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The decision to obtain double-degree versus single-degree training in oral and maxillofacial surgery (OMS) has been a widely debated topic in the United States over the past several decades. The purpose of this study is to determine if OMS faculty holding leadership positions (ie, program directors and chairs/chiefs) are more likely to be single-degree trained versus double-degree trained.The authors designed a cross-sectional observational study to address the research purpose. The primary predictor variable was faculty leadership education (single-degree trained vs double-degree trained). The secondary predictor variable was accredited OMS program type led by the faculty with leadership positions (double-degree, both single-degree and double-degree, single-degree, or military program). The primary outcome variable was faculty leadership position (program director or chair/chief). Sums and percentages were calculated and Chi-squared (χThe study sample was composed of 198 subjects, of which 99 subjects were identified as program directors and 99 subjects were identified as chairs/chiefs. There was no statistically significant difference between the proportions of program directors and chairs/chiefs who were single-degree trained versus double-degree trained when looking at all accredited OMS programs in the United States (52.5% vs 47.5%, P = .615 and 56.6% vs 43.4%, P = .191, respectively). However, program directors of double-degree programs were statistically significantly more likely to be double-degree trained than single-degree trained (77.1% vs 22.9%, P = .001) and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained than double-degree trained (67.4% vs 32.6%, P = .022 and 65.1% vs 34.9%, P = .047, respectively).Overall, no statistically significant difference exists between the proportions of program directors and chairs/chiefs that were single-degree trained versus double-degree trained at accredited OMS programs. However, when stratifying programs by program type, program directors of double-degree programs were statistically significantly more likely to be double-degree trained and program directors and chairs/chiefs of single-degree programs were statistically significantly more likely to be single-degree trained.

The purpose of this study was to analyze the pro re nata (PRN) opioid consumption of patients with severe odontogenic infections following operating room incision and drainage using odontogenic infection severity scores (SS).This retrospective study reviewed consecutive charts of patients admitted for severe odontogenic infections from January 2016 to December 2020. Postoperative opioid doses were tabulated. Severity scores (SSs) were assigned based on the risk to the airway and vital structures. Patients with SS ≥5 were designated as group A and patients with SS5 as group B. The primary predictor variable was SS, and the primary outcome variable was amount of milligram morphine equivalent consumed.A total of 93 patients met the inclusion criteria. Group A included 40 patients, and group B included 53 patients. No statistically significant difference was found between the 2 groups in age, hospital duration, and American Society of Anesthesiologists classification. Group A consumed a significantly greater amount of PRN postoperative inpatient opioid medications (P = .02).Patients with odontogenic infection SS ≥5 consumed more postoperative PRN opioid analgesic medications. Given that odontogenic infections are largely preventable, it is imperative to prevent progression of odontogenic infections to limit patient exposure to opioid medication.

To determine if the method of orthognathic surgery planning used-computer aided surgical simulation (CASS) versus analog model surgery-influenced patients' post-operative satisfaction. The authors hypothesized that there was no difference in patient satisfaction based on the type of planning in orthognathic surgery.This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a 6-year period. Patients were asked to complete a survey questionnaire that consisted of eight questions, each utilizing a five-point Likert scale.There were 643 patients initially identified with 401 potential subjects meeting the inclusion criteria. Of these 401 patients, the survey was successfully administered to 161. Patients whose orthognathic surgery was planned virtually were not only significantly more likely to be satisfied with their appearance post-operatively, but also more likely to go through with surgery again if they could choose to (p 0.05). CASS patients were also more likely to identify that their surgery was planned virtually. When stratified by age, younger patients were more likely to have read about CASS. When each survey question was stratified based on the type of surgery that was performed, there were no significant differences.Patients whose surgeries were virtually planes were significantly more likely than model surgery patients to be satisfied with their post-operative appearance as well as with their decision to have orthognathic surgery. CASS has proven to be an accurate, time-saving, and potentially cost-saving tool for surgeons. Based on the results of this study, the type of surgical planning method matters for post-operative patient satisfaction with their appearance.

Purpose Our hypothesis is that direct manipulation of the third and second divisions of the trigeminal nerve during microneurosurgery does not affect the incidence of trigeminocardiac reflex (TCR). The purpose of this paper was to analyze the incidence of TCR events during microneurosurgery involving the second and third divisions of the trigeminal nerve. Materials and Methods This was a retrospective cohort study of 94 patients who underwent nerve repair of the second and third divisions of the trigeminal nerve, between July 2014 and February 2021 by a single surgeon (J. Z.). The independent variables were the trigeminal nerve branch injured, the laterality of the trigeminal nerve injury, the Sunderland classification, the ASA classification, the intraoperative narcotic(s) used, and the depth of anesthesia. The dependent variables included the occurrence of intraoperative hypercapnia, hypoxia, and TCR event. Since the data was retrospective and categorical in nature, χ2 analysis was performed initially. Results None of the patients in this retrospective cohort demonstrated intraoperative hypercapnia, hypoxia or TCR events. Initial χ2 calculation was performed for the dependent variables with the trigeminal nerve groups (IAN, LN, and ION). The χ2 calculation [χ2 (1, n = 101)] was 0.2235. The P-value was .6364. Since there was no statistical significance found, there was no further analysis of surgical and anesthesia independent variables in the data collection. Conclusions The zero incidence of TCR in a large number of patients provides strong evidence supporting the rejection of the hypothesis that TCR can occur during the surgical repair of peripheral trigeminal nerves.

Soft tissue myofibromas of the head and neck are relatively common lesions diagnosed within the first two decades of life; however, these myofibromas are rarely found to affect the jaw bones. Myofibromas that do develop within the bone are referred to as intraosseous myofibromas (IM). A thorough search and review of the literature has found only five cases of IM impacting the mandible of an adult patient. The current case report describes a myofibroma impacting the right posterior mandible in a 44-year-old male patient with no previous history of pathology or surgery within the affected area. Histologic examination of the incisional biopsy specimen revealed a proliferation of spindle cells, and the spindle cells showed positivity for SMA on immunohistochemical staining supporting the diagnosis of myofibroma. The final pathology results of the subsequent composite resection of the lesion yielded a 1.5cm myofibroma that was < 1mm from the nearest bone/soft tissue edge; the resection margin was uninvolved by tumor. The purpose of this case report is to present the sixth case of IM of the mandible of an adult patient and to review the pertinent radiographic and clinical features, and necessary methods for diagnosis and treatment of this rare entity.

The purpose of this report is to highlight the presentation and review the clinical and histopathological features of DGCT. There have been 130 DCGT diagnoses reported in the literature. DGCT is part of the odontogenic ghost cell tumor family which also includes the calcifying odontogenic cyst (COC) and the ghost cell odontogenic carcinoma (GCOC). In June of 2018, a 48-year-old female presented with a painless, soft tissue growth overlying the right mandibular alveolar ridge. Further workup of the lesion included a panoramic radiograph and maxillofacial computed tomography (CT) which revealed a well-defined, multilocular lytic expansile radiolucency occupying the right mandibular body. An incisional biopsy of the right mandibular gingival mass was performed which revealed an unusual odontogenic neoplasm with mineralization and ghost cells. The patient was subsequently treated with excisional biopsy of the right mandibular lesion via enucleation and curettage. The specimen was sent to pathology and the tumor was found to have an epithelial neoplastic proliferation resembling that of ameloblastoma, accompanied by foci of ghost cells. Since mandibular bone was involved, a diagnosis of a benign central DGCT with extension into the overlying gingiva was rendered. She was successfully treated with excisional biopsy via enucleation and curettage and has no evidence of recurrence at three years post-operatively. DGCT can exhibit locally aggressive behavior and is characterized by ameloblastoma-like epithelial cells and the presence of dentinoid material and ghost cells.

Structured Abstract Objectives The purpose of this study is to determine whether various serum marker levels [C-reactive protein (CRP), white blood cell (WBC) count, glucose] or body temperature at admission are associated with severity of odontogenic infections. Study Design This retrospective chart review of patients admitted to the hospital for treatment of severe odontogenic infections (SOIs) over a five-year period (2016- 2020) assigned patients with a severity score (SS) of greater than or equal to five to Group A and those with a SS of less than five to Group B. Serum marker levels and temperature at admission were collected, and comparisons between Group A and Group B were conducted for serum marker levels and body temperature at admission using two sample t-tests. Results The mean serum CRP and temperature at admission between the two groups was not statistically significant (p > 0.05). The mean WBC count and serum glucose at admission between the two groups was statistically significant (p = 0.001 and p = 0.036, respectively). Conclusions This study demonstrates that serum glucose and WBC at admission are significantly higher in patients with more severe SOIs. In addition, serum CRP and body temperature at admission are not adequate prognostic indicators of odontogenic infection severity.

Hospital treatment of odontogenic infections can be costly, and often these infections present with varying degrees of severity that can be quantified with odontogenic infection severity scores (OISSs). The purposes of this study were (1) to measure the association between OISSs and hospital bills and (2) to identify risk factors associated with OISSs.This retrospective cohort study assessed subjects from January 1, 2016, to December 31, 2020, with severe odontogenic infections treated in the operating room and admitted to the University of Texas Southwestern Medical Center/Parkland Memorial Hospital for1 hospital day. OISSs were assigned based on the risk to the airway and vital structures. OISSs ≥ 5 were designated group A andOISSs 5 group B. The primary predictor variable was OISSs, and the primary outcome variable was the mean billed cost of the stay. Analysis to identify associated variables for OISS ≥ 5 was also conducted. Secondary predictor variables were age, gender, smoking status, HIV diagnosis, diabetes mellitus diagnosis, blood glucose at admission, and white blood cell count (WBC) at admission. The secondary outcome variable was OISS. Comparisons between Group A and Group B were conducted using t-tests. Analysis to identify associated variables for OISS ≥ 5 was conducted using univariate and multivariate analysis. Values of P .05 were considered statistically significant.There were 144 subjects that met inclusion criteria. There were 65 subjects in Group A and 69 in Group B. Group A had a significantly larger mean billed cost of stay (95% CI 8937.7 to 48,225.74; P = .001). Analysis of secondary predictor variables revealed that male sex (OR 2.07; 95% CI 1.06 to 4.07; P = .03), blood glucose ≥ 100 at presentation (OR 3.05; 95% CI 1.46 to 6.38; P = .002), and WBC of11,000/mL at presentation (OR 3.17; 95% CI 1.44 to 6.98; P = .003) resulted in an increased likelihood of OISS ≥ 5.Patients with OISSs ≥ 5 have higher mean billed costs when compared to patients with OISSs5. Male sex, blood glucose ≥ 100, and WBC11,000/mL at presentation is associated with increased likelihood of OISS5.

The current research aims to determine the level of representation of the values of peace in the music and chants curriculum for the first three primary classes in the Hashemite Kingdom of Jordan schools. Music and chants have a profound impact on the establishment of this positive value, and they have a reflection on the behavior of students in the way they deal with each other and with those around them. In light of the conflicts and wars taking place worldwide, and in light of what is presented by the media, it has become necessary to conduct a comprehensive review to analyze the basic music curriculum for the first primary stages of basic education in Jordan. It is also important to understand what these books need to contain from the various values of peace. This is crucial as Jordan lives in a region surrounded by conflicts, which makes it necessary to be aware of the content and values of the music curriculum, given that music has a major and effective impact on guiding behavior and upholding the values of humanity and tolerance. The importance of such a notion arises from the fact that for more than 20 years, there has been no effort on developing the target curricula to keep pace with the developments of this century and its terminologies.

Objectives This purpose of this study was to analyze the cost of surgically treated severe odontogenic infections to both the patient and the hospital system. Materials and Methods This retrospective chart review assessed data of patient hospital charts surgically treated for severe odontogenic infections in the operating room and admitted for greater than one day. Hospital charts of consecutive inpatients admitted from the ED to the University of Texas Southwestern Medical Center and Parkland Memorial Hospital for treatment from January 1st 2016 to December 31st 2020, were reviewed. Patients with infections of non-odontogenic origin were excluded. The specific outcome measures included total hospital stay cost, amount not collected, hospital charity adjustments, insurance type, length of stay, number of infected spaces, number of operating room visits, imaging ordered, and preadmission antibiotics. Results Data from 144 consecutive hospital charts were analyzed. The total billed cost of stay across all study years was $6,888,326.52, the average billed cost per hospital stay was $47,835.60, and the amount not collected was $2,864,857.82. Of the total billed cost, $2,107,692.15 was covered by hospital charity. Only $777,276.43 (11.3%) of the total $6,888,326.52 billed was collected by the hospital. Conclusions Patients that are treated for severe odontogenic infections incur a large hospital bill that could have been avoided. Often, a very small percentage of this bill is collected by the hospital.

Background: The trigeminocardiac reflex (TCR) is a brainstem reflex following stimulation of the trigeminal nerve, resulting in bradycardia, asystole and hypotension. It has been described in maxillofacial and craniofacial surgeries. This case series highlights TCR events occurring during sphenopalatine ganglion (SPJ) neurostimulator implantation as part of the Pathway CH-2 clinical trial “Sphenopalatine ganglion Stimulation for Treatment of Chronic Cluster Headache”. Methods: This is a case series discussing sphenopalatine ganglion neurostimulator implantation in the pterygopalatine fossa as treatment for intractable cluster headaches. Eight cases are discussed with three demonstrating TCR events. All cases received remifentanil and desflurane for anesthetic maintenance. Results: Each patient with a TCR event experienced severe bradycardia. In two cases, TCR resolved with removal of the introducer, while the third case’s TCR event resolved with both anticholinergic treatment and surgical stimulation cessation. Conclusion: Each TCR event occurred before stimulation of the fixed introducer device, suggesting the cause for the TCR events was mechanical in origin. Due to heightened concern for further TCR events, all subsequent cases had pre-anesthesia external pacing pads placed. Resolution can occur with cessation of surgical manipulation and/or anticholinergic treatment. Management of TCR events requires communication between surgical teams and anesthesia providers, especially during sphenopalatine ganglion implantation when maxillary nerve stimulation is possible.

Secretory carcinoma (SC), formerly known as mammary analogue secretory carcinoma (MASC), is a rare salivary gland tumor that was first described by Skalova et al., in 2010 [1]. Thirty-two cases of SC involving the lips have been reported in the literature. The current report describes a case of SC discovered in the upper lip of a 20-year-old-female. The lesion was excised, and the pathology report returned as SC with positive margins. One month later, the patient was treated with radical excision of the lesion with 1cm margins, and the pathology report described SC of the inner aspect of the right side of the upper lip that was unifocal, 0.3cm in size with a 3mm depth of invasion. The margins were uninvolved by the invasive tumor, and the distance from the closest margin was at least 5mm to the deep margin. No lymphovascular invasion or perineural invasion was identified. The tumor cells were positive for mammaglobin, S100, and GATA-3. The purpose of this report is to highlight the presentation and review the morphologic and immunohistochemical features of SC. Our aim is to add to the existing body of literature and present an extremely rare case of SC of the upper lip.