlantaGeorgia
| | - Thomas K. Pedersen
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | | | - Annelise Küseler
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Bernd Koos
- Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
| | - Carlalberta Verna
- Department of Pediatric Oral Health and OrthodonticsUZB University Center for Dentistry Basel, University of BaselBaselSwitzerland
| | - Ellen B. Nordal
- Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Eric J. Granquist
- Department of Oral and Maxillofacial Surgery, School of Dental MedicineUniversity of PennsylvaniaPhiladelphia
| | - Josefine Mareile Halbig
- The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | | | - Leonard B. Kaban
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | - Linda Z. Arvidsson
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Lynn Spiegel
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Melissa A. Lerman
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvania
| | - Mia Glerup
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | | | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical DentistryUiT The Arctic University of NorwayTromsøNorway
| | - Per Alstergren
- Faculty of Odontology, Orofacial Pain UnitMalmö UniversityMalmöSweden
| | | | | | - Sven Erik Nørholt
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Timo Peltomaki
- Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University HospitalKuopioFinland
| | - Tore A. Larheim
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Troels Herlin
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | - Zachary S. Peacock
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | | | - Marinka Twilt
- Alberta Children's Hospital and University of CalgaryCalgaryAlbertaCanada
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13
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Jeong J, Manhan AJ, Abramowicz S, Amin D. How Accurate Are Surgeons at Calculating Orbital Volumes? J Oral Maxillofac Surg 2022; 80:1777-1783. [PMID: 35870509 DOI: 10.1016/j.joms.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Bilateral orbital volume (OV) symmetry is imperative for successful orbital reconstruction to prevent complications such as enophthalmos, diplopia, and orbital dystopia. The purpose of this study was to determine the accuracy of surgeon-led in-house OV calculation for reconstructed orbits after orbital floor fracture. MATERIALS AND METHODS This is a retrospective cross-sectional observational study of maxillofacial computed tomography scans for patients undergone orbital fracture repair by Emory Oral and Maxillofacial service at Grady Memorial Hospital (Atlanta, Georgia) from 2018 to 2020.The primary predictor variable was OV calculation approach (outsourced vs surgeon-led in-house approach). The primary outcome variable was OV. Secondary variables were age, gender, and race. Interobserver reliability was calculated with a 2-way mixed-effects model, intraclass correlation coefficients, 95% confidence intervals, and P values. Differences between OV (in-house and outsourced) were calculated using student t-test. Statistical significance was determined at P < .05. RESULTS During the study period, 172 patients sustained orbital floor fracture. Of them, 49 patients (31 male, 18 females; 98 orbits) with the mean age of 41.3 years (range, 19 to 89 years) met inclusion criteria. Subjects with incomplete medical records and inadequate computed tomography scans were excluded from the study. The racial distribution in descending order was 87.8% African American, 8.2% Caucasian, 2% Hispanic, and 2% Asian. There was excellent inter-rater reliability for calculating uninjured OV (OV-U, P < .0001) and reconstructed OV (OV-R, P < .0001). The mean OV difference of outsourced approach was 0.8 cm3and for surgeon-led in-house approach was 0.07 cm3. There was no significant difference in OV difference between outsourced and in-house approach (P = .16). CONCLUSIONS In conclusion, using open-source 3-dimensional imaging software is a reliable and a predictable method at calculating reconstructed OV in patients who underwent open reduction and internal fixation of orbital fractures. By having this software in our personal computers and laptops, one can easily calculate OVs in an efficient manner.
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Affiliation(s)
- James Jeong
- Resident, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, Georgia
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14
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Amin D, Marwan H, Rowen B, Abramowicz S, Zaid W, Sahebi M. Is the Porcine Urinary Bladder Matrix an Effective Option in Extensive Skin Defect? Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Laouani A, Makhoul D, Abramowicz S, Owen M. Maculopathie vitelliforme polymorphe exsudative aiguë paranéoplasique se présentant comme un « masquerade syndrome ». J Fr Ophtalmol 2022; 45:831-835. [DOI: 10.1016/j.jfo.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022]
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16
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Stern E, Manhan AJ, Smith R, Abramowicz S, Amin D. Does Socioeconomic Profile Predict Etiology of Firearm Injuries To Head And Neck? J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.joms.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Smith NR, Bradshaw SM, Roser SM, Abramowicz S. What do dental students expect from oral and maxillofacial surgery externships? J Dent Educ 2022; 86:1435-1438. [PMID: 35838310 DOI: 10.1002/jdd.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/25/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Limited information exists on the goals and expectations of dental students from oral and maxillofacial surgery (OMS) externships. This information is valuable to OMS residency programs. Dental students use externships to gain insight into various OMS residency programs. The purpose of this project was to answer the following question: "what do dental students expect from OMS externships?" PURPOSE The aim of this study was to report the expectations of dental students from OMS externships. MATERIALS AND METHODS This cross-sectional study took place from June 2015 to September 2019. Every student completing an Emory OMS externship completed an anonymous survey. The survey consisted of questions regarding (1) demographics, (2) previous OMS experience, and (3) open-ended questions regarding expectations and sources of anxiety. Answers were grouped into categories with similar answers. Descriptive statistics summarized data. RESULTS Of 116 externs who completed the survey, the majority were males (n = 80, 68.9%) with a mean age of 25 (range 21-30) years old in the 3rd/4th year of dental school. Most had previous OMS experience (n = 103, 89.6%) and plan to apply to OMS residency (n = 104, 90.4%). Most externs hoped to learn about life as a resident and the scope and culture of the program. Externs expressed the highest level of anxiety regarding their own experience and/or knowledge level. CONCLUSIONS This project demonstrated that during the externship, externs expect to gain insight into the daily activities, scope, and culture of the OMS program they are visiting.
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Affiliation(s)
- Natalie R Smith
- Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Steven M Roser
- Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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18
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Shurley CD, Abramowicz S, Manhan AJ, Roser SM, Amin D. Comprehensive analysis of patients with failure of mandibular hardware. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:15-19. [PMID: 35153183 DOI: 10.1016/j.oooo.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of the study was to characterize patients who had failure of mandibular hardware (FMH). STUDY DESIGN This retrospective cohort study consisted of patients with mandible fractures (MFs) that required surgical intervention from 2012 to 2020. Patients were included when mandibular hardware failed. Descriptive variables were collected. RESULTS During the study period, 57 patients (47 male, average age 38.7 years) met the inclusion criteria. Incidence of FMH was 7.4%. Most patients were African American (n = 45, 78.9%) with American Society of Anesthesiologists classification II (n = 40, 70.2%). Tobacco use (n = 31, 54.4%) and/or alcohol (n = 33, 57.9%). The most common etiology was assault (n = 28, 49.1%). The most common location was the angle of the mandible. Most mandibles had fracture at 1 location (n = 31, 54.4%) and a tooth was involved in the fracture line (n = 44, 77.2%). More than half of patients were treated with transoral surgical approach (n = 35, 61.4%). The majority of patients received preoperative antibiotics (n = 51, 89.4%). Patients had varying levels of compliance with postoperative care, and most were not compliant. Infection (n = 45) was the most common presentation of FMH. CONCLUSION High American Society of Anesthesiologists score, smoking, excessive alcohol use, parafunctional habits, and compliance with postoperative instructions may affect surgical outcome.
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Affiliation(s)
- Christine D Shurley
- Resident-in-training, Oral and Maxillofacial Surgery, Emory University School of Medicine
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University; Program Director of Oral and Maxillofacial Surgery and Service Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital
| | - Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA, USA.
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19
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Whittingslow DC, Gergely T, Prahalad S, Inan OT, Abramowicz S. TEMPOROMANDIBULAR JOINT ACOUSTIC EMISSIONS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS DIFFER FROM HEALTHY CHILDREN. J Oral Maxillofac Surg 2022; 80:1466-1473. [DOI: 10.1016/j.joms.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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20
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Le Roux P, Delle Fave M, Abramowicz S, Delvaulx P, Buisseret D, Postolache L. [Extensive myelination of retinal nerve fibers in a child]. J Fr Ophtalmol 2022; 45:567-571. [PMID: 35459575 DOI: 10.1016/j.jfo.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- P Le Roux
- Service d'ophtalmologie, hôpital Erasme, Université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique.
| | - M Delle Fave
- Service d'ophtalmologie, hôpital universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique
| | - S Abramowicz
- Service d'ophtalmologie, hôpital Saint-Pierre, Université libre de Bruxelles, rue aux Laines 105, 1000 Bruxelles, Belgique
| | - P Delvaulx
- Service d'ophtalmologie, hôpital Erasme, Université libre de Bruxelles, route de Lennik 808, 1070 Bruxelles, Belgique
| | - D Buisseret
- Service d'ophtalmologie, hôpital universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique
| | - L Postolache
- Service d'ophtalmologie, hôpital universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, avenue Jean-Joseph-Crocq 15, 1020 Bruxelles, Belgique
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21
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Michel JC, Amin D, Gelbard RB, Abramowicz S. An evidence-based approach to antibiotic use in maxillofacial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:151-158. [PMID: 35428598 DOI: 10.1016/j.oooo.2021.12.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/13/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
A patient with craniomaxillofacial (CMF) trauma often receives consultations from multiple medical and surgical services. Antibiotics are sometimes prescribed without consistent evidence. This article reviews current literature regarding antibiotic prophylaxis of patients with CMF fractures. This article also presents the guidelines for the appropriate use of antibiotics for patients with CMF fractures at 2 level I trauma centers.
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Affiliation(s)
- Jonathan C Michel
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA; Associate Professor of Surgery, Acute Care Surgery, Medical Director of Trauma Burn Intensive Care Unit, Chief of Critical Care Services, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Dina Amin
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shelly Abramowicz
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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22
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Amin D, Jeong J, Manhan AJ, Bouloux GF, Abramowicz S. Do Racial Differences in Orbital Volume Influence the Reconstruction of Orbital Trauma. J Oral Maxillofac Surg 2022; 80:121-126. [PMID: 34973720 DOI: 10.1016/j.joms.2021.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Successful orbital reconstruction relies on an accurate restoration of orbital volume (OV). The purpose of this study was to determine if the OV of African American (AA) subjects differs from that of Caucasian subjects. METHODS The authors implemented a retrospective observational study of successive subjects who received a maxillofacial computed tomography (CT) scan at a level I trauma center between 2017 and 2020. The primary predictor variable was race (AA/Caucasian). The primary outcome variable was orbital volume. Two independent examiners calculated OV with an open access OsiriX MD software version 10.0.5 (Pixmeo, Switzerland). Inter-rater reliability was calculated. Differences between races, genders, and sides were tested using independent samples t test with a significance of P < .05. RESULTS Sixty subjects (120 orbits) were included in the study. The mean age was 36.7 (SD ± 13.2) years with a range of 22 to 78 years. Gender distribution was equal with 30 male (50%) and 30 female (50%) subjects. Inter-examiner reliability was 0.973. The mean OV of AA and Caucasians was 22.38 and 23.23 cm3, respectively (P = .07). The mean OV of AA and Caucasian males was 23.92, and 24.17cm3, respectively (P = .71). The mean OV in AA and Caucasian females was 20.84 and 22.28cm3, respectively (P = .013). CONCLUSIONS African-American female subjects appear to have a smaller OV when compared with Caucasians which may influence orbital reconstruction. Laterality does not appear to be associated with any differences in OV.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - James Jeong
- Resident-in-training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Gary F Bouloux
- Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Abstract
Antibiotic prophylaxis is the use of antibiotics in the perioperative period to prevent surgical site infections from local flora. Specific guidelines and criteria exist to prevent these infections while also practicing antimicrobial stewardship. Most dentoalveolar procedures do not require antibiotic prophylaxis. For nondentoalveolar procedures, the decision to provide antibiotic prophylaxis is based on involvement of the respiratory, oral, or pharyngeal mucosa. Special considerations exist for patients at high risk for infective endocarditis, patients with head and neck cancer, and temporomandibular joint replacement procedures. This article discusses indications for antibiotic prophylaxis during oral and maxillofacial surgical procedures.
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Affiliation(s)
- Chad Dammling
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South, Room 406, Birmingham, AL 35233, USA.
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA
| | - Brian Kinard
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South, Room 406, Birmingham, AL 35233, USA
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Xu J, Gilbert JR, Sutton KS, Goudy SL, Abramowicz S. Head and Neck Langerhans Cell Histiocytosis in Children. J Oral Maxillofac Surg 2021; 80:545-552. [PMID: 34852246 DOI: 10.1016/j.joms.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Controversy exists among head and neck surgical specialties regarding management of Langerhan's Cell Histiocytosis (LCH). The purpose of this study was to evaluate diagnosis, management, and treatment outcomes in children with LCH of the head and neck. METHODS This is a retrospective cohort study of children with LCH of the head and neck who presented to Children's Healthcare of Atlanta hospital from 2009 to 2021. The independent variables were demographic information, lesion locations, clinical presentation, radiographic findings, diagnostic workup, treatment, and length of follow-up. The patients were grouped based on these variables. The outcome variable was disease reactivation. Descriptive statistics were calculated. RESULTS There were 3 presentations of LCH of the head and neck. Group 1 presented as a lesion in 1 system without CNS risk (SS-). There were 24 patients with an average age of 10 years. Lesions were located in calvaria and/or mandible. Majority of the patients were treated with only debridement. Two of the patients experienced reactivation. Group 2 presented as a lesion in 1 system with CNS risk (SS+). There were 30 patients with an average age of 6 years. Common locations were temporal bone and/or orbit. These patients present with recurrent ear infections and ptosis. Majority of the patients were treated with chemotherapy (n = 28). One patient had disease reactivation. Group 3 presented with multisystem involvement. There were 13 patients with an average age of 2 years. LCH was found in skin and the lymphatic system. Imaging demonstrated extracranial organ involvement. All of them were treated with chemotherapy. There was 40% reactivation of LCH. CONCLUSIONS Treatment of LCH depends on presentation. SS- subgroup can be adequately treated via surgical debridement. SS+ and multisystem groups benefit from an early disease diagnosis and require chemotherapy.
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Affiliation(s)
- Joyce Xu
- Resident in Training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Julie R Gilbert
- Fellow in Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kathryn S Sutton
- Assistant Professor, Division of Hematology and Oncology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Steven L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Amin D, Manhan AJ, Smith RN, Roser SM, Abramowicz S. Frequency of Firearm Injuries to Head and Neck Increased During Covid-19 Pandemic. J Oral Maxillofac Surg 2021; 79:2299-2305. [PMID: 34756303 PMCID: PMC8554223 DOI: 10.1016/j.joms.2021.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE During coronavirus disease-19 (COVID-19) pandemic, hospitals faced challenges which were different than previous years. The purpose this study was to report frequency of firearm injuries (FI) to head and neck during the COVID-19 pandemic. MATERIALS AND METHODS This cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they sustained FI to head and neck, were listed in TR, and were treated at GMH. Patients were stratified according to date of injury into 1) before COVID-19 pandemic, (BC19) or 2) during initial 5 months of COVID-19 pandemic, (C19). Variables were patient demographics, illegal substance use, etiology, place of injury, distressed communities index, location of injury, Glasgow Coma scale on arrival, cardiopulmonary resuscitation in Emergency Department (ED), shock on admission, disposition from ED, length of stay, days on mechanical ventilation and discharge status. Descriptive, univariate, and bivariate analysis were completed. Chi square test was used for categorical variables. Statistical significance was P < .05. RESULTS There were 215 patients who met inclusion criteria. There were 96 patients (78 males) with a mean age of 31.5 years old during BC19. There were 119 patients (101 males) with a mean age 32.7 years old during C19. There was a 10.4% increase in FI to head and neck during COVID-19. Our data showed that alcohol use was associated with FI during C19 (P≤ .0001). FI to base of skull occurred 34.5% more often during C19 (P = .002). Cranial injuries occurred 26% more often during BC19 (P = .03). During BC19, 85.4% of the patients arrived alive to GMH, but only 16% arrived alive during C19 (P ≤ .0001). CONCLUSIONS There were more FI to head and neck during COVID-10 pandemic than during the previous time period.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA,Address correspondence and reprint requests to Dr. Amin, Emory University, School of Medicine, 1365 Clifton Road NE, Building B, Suite 2300, Atlanta, GA 30322
| | - Andrew J. Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Randi N. Smith
- Assistant Professor of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Steven M. Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University; Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Dunlop N, Abramowicz S, Fisher E. Pharmacology of Aesthetic Medicines. Oral Maxillofac Surg Clin North Am 2021; 34:189-200. [PMID: 34711465 DOI: 10.1016/j.coms.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The realm of aesthetic medicine is broad, and there are countless medications and topical agents used in the practice of aesthetic medicine. The most commonly used injectable medicines include botulinum toxin for mimetic lines and hyaluronic acid fillers for deeper facial rhytids and volume rejuvenation. Topical aesthetic medicines are useful adjuncts for facial rejuvenation and commonly include tretinoin, hydroquinone, growth factors, and vitamin C, as well as a wide range of chemical peels.
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Affiliation(s)
- Natalie Dunlop
- Oral and Maxillofacial Surgery, Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB #7450, Chapel Hill, NC 27599, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Section of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, 1365 Clifton Road, Northeast, Building B, Suite 2300, Atlanta, GA 30322, USA
| | - Elda Fisher
- Division of Craniofacial and Surgical Care, Residency Program in Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB #7450, Chapel Hill, NC 27599, USA.
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Abstract
Objective The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children's Healthcare of Atlanta (CHOA). Methods This study was a retrospective chart review of children who presented from 2006 to 2015. Inclusion criteria were: (1) age 18 years old or younger, (2) presentation to emergency department, (3) diagnosis of maxillofacial fractures, and (4) evaluation by Oral and Maxillofacial Surgery, Otolaryngology, or Plastic Surgery services. Medical records were reviewed to record demographic, mechanism of injury, fracture location, and yearly incidence of injury. Descriptive statistics were computed to summarize findings and overall trends. Results During the study period, 39,833 patients were identified. Of them, 1995 met the inclusion criteria. The majority were male (n = 1359, 68%) with an average age of 9.4 years old (range of 1 month to 18 years old). Mechanisms of injury were motor vehicle collisions (MVC) (n = 597, 29.9%), fall (n = 565, 28.3%), sports injury (n = 317, 15.9%), pedestrian struck (n = 215, 10.8%), assault/abuse (n = 204, 10.2%), other (n = 81, 4.1%), or gunshot wound (n = 16, 0.8%). Fracture sites were mandible (n = 519, 26%), complex (n = 479, 24%), nasal (n = 419, 21%), dentoalveolar (n = 279, 14%), orbital (n = 259, 13%), and maxilla (n = 40, 2%). Males had a higher incidence of assault than females (n = 185, 91% of assaults). The incidence of maxillofacial trauma increased with age with a peak incidence in 13 to 16-year-olds (n = 566, 28.3%). During the years examined, there was an upward trend in MVCs as the etiology with a peak incidence of facial fractures due to MVCs occurring in 2015. All other mechanisms remained constant during this time period. Conclusions There was an increase in pediatric facial fractures secondary to motor vehicle collisions from 2007 to 2015 despite improvements in regulations, traffic safety, and technology.
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Affiliation(s)
- Kevin Hong
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - James Jeong
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Diaz D, Freburg-Hoffmeister D, Abramowicz S, Austin T, Nyshadham S. Parental Policy in OMS Residency Programs is Necessary but Unavailable: Cross-sectional Survey of OMS Resident Attitudes toward Parental Leave. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Xu J, Gilbert J, Sutton K, Goudy S, Abramowicz S. Head and Neck Langerhans Cell Histiocytosis in Children. J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.joms.2021.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Diaz D, Freburg-Hoffmeister DL, Austin TM, Nyshadham S, Abramowicz S. Parental Policy in Oral and Maxillofacial Surgery Residency Programs Is Necessary but Not Available: A Cross-Sectional Survey of Oral and Maxillofacial Surgery Residents' Attitudes Toward Parental Leave. J Oral Maxillofac Surg 2021; 79:2404-2410. [PMID: 34547262 DOI: 10.1016/j.joms.2021.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Guidelines regarding parental leave in oral and maxillofacial surgery do not exist. This inconsistency may contribute to gender disparities and an increase in resident burnout. The purpose of this study was to examine perceptions and attitudes of oral and maxillofacial surgery residents toward parental leave. MATERIALS AND METHODS This was a cross-sectional study in which an anonymous 26-item questionnaire was electronically mailed to all current oral and maxillofacial surgery residents in the United States during August 2020. The survey consisted of 5 sections: 1) resident information, 2) residency program information, 3) parental policy information, 4) attitudes regarding parental leave, and 5) attitudes regarding early parenthood. RESULTS Surveys were sent to 860 oral and maxillofacial surgery residents; 220 completed the questionnaire (25.6%). Majority of respondents were male between the ages of 26 and 30. Half of the respondents did not know whether their oral and maxillofacial surgery program had a formal parental leave policy. Almost a third of residents reported that their program did not have a policy regarding parental leave. Only some programs had a policy regarding parental leave. Most programs allotted 2 days to 2 weeks for parental leave. Parenthood did not prevent pursuit of fellowship training. The majority of co-residents indicated that parenthood had a neutral impact on the performance of their colleagues. Lactation facilities and/or childcare services were not present in all programs. CONCLUSIONS Most oral and maxillofacial surgery residents support parental leave despite the lack of a formal policy in their residency program. Residents who had a child during residency received up to 2 weeks as parental leave. Residents felt that their programs were supportive of parental leave. Parenthood did not prevent the pursuit of fellowship training.
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Affiliation(s)
- Daili Diaz
- Resident, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Gainesville, FL.
| | - Danielle L Freburg-Hoffmeister
- Clinical Assistant Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Gainesville, FL
| | - Thomas M Austin
- Associate Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Soumya Nyshadham
- Assistant Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Section Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Abramowicz S, Amin D, Goudy SL, Austin TM, Santore MT, Milder MJ, Roser SM. Management of pediatric facial fractures during COVID-19 pandemic. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e169-e174. [PMID: 34511346 PMCID: PMC8127516 DOI: 10.1016/j.oooo.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic caused delays in medical and surgical interventions in most health care systems worldwide. Oral and maxillofacial surgeons (OMSs) delayed operations to protect themselves, patients, and staff. This article (1) presents one institution's experience in the management of pediatric craniomaxillofacial trauma during the COVID-19 pandemic and (2) suggests recommendations to decrease transmission. Methods This was a retrospective review of children aged 18 years or younger who underwent surgery at Children's Healthcare of Atlanta in Atlanta, GA, between March and August 2020. Patients (1) were aged 18 years old or younger, (2) had one or more maxillofacial fractures, and (3) underwent surgery performed by an OMS, otolaryngologist, or plastic surgeon. Medical records were reviewed regarding (1) fracture location, (2) COVID-19 status, (3) timing, (4) personal protective equipment, and (5) infection status. Descriptive statistics were computed. Results Fifty-eight children met the inclusion criteria. The most commonly injured maxillofacial location was the nose. Operations were performed 50.9 hours after admission. Specific prevention perioperative guidelines were used with all patients, with no transmission occurring from a patient to a health care worker. Conclusions With application of our recommendations, there was no transmission to health care workers. We hope that these guidelines will assist OMSs during the COVID-19 pandemic.
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Affiliation(s)
- Shelly Abramowicz
- Associate Professor of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Dina Amin
- Assistant Professor, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA, USA; Director, Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA, USA
| | - Steven L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Thomas M Austin
- Associate Professor, Anesthesiology and Pediatrics, Department of Anesthesia, Emory University School of Medicine, Atlanta, GA, USA; Director, Operative Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matthew T Santore
- Assistant Professor, Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Medical Director, Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Megan J Milder
- Oral and Maxillofacial Surgery resident-in-training, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery and Chief, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Tolend M, Doria AS, Meyers AB, Larheim TA, Abramowicz S, Aguet J, Appenzeller S, Arvidsson LZ, Averill LW, Feldman BM, Guleria S, Inarejos Clemente EJ, Jaremko JL, Junhasavasdikul T, von Kalle T, Kirkhus E, Koos B, Miller E, Moineddin R, Panwar J, Peacock ZS, Resnick CM, van Rossum MA, Stimec J, Tomlinson G, Tzaribachev N, Kellenberger CJ. Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ). J Clin Med 2021; 10:jcm10184047. [PMID: 34575158 PMCID: PMC8467699 DOI: 10.3390/jcm10184047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61–0.67 for the inflammatory and 0.66–0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties.
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Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
| | - Andrea S. Doria
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
- Correspondence: ; Tel.: +1-416-813-6079
| | - Arthur B. Meyers
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Tore A. Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Oral and Maxillofacial Surgery, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13083-970, Brazil;
| | - Linda Z. Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Lauren W. Averill
- Department of Medical Imaging, Nemours Children’s Health System, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Brian M. Feldman
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | | | | | - Jacob L. Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | | | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India;
| | - Zachary S. Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Cory M. Resnick
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marion A. van Rossum
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Rheumatology and Immunology Center, Reade, 1007 MB Amsterdam, The Netherlands
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada;
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Anderson SH, Moe JS, Abramowicz S. Work-Life Balance for Oral and Maxillofacial Surgeons. Oral Maxillofac Surg Clin North Am 2021; 33:467-473. [PMID: 34364748 DOI: 10.1016/j.coms.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Oral and maxillofacial surgeons experience high levels of stress and work-home conflict, which predispose them to burnout. There is emerging evidence in support of work-life integration to prevent burnout; interventional strategies exist on an individual and organizational level. This article explores the current evidence on promoting work-life integration for improved surgeon satisfaction, performance, and efficiency. Work-life integration initiatives can help promote the recruitment and retention of a diverse surgical workforce in oral and maxillofacial surgery.
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Affiliation(s)
- Sara Hinds Anderson
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Justine Sherylyn Moe
- Department of Oral and Maxillofacial Surgery, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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Abstract
Coronavirus disease 2019 (COVID- 19) affected daily activities since December 2019. Burn injuries to head and neck can result in cosmetic and functional deformities. The purpose of this study was to characterize patients with burns to head and neck during the pandemic. This cross-sectional study reviewed patients in Burn Care Quality Platform Registry. Patients were included if they were age 18 years of age or older, and sustained burns to head and neck. Patients were stratified according to date of injury into: (1) March 13 to September 13, 2019 (i.e., before COVID-19 pandemic, BC19) or (2) March 13 to September 13, 2020. March 13, 2020 was chosen because (1) COVID-19 was announced as a national emergency on that date and (2) it was the last day of in-person schools in state of Georgia. Data collection included patient demographics, admission details, burn details, and hospital related variables were documented. During the study period, 157 patients had burn to head and neck (BC-19; 70, C-19; 71). Our data showed a 375% increase in March following the announcement of the pandemic (BC19; 4, C19;19). Admissions from another facility were statistically more than in C19 group (p=<0.0001). For C19 group, there were 53% more admissions from ED than BC19 (p=0.001). Additionally, in BC19 group patients presented with concomitant inhalation injuries significantly more than C19 group (p=0.04). In conclusion, the total number of burns is the same during BC and C19, however there was a significant spike in number of cases in March 2020.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University, School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rohit Mittal
- Assistant Professor in Surgery, Emory University School of Medicine, Department of Surgery, Director Burn Outcomes Research, Burn Center, Grady Memorial Hospital, Atlanta, GA
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Abramowicz S, Woerner J, Tiwana PS. Proceedings From the First Cleft, Craniofacial, and Pediatric Oral and Maxillofacial Surgery Summit. J Oral Maxillofac Surg 2021; 79:2389-2391. [PMID: 34245703 DOI: 10.1016/j.joms.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine; Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Jennifer Woerner
- Assistant Professor and Associate Dean, Department of Oral and Maxillofacial Surgery, Louisiana State University Shreveport, Shreveport, LA
| | - Paul S Tiwana
- Reichmann-Staples Professor and Chair, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Oklahoma, Oklahoma City, OK
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Somineni HK, Weitzner JH, Venkateswaran S, Dodd A, Prince J, Karikaran A, Sauer CG, Abramowicz S, Zwick ME, Cutler DJ, Okou DT, Chopra P, Kugathasan S. Site- and Taxa-Specific Disease-Associated Oral Microbial Structures Distinguish Inflammatory Bowel Diseases. Inflamm Bowel Dis 2021; 27:1889-1900. [PMID: 34002220 PMCID: PMC8599042 DOI: 10.1093/ibd/izab082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The gut and oral microbiome have independently been shown to be associated with inflammatory bowel disease (IBD). However, it is not known to what extent gut and oral microbial disease markers converge in terms of their composition in IBD. Further, the spatial and temporal variation within the oral microenvironments of IBD remain to be elucidated. PATIENTS AND METHODS We used a prospectively recruited cohort of patients with IBD (n = 47) and unrelated healthy control patients (n = 18) to examine the spatial and temporal distribution of microbiota within the various oral microenvironments, represented by saliva, tongue, buccal mucosa, and plaque, and compared them with stool. Microbiome characterization was performed using 16S rRNA gene sequencing. RESULTS The oral microbiome displayed IBD-associated dysbiosis, in a site- and taxa-specific manner. Plaque samples depicted a relatively severe degree of dysbiosis, and the disease-associated dysbiotic bacterial groups were predominantly the members of the phylum Firmicutes. Our 16S rRNA gene analyses show that oral microbiota can distinguish patients with IBD from healthy control patients, with salivary microbiota performing the best, closely matched by stool and other oral sites. Longitudinal profiles of microbial composition suggest that some taxa are more consistently perturbed than others, preferentially in a site-dependent fashion. CONCLUSIONS Collectively, these data indicate the potential of using oral microbial profiles in screening and monitoring patients with IBD. Furthermore, these results support the importance of spatial and longitudinal microbiome sampling to interpret disease-associated dysbiotic states and eventually to gain insights into disease pathogenesis.
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Affiliation(s)
- Hari K Somineni
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Genetics and Molecular Biology Program, Emory University, Atlanta, Georgia, USA
| | - Jordan H Weitzner
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Suresh Venkateswaran
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anne Dodd
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jarod Prince
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Arjuna Karikaran
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cary G Sauer
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Shelly Abramowicz
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University, Atlanta, Georgia, USA
| | - Michael E Zwick
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - David J Cutler
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - David T Okou
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Pankaj Chopra
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Subra Kugathasan
- Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Genetics and Molecular Biology Program, Emory University, Atlanta, Georgia, USA,Department of Human Genetics, Emory University, Atlanta, Georgia, USA,Address correspondence to: Subra Kugathasan, MD, Division of Pediatric Gastroenterology, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, W-427, Atlanta, GA 30322 ()
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Milder MJ, Roser SM, Austin TM, Abramowicz S. Does Burnout Exist in Academic Oral and Maxillofacial Surgery in the United States? J Oral Maxillofac Surg 2021; 79:1602-1610. [PMID: 33984289 DOI: 10.1016/j.joms.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Information regarding burnout in academic oral and maxillofacial surgeons (OMSs) in the United States (US) does not exist. The purpose of this project was to answer the following question: "Does burnout exist in academic OMSs in the United States?" MATERIALS AND METHODS A 15-question anonymous survey was created based on Expanded Physician Well-Being Index (WBI, MedEd Web Solutions). The survey was sent electronically to fellows of the American Academy of Craniomaxillofacial Surgeons (AACMS) consisting of demographics, professional obligations, wellness indicators (burnout, emotional hardening, depression, anxiety, fatigue, overwhelmed), and overall quality-of-life statements. Responses were quantified according to a scaled scoring system specific for WBI. Multivariable logistic regression was then used to create a predictive model of being "at risk" of burnout. RESULTS Surveys were sent to 180 active AACMS fellows; 110 completed the questionnaire (61.1%). One hundred eight active fellows met inclusion criteria. Majority were males between the ages of 41 and 50. About a quarter spent more than 20 years in an academic setting. Activities concentrated on patient care, teaching, and/or administrative duties. More than half of respondents felt emotionally hardened, anxious/irritable, and/or overwhelmed. About a third had adequate time for personal and family life. Most felt that their work was meaningful. Using WBI, the average score was 2.21, meaning that as a whole oral-maxillofacial surgery academicians are not considered at risk for burnout. Risk factors for burnout were age >40 years old, female gender, patient care more than 55 hours per week, call more than 10 times per month, and majority of time spent on teaching responsibilities. CONCLUSIONS According to WBI, OMSs as a group are not at risk for burnout. Certain traits (age, gender, more than 55 weekly hours and/or more than 10 call shifts per month, high percentage of time teaching responsibilities) are at higher risk for burnout.
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Affiliation(s)
- Megan J Milder
- Oral and Maxillofacial Surgery Resident-in-Training, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery and Chief of Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Thomas M Austin
- Associate Professor of Anesthesiology and Pediatrics, Department of Anesthesia, Emory University School of Medicine; Director of Operative Services, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
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Diaz D, Goldberg B, Abramowicz S. Management of inflammatory temporomandibular joint collapse in children. J Oral Biol Craniofac Res 2021; 11:284-286. [PMID: 33717866 DOI: 10.1016/j.jobcr.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis is the most common pediatric rheumatologic condition.( Abramowicz et al., 2016 Jul) 2 The etiology and pathogenesis have not been fully elucidated; a combination of environmental and certain immunogenic factors is suspected. This review will provide current knowledge and concepts of diagnosis and management of children with JIA and TMJ arthritis.
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Affiliation(s)
- Daili Diaz
- Oral and Maxillofacial Surgery Resident, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, P.O. Box 100416, Gainesville, FL, 32610, USA
| | - Baruch Goldberg
- Emory University School of Medicine, Division of Pediatric Rheumatology, Children's Healthcare of Atlanta, 1400 Tullie Road NE, Suite 8309, Atlanta, GA, 30329, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Section Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA, 30322, USA
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Kinard B, Goldberg B, Kau C, Abramowicz S. Clinical trials of temporomandibular joint involvement of juvenile idiopathic arthritis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:617-619. [PMID: 33875398 DOI: 10.1016/j.oooo.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Brian Kinard
- Assistant Professor, Department of Oral Maxillofacial Surgery, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA
| | - Baruch Goldberg
- Assistant Professor, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Chung Kau
- Professor and Chair, Department of Orthodontics, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA
| | - Shelly Abramowicz
- Associate Professor, Division of Oral Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Tolend M, Junhasavasdikul T, Cron RQ, Inarejos Clemente EJ, von Kalle T, Kellenberger CJ, Koos B, Miller E, van Rossum MA, Saurenmann RK, Spiegel L, Stimec J, Twilt M, Tzaribachev N, Abramowicz S, Appenzeller S, Arvidsson LZ, Guleria S, Jaremko JL, Kirkhus E, Larheim TA, Meyers AB, Panwar J, Resnick CM, Shelmerdine SC, Feldman BM, Doria AS. Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:308-316. [PMID: 33555146 DOI: 10.1002/acr.24577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
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Affiliation(s)
- Mirkamal Tolend
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Randy Q Cron
- Children's of Alabama, Birmingham, AL, United States
| | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, and University of Calgary, Calgary, Alberta, Canada
| | | | - Shelly Abramowicz
- Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | | | | | | | | | | | - Arthur B Meyers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jyoti Panwar
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Amin D, Austin TM, Roser SM, Abramowicz S. A cross-sectional survey of anxiety levels of oral and maxillofacial surgery residents during the early COVID-19 pandemic. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:137-144. [PMID: 34020914 PMCID: PMC7869686 DOI: 10.1016/j.oooo.2021.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has increased anxiety among the general population. The purpose of this project was to investigate attitudes and anxiety among oral and maxillofacial surgery (OMS) residents during the early COVID-19 pandemic. MATERIALS AND METHODS This was a cross-sectional study. OMS residents were sent electronic invitations to answer a survey. The survey was sent in April and May 2020. Residents enrolled in OMS residency programs accredited by the Commission on Dental Accreditation were included. Predictor variable was attitudes of OMS residents toward the pandemic. The outcome variable was anxiety levels of OMS residents due to the pandemic according to the Hospital Anxiety and Depression Scale-A. Other variables were demographic characteristics, general knowledge regarding the pandemic, and attitudes of OMS residents toward the pandemic. Statistical analysis was performed using Fisher's exact test, Wilcoxon rank sum test, and univariate and multivariate logistic regression (P < .05). RESULTS We received 275 responses. The majority of respondents were males (74.5%) aged 26 to 30 (52.7%). Residents reported different levels of anxiety (i.e., mild 58.2%, severe 41.8%). Based on multivariate analysis, moderate or severe anxiety was associated with being female (P = .048) and a senior resident (P = .049). Factors such as potential deployment to other services, availability of personal protective equipment, and unclear disease status of patients contributed to anxiety. CONCLUSION Our study found that during the early COVID-19 pandemic, all residents experienced some anxiety. Senior OMS residents and female OMS residents experience higher anxiety levels than other residents.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Thomas M Austin
- Associate Professor in Anesthesia and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Chief, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Department of Surgery, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Abramowicz S, Crotts SJ, Hollister SJ, Goudy S. Tissue-engineered vascularized patient-specific temporomandibular joint reconstruction in a Yucatan pig model. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:145-152. [PMID: 33785329 DOI: 10.1016/j.oooo.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Current pediatric temporomandibular joint (TMJ) reconstruction options are limited. The aim of this project was to develop a proof-of-principle porcine model for a load-bearing, customized, 3D-printed and bone morphogenic protein 2 (BMP-2)-coated scaffold implanted in a pedicled (temporal) flap as a regenerative approach to pediatric TMJ mandibular condyle reconstruction. MATERIALS AND METHODS Scaffolds were customized, 3D-printed based on porcine computed tomography, and coated with BMP-2. Two operations occurred: (1) implantation of the scaffold in temporalis muscle to establish vascularity and, (2) 6 weeks later, unilateral condylectomy and rotation of the vascularized scaffold (with preservation of superficial temporal artery) onto the defect. Six months later, pigs were sacrified. The experimental side (muscle-scaffold) and control side (unoperated condyle) were individually evaluated by clinical, mechanical, radiographic, and histologic methods. RESULTS Scaffolds maintained physical properties similar in appearance to unoperated condyles. Vascularized scaffolds had new bone formation. Condyle height on the reconstructed side was 68% and 78% of the control side. Reconstructed condyle stiffness was between 20% and 45% of the control side. CONCLUSION In our porcine model, customized 3D-printed TMJ scaffolds coated with BMP-2 and implanted in vascularized temporalis muscle have the ability to (1) reconstruct a TMJ, (2) maintain appropriate condylar height, and (3) generate new bone, without impacting functional outcomes.
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Affiliation(s)
- Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Sarah Jo Crotts
- Center for 3D Medical Fabrication, Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Scott J Hollister
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Steve Goudy
- Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Amanso AM, Kamalakar A, Bitarafan S, Abramowicz S, Drissi H, Barnett JV, Wood LB, Goudy SL. Osteoinductive effect of soluble transforming growth factor beta receptor 3 on human osteoblast lineage. J Cell Biochem 2021; 122:538-548. [PMID: 33480071 DOI: 10.1002/jcb.29888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 01/05/2023]
Abstract
The development of bone requires carefully choregraphed signaling to bone progenitors to form bone. Our group recently described the requirement of transforming growth factor beta receptor 3 (TGFβR3), a receptor involved in TGFβ pathway signaling, during osteoblast lineage commitment in mice. The TGFβ pathway is known to play multiple osteo-inductive and osteo-inhibitory roles during osteoblast development and TGFβR3 human mutations are associated with reduced bone mineral density, making TGFβR3 a unique target for bone inductive therapy. In this article, we demonstrated increased mineralization of human pediatric bone-derived osteoblast-like cells (HBO) when treated with soluble TGFβR3 (sR3) using Alizarin Red staining. Osteogenic commitment of HBO cells was demonstrated by induction of osteogenic genes RUNX2, osteocalcin, osteopontin, and osterix. Evaluation of the canonical TGFβ pathway signaling demonstrated that sR3 was able to induce bone formation in HBO cells, mainly through activation of noncanonical targets of TGFβ pathway signaling including AKT, ERK, and p38 MAP kinases. Inhibition of these osteogenic noncanonical pathways in the HBO cells also inhibited mineralization, suggesting they are each required. Although no induction of SMAD1, 5, and 9 was observed, there was the activation of SMAD2 and 3 suggesting that sR3 is primarily signaling via the noncanonical pathways during osteogenic induction of the HBO. Our results highlight the important role of TGFβR3 in osteoblast induction of mineralization in human bone cells through noncanonical targets of TGFβ signaling. Future studies will focus on the ability of sR3 to induce bone regeneration in vivo using animal models.
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Affiliation(s)
| | - Archana Kamalakar
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Sara Bitarafan
- George W. Woodruff School of Mechanical Engineering and Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Hicham Drissi
- Department of Cell Biology, Emory University, Atlanta, Georgia, USA.,Department of Orthopaedics, Emory University, Atlanta, Georgia, USA.,The Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Joey Victor Barnett
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
| | - Levi Benjamin Wood
- George W. Woodruff School of Mechanical Engineering and Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - S L Goudy
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
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Oh MS, Kadom N, Abramowicz S, Todd NW. Pediatric unilateral isolated choanal atresia is not associated with mandibular condyle hypoplasia. Am J Otolaryngol 2021; 42:102824. [PMID: 33221635 DOI: 10.1016/j.amjoto.2020.102824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We hypothesized that the ontogeny of unilateral isolated choanal atresia involves a field defect manifesting as ipsilateral mandibular condylar hypoplasia. The topic is important because the mechanism of the unilateral isolated choanal atresia is unknown. MATERIALS AND METHODS Retrospective self-controlled case series. We included 20 patients (2 males and 18 females, ages 2 weeks to 13 years) with unilateral isolated non-syndromic choanal atresia. We studied their high-resolution computed tomographic scans. Two otolaryngologists measured the largest cross-sectional area of the mandibular condyle in the axial plane perpendicular to the posterior border of each mandibular ramus independently. Statistical significance and inter-rater agreement were calculated with paired Wilcoxon rank sum test and Spearman's non-parametric correlation coefficient respectively. RESULTS Cross-sectional areas of the condyles ipsilateral to the choanal atresia were not statistically different than those of the contralateral condyle (P = 0.27). Inter-observer agreement of condyle areas was excellent: Spearman's r = 0.85 on the right and r = 0.94 on the left. CONCLUSIONS In this cohort of children with the rarity of isolated non-syndromic unilateral congenital choanal atresia, no associated mandibular condyle hypoplasia was found. The data suggest that the underlying ontogeny was unlikely attributable to a field defect.
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Abstract
BACKGROUND Pediatric head and neck burns (HNBs) require special attention due to the potential for long-term disfigurement, functional impairment, and psychosocial stigma. METHODS We performed a retrospective review of patients <18 years old admitted to Grady Memorial Hospital with a diagnosis of HNB from 2009-2017. Demographic data, burn characteristics, management, and hospital course were analyzed. RESULTS Of the 272 patients included, 65.4% were male with a mean age of 63.2 months. Burn mechanism was primarily secondary to scalding liquids (70.2%) or flames (23.9%). The average total body surface area involved was 10.3%, and 3.0% for the head/neck. Average length of stay was 5.2 days and overall mortality was 1.1%. Twenty-five patients (9.2%) required surgery in the acute setting, and 5 (1.8%) required secondary surgery for hypertrophic scarring or contracture. DISCUSSION Pediatric HNBs occur most commonly in males <6 years old secondary to scalding liquids or open flames. Most patients can be managed nonoperatively without long-term sequelae.
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Affiliation(s)
- Tyler K Merceron
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachael Y Williams
- Trauma-Surgical Critical Care, Grady Memorial Hospital, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Grady Memorial Hospital Burn Unit, Atlanta, GA, USA.,Grossman Burn Centers, Los Angeles, CA, USA
| | - Walter L Ingram
- Trauma-Surgical Critical Care, Grady Memorial Hospital, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Grady Memorial Hospital Burn Unit, Atlanta, GA, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Section of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Satishchandran S, Hamilton J, Abramowicz S, Amin D. An Algorithm for Management of Post-Traumatic Maxillofacial Pseudoaneurysms. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abramowicz S, Kupka M, Aguet J, Wagner M, Callaghan F, Kellenberger C. Preliminary Experience with 3-Dimensional Morphometric Assessment of the Face with “Black Bone” Magnetic Resonance Imaging in Children with Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abramowicz S, Whittingslow D, Prahalad S, Inan O. Listening to the Jaw: TMJ Acoustic Emissions as a Digital Biomarker of Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abramowicz S, Goudy SL, Mitchell CE, Prickett K, Marchica C, Austin TM, El-Deiry MW. A Protocol for Resection and Immediate Reconstruction of Pediatric Mandibles Using Microvascular Free Fibula Flaps. J Oral Maxillofac Surg 2020; 79:475-482. [PMID: 32950472 DOI: 10.1016/j.joms.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/22/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of a vascularized free fibula graft (FFF) for the reconstruction of a mandible in a child with a mandibular tumor is infrequent. The purpose of this study is to report our protocol for resection of mandibular jaw tumors and immediate reconstruction using FFF in pediatric patients. METHODS This was a retrospective case series of children with a mandibular tumor, which was resected and immediately reconstructed with FFF. All patients were treated via the same staged protocol: 1) presurgical digital planning, 2) surgical intervention (resection and immediate reconstruction), 3) postoperative care in the pediatric intensive unit, and 4) prosthodontic dental rehabilitation. Outcomes were complications and recurrence. Medical records were reviewed to document demographic information, tumor details, surgical interventions, postoperative course, and prosthodontic rehabilitation. RESULTS Fifteen patients (10 males, average age of 13.7 years) met inclusion criteria. Ten patients had mandibular ameloblastoma. All patients were treated by a dedicated pediatric team and followed the same protocol. The average tumor size was 4.87 × 3.22 × 2.03 cm. Most fibulas (n = 12) had one osteotomy to reestablish mandibular continuity and create appropriate contour. The most common microvascular anastomosis was with a facial artery (n = 13) and the external jugular vein (n = 9). At an average follow-up of 15.5 months, there were only 3 minor donor site complications. Eight implants were placed without complications. No tumors recurred. CONCLUSIONS The results of this study suggest that pediatric mandibular tumors can be successfully treated using a specific protocol involving resection and immediate reconstruction using FFF with minimal complications and without recurrence.
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Affiliation(s)
- Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Associate Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Steve L Goudy
- Professor and Chief, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Chelsea E Mitchell
- Oral and Maxillofacial Surgery Resident-In-Training, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Kara Prickett
- Associate Professor, Division of Pediatric Otolaryngology, Department of Otolaryngology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Cinzia Marchica
- Assistant Professor, Otolaryngology Head and Neck Surgery, McGill University, Montreal, Canada
| | - Thomas M Austin
- Associate Professor of Anesthesiology and Pediatrics, Department of Anesthesia, Emory University School of Medicine, Director of Operative Services, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark W El-Deiry
- Associate Professor, Head and Neck Oncology/Microvascular Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
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Amin D, Satishchandran S, Hamilton JM, Grossberg JA, Abramowicz S. Management of Post-Traumatic Maxillofacial Pseudoaneurysms: Review of the Literature and Suggested Algorithm. J Oral Maxillofac Surg 2020; 78:2008.e1-2008.e9. [PMID: 32771443 DOI: 10.1016/j.joms.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
A pseudoaneurysm (PA) is a collection of blood caused by an incomplete tear in the vessel wall. PA can be arterial or venous in origin. In the maxillofacial region, arterial PA can result from surgical interventions. Venous PAs in the maxillofacial region have never been described. A standardized protocol for management of post-traumatic PAs in the maxillofacial region would help clinicians make treatment decisions. On the basis of the available literature and our institutional experience, we present an algorithm for management of post-traumatic maxillofacial PAs. We also present patients from our institution who illustrate some of the management options in the algorithm.
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Affiliation(s)
- Dina Amin
- Assistant Professor, Oral and Maxillofacial Surgery, Emory University School of Medicine, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - Sruthi Satishchandran
- Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - James M Hamilton
- Assistant Professor, Otolaryngology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Jonathan A Grossberg
- Assistant Professor, Neurosurgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor, Oral and Maxillofacial Surgery and Pediatrics, Emory University, School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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