Publications by authors named "Brian J Christensen"

17 Publications

  • Page 1 of 1

Porous Bone Increases the Risk of Posterior Mandibular Implant Failure.

J Oral Maxillofac Surg 2021 Mar 2. Epub 2021 Mar 2.

Assistant Professor, Department of Oral & Maxillofacial Surgery, LSU School of Dentistry, New Orleans, La.

Purpose: Our recent study indicated that patients with osteoporosis had an increased risk for early and late implant failure perhaps due to a large cancellous space. Therefore, the purpose of the article is to explore the relationship between the amount of cancellous space in an implant site and implant failure.

Patients And Methods: The authors conducted a retrospective cohort study on patients who received dental implants in the posterior mandible at the senior author's practice from January 1, 2008 to October 1, 2019. The primary outcome variable was time to implant failure. The primary predictor variable was the amount of cancellous bone between the buccal and lingual cortices (cancellous space). Other study variables included demographic variables, medical history variables, and implant site measurements. Statistical analysis was performed using descriptive statistics, chi-squared tests, single variable and multiple Cox proportional hazard analyses.

Results: The study cohort (n = 220) was composed of 62.3% women and the average age was 58.2 years. The median follow-up time was 3.5 years (range: 1-12). Five-year survival rates for patients with a cancellous space of <4 mm was 100%, with a cancellous space of 4-6 mm was 95.3%, with a cancellous space of 6-8 mm was 88.2%, and with a cancellous space of >8 mm was 64.1%. In the final multivariate Cox proportional hazard model adjusting for age, gender, smoking status, site and buccal cortex width, cancellous space remained significantly associated with time to implant failure (aHR 1.7 per millimeter change [1.4 - 2.2], P < .0001).

Conclusions: The width of the cancellous space and subsequent gap between implant and cortical bone should be considered when placing implants into the mandibular molar sites. When the patient presents for an implant in the mandibular molar region, if the cancellous space is large, the patient should be informed of the risk.
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http://dx.doi.org/10.1016/j.joms.2021.02.039DOI Listing
March 2021

Is Arthroscopic Disk Repositioning Equally Efficacious to Open Disk Repositioning? A Systematic Review.

J Oral Maxillofac Surg 2021 Feb 15. Epub 2021 Feb 15.

Assistant Professor, Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry, Ann Arbor, MI. Electronic address:

Purpose: Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The procedure can be arthroscopic disc repositioning or open disc repositioning. This systematic review measured and compared the efficacy of arthroscopic and open disc repositioning procedures.

Materials And Methods: The authors conducted a systematic review without meta-analysis by performing a literature search electronically and manually covering arthroscopic and open disc repositioning studies published up to July 2020 in Pubmed, Embase, and Cochrane databases. Surgical outcomes such as changes in maximal incisal opening (MIO) and pain scores, temporomandibular joint noises, diet consistency, malocclusion, and postoperative complications were extracted and analyzed.

Results: A total of 28 studies were included in the review and split into those assessing open disc repositioning (n = 13) and those assessing arthroscopic disc repositioning (n = 15). The average age of the study patients in the included studies was 31.5 ± 6.8 years, and women represented 83.3% of the study population. Both arthroscopic and open disc repositioning showed to be efficacious in reducing pain and increasing MIO. Due to heterogeneity in study designs and data reporting between the studies, no quantitative analysis was performed, and the groups were not directly compared.

Conclusions: Both arthroscopic and open disc repositioning led to significant improvements in clinical outcomes based on pain scores and MIO. This study highlights the need for comparative studies of the 2 techniques with well-documented case selection including standardized diagnosis based on Wilkes stages and rigorous outcomes assessment including patient reported outcomes.
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http://dx.doi.org/10.1016/j.joms.2021.02.007DOI Listing
February 2021

Subnasal Lip Lift and Its Effect on Nasal Esthetics.

J Oral Maxillofac Surg 2021 04 13;79(4):895-901. Epub 2020 Dec 13.

Assistant Professor, Louisiana State University Health Science Center, New Orleans, Department of Oral and Maxillofacial Surgery, New Orleans, Louisiana.

Background: The subnasal lip lift has emerged as a standard procedure for the treatment of an elongated upper lip. Despite its popularity, limited literature has studied its effect on nasolabial esthetics. The purpose of this study is to describe the effect of the subnasal lip lift on nasal and labial esthetic parameters.

Methods: The authors conducted a retrospective case review of patients who underwent a subnasal lip lift procedure without concurrent rhinoplasty between January 1, 2008, and December 31, 2019. The outcome variables were lip length, tooth show, vermillion display, alar width, nasolabial angle, columellar-lobular angle, Crumley analysis, and Simons analysis. Preoperative and postoperative values were compared and analyzed using paired sample t-tests.

Results: Overall, 55 female patients with an average age of 52 years and a mean follow-up of 14 months were included in the study. Subnasal lip lift resulted in a statistically significant 21.5% reduction in lip length, 31.5% increase in the vermilion show, and a 1.52 mm increase in tooth show (P < .0001). In relationship to nasal esthetics, there was a statistically significant decrease in nasolabial angle of 4.56° (P < .0001), a 2.2% increase in alar width (P < .001), and a 26.3% increase in nasal projection per Simons analysis (P < .0001). The study did not demonstrate a significant change in columellar-lobular angle or Crumley projection analysis.

Conclusions: Subnasal lip lift procedure can significantly impact lower nasal esthetics, specifically by decreasing the nasolabial angle and potentially contribute to pseudo-overprojection of the nasal tip, as shown by the results of this study.
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http://dx.doi.org/10.1016/j.joms.2020.12.007DOI Listing
April 2021

Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation.

Anesth Prog 2020 12;67(4):193-199

Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. The secondary outcomes included the success of first attempt at intubation and the use of Magill forceps. Results demonstrated a mean time to intubation of 142 seconds in the DL group and 94 seconds in the VL group (p = .011). First attempt intubation success was 92.0% in the VL group and 84.0% in the DL group (p = .34). The use of Magill forceps was significantly increased in the DL group (p = .007). VL for routine nasotracheal intubation in oral and maxillofacial surgery procedures results in significantly faster intubation times and decreased use of Magill forceps compared with traditional DL.
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http://dx.doi.org/10.2344/anpr-67-02-08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780258PMC
December 2020

Risk Factors for Postoperative Inflammatory Complications After Maxillofacial Reconstruction Using Polyether-Ether-Ketone Implants.

J Oral Maxillofac Surg 2021 Mar 5;79(3):696.e1-696.e7. Epub 2020 Oct 5.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: Polyether-ether-ketone (PEEK) implants are increasingly used for the reconstruction of craniomaxillofacial deformities, but limited data exist on their limitations or risk factors for complications associated with their use. The purpose of the present study was to identify risk factors for postoperative inflammatory complications (POICs) after the use of PEEK implants in craniomaxillofacial reconstruction.

Methods: A retrospective cohort study was conducted, incorporating all patients treated with patient-specific PEEK implants at the authors' institution from August 1, 2012 to June 30, 2019. The outcome variable was the presence of POICs. The potential predictor variables were demographic, medical, anatomic, and treatment related. Statistical analysis was performed using Fisher exact tests, t tests, and multivariable logistic regression analysis where appropriate.

Results: The 32 patients included in the study were composed of 68.8% men; mean age was 40.6 years. The PEEK implant was placed adjacent to the paranasal sinuses in 56.3% of patients. The indication for use was malar depression in 50.0%, orbital dystopia in 46.9%, forehead or skull defects in 21.9%, and mandibular contour deformities in 6.2%; 8 patients had more than 1 indication. The overall rate of POICs was 28.1%. Of the POICs, 66.7% were managed with incision and drainage, revision surgery, or removal and 33.3% were managed with outpatient wound care or antibiotics. Tobacco use, the presence of an intraoral incision, and the presence of multiple incisions were all associated with POICs. On multivariable analysis, tobacco use approached significance (odds ratio, 17.3 [95% confidence interval, 0.98 to 306.7]) and multiple incisions (odds ratio, 6.9 [95% confidence interval, 1.5 to 32.3]) had a statistically significant association with the occurrence of complications.

Conclusions: The present study identified several variables potentially associated with complications after the use of PEEK implants in maxillofacial reconstruction. Consideration should be given in the preoperative evaluation when a smoker is identified and when multiple incisions are planned.
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http://dx.doi.org/10.1016/j.joms.2020.09.039DOI Listing
March 2021

What Factors Are Associated With Implant Failure?

J Oral Maxillofac Surg 2021 Jan 27;79(1):91-97. Epub 2020 Aug 27.

Assistant Professor, Department of Biostatistics, LSU School of Public Health, New Orleans, LA.

Purpose: Recognition of patient-specific risk factors should reduce implant failure. The purpose of this study was to identify risk factors associated with implant failure and to determine if these factors differ over time after implant placement.

Methods: The investigators implemented a retrospective case-controlled study and enrolled a sample composed of patients who had 1 or more implants removed from December 1, 2007 to February 29, 2020. Risk factors were grouped into demographic, medical history, and treatment-related variables. The primary outcome variable was whether the patient's implant failed, with control patients including those without implant failure. The duration was recorded for follow-up from the time of implant placement to the last visit or implant removal. Backward variable selection was used to predict whether an implant failed within 1 year, 1 to 4 years, or after 4 years in 3 multivariable logistic regressions.

Results: Of 224 patients in this cohort, 82 experienced an implant failure. The mean age was 58.6 ± 15.3 years, and 53.1% were females. Patients with osteoporosis had an increased risk of failure in each period. Alcohol use, smoking, depression, and penicillin allergy were all associated with an increased probability of failure within 1 or more of the periods considered.

Conclusions: This study has identified multiple discrete risk factors for implant failure and has demonstrated that these factors are associated with implant failure at different periods after placement.
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http://dx.doi.org/10.1016/j.joms.2020.08.023DOI Listing
January 2021

Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections.

J Oral Maxillofac Surg 2021 Jan 1;79(1):141-151. Epub 2020 Jul 1.

Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections.

Patients And Methods: We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ test and logistic regression, and from these results, a multiple logistic regression model was created.

Results: A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation.

Conclusions: Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.
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http://dx.doi.org/10.1016/j.joms.2020.06.032DOI Listing
January 2021

Capnography Detection Using Nasal Cannula Is Superior to Modified Nasal Hood in an Open Airway System: A Randomized Controlled Trial.

J Oral Maxillofac Surg 2019 Aug 12;77(8):1576-1581. Epub 2019 Feb 12.

Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: The nasal cannula and modified nasal hood are methods used by oral and maxillofacial surgeons to detect expired carbon dioxide during procedural sedation in an open airway system. The purpose of this study was to compare the accuracy of the detection of expired carbon dioxide between the nasal cannula and modified nasal hood.

Materials And Methods: The authors designed a parallel-group randomized controlled trial to compare the nasal cannula and modified nasal hood. Patients presenting to the authors' institution for outpatient oral and maxillofacial surgery (OMS) using intravenous deep sedation or general anesthesia were randomized to have capnography detection by the modified nasal hood or the nasal cannula. The primary outcome variable was the percentage of accurately captured breaths, as determined by the average number of capnography waveforms per auscultated breath using a precordial stethoscope. The 2 groups were compared using t test.

Results: Fifty patients were screened for enrollment in the study. Twenty-five patients were randomized to the nasal cannula group and 25 patients were randomized to the modified nasal hood group. The proportion of accurate waveforms, recorded as a percentage of total breaths, was 95.7 ± 4.7% for the nasal cannula and 75.8 ± 14.1% for the modified nasal hood (P < .0001).

Conclusions: When used for capnography for procedural sedation in an open airway system for routine OMS, the nasal cannula accurately recorded more breaths than the modified nasal hood.
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http://dx.doi.org/10.1016/j.joms.2019.02.002DOI Listing
August 2019

What Is the Effect of Treating Mandibular Fractures on Weight and Prealbumin?

J Oral Maxillofac Surg 2019 Jun 12;77(6):1227.e1-1227.e6. Epub 2019 Feb 12.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: Fracture healing relies on the body to coordinate an inflammatory and anabolic reaction to re-establish osseous union. Although many factors affect this process or even disrupt it, the role of the body's nutritional reserves is not well understood. The purposes of this study were to describe the weight changes and to identify trends in laboratory values commonly used in nutritional assessment during mandibular fracture treatment.

Materials And Methods: A prospective cohort study was designed. The study cohort included patients who sustained a mandibular fracture from September 1, 2017, to March 31, 2018. The primary outcome variable was the percentage weight change from baseline. Secondary outcome variables included serum albumin and serum prealbumin levels. Weight change was analyzed using a linear mixed model. Paired Wilcoxon tests were used to compare laboratory values with baseline levels.

Results: Thirty-nine patients met the inclusion criteria with sufficient follow-up data for analysis. The linear mixed model predicted a peak weight loss of 4.1% of the initial body weight by day 34. The serum prealbumin level increased over the study period (P < .001), and the albumin level was increased from baseline at week 3 (P < .05) but not significantly different from baseline after that time.

Conclusions: During the course of treatment for mandibular fractures, patients lost an average of more than 4% of their body weight. However, the study did not show any meaningful change in nutritional laboratory values. Although it is important for patients and surgeons to be able to anticipate a weight loss of about 4 to 5% during mandibular fracture treatment, it is unlikely that this represents a large challenge to the nutritional status of patients.
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http://dx.doi.org/10.1016/j.joms.2019.01.059DOI Listing
June 2019

Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared With Erich Arch Bars During the Application of Intermaxillary Fixation: A Randomized Controlled Trial.

J Oral Maxillofac Surg 2019 Jun 30;77(6):1228.e1-1228.e8. Epub 2019 Jan 30.

Chief Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: The purpose of this study was to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system (Stryker Craniomaxillofacial, Kalamazoo, MI) with traditional Erich arch bars.

Materials And Methods: We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared using t tests.

Results: We enrolled 90 patients in the study, with 43 randomized to the Erich arch bar group and 47 randomized to the hybrid arch bar group. The mean application time was 31.3 ± 9.3 minutes for Erich arch bars and 6.9 ± 3.1 minutes for hybrid arch bars (P < .0001). Significantly more glove tears or penetrations occurred during application in the Erich Arch Bar group (0.56 ± 0.91 per application) than in the hybrid group (0.11 ± 0.32 per application) (P = .0025). At removal, no difference in overall gingival appearance or amount of loose hardware was noted. The time for removal was significantly less for the hybrid arch bar group (10.5 ± 5.1 minutes vs 17.9 ± 10.7 minutes, P = .0007).

Conclusions: Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including shorter placement and removal times and a greater margin of safety for the operating surgeon as shown by significantly fewer glove tears and penetrations.
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http://dx.doi.org/10.1016/j.joms.2019.01.030DOI Listing
June 2019

How Much Weight Loss Can Be Expected After Treating Mandibular Fractures?

J Oral Maxillofac Surg 2019 Apr 15;77(4):777-782. Epub 2018 Nov 15.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: Surgeons treating facial trauma are faced with a dilemma: Fracture healing requires a tremendous energy expenditure, yet the treatments for mandibular fractures commonly include dietary limitations. Despite this, almost no studies have attempted to quantify the effect of fracture treatments on patient weight. The purposes of this study were to quantify the effect that mandibular fractures and their treatment have on a patient's weight and to identify risk factors associated with an increased change in weight.

Materials And Methods: A retrospective cohort study was designed. The patients were considered eligible for inclusion if they sustained a mandibular fracture and had at least 1 follow-up visit within 4 weeks after the fracture from August 1, 2012, to April 30, 2015. The study variables were time since presentation, age, gender, open versus closed treatment, and trauma intensive care unit (TICU) stay. The outcome variable of interest was the percentage weight change from baseline. A linear mixed model was used to analyze the data.

Results: A total of 439 patients met the inclusion criteria during the study period. In the final linear mixed model, TICU stay had a significant effect whereas open versus closed treatment did not have a significant effect. The final model predicted a peak weight loss of 4.9% of the initial body weight by day 49. For patients admitted to the TICU, the peak weight loss was 8.8%.

Conclusions: During the course of treatment of mandibular fractures, patients lost an average of almost 5% of their body weight. Closed reduction was not associated with an increased change in weight; however, a stay in the TICU was associated with an increase in weight loss. Further studies will be directed at correlating declining weight with outcomes.
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http://dx.doi.org/10.1016/j.joms.2018.11.005DOI Listing
April 2019

Evidence-Based Clinical Criteria for Computed Tomography Imaging in Odontogenic Infections.

J Oral Maxillofac Surg 2019 Feb 27;77(2):299-306. Epub 2018 Sep 27.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: Odontogenic infections are a common problem in emergency departments and impose a burden on hospital budgets and provider time. Compounding this is the lack of evidence guiding the patient's initial evaluation. The purpose of this study was to derive evidence-based guidelines for the use of computed tomographic (CT) imaging in the management of odontogenic infections.

Materials And Methods: A prospective cohort study was designed. Patients with an odontogenic infection presenting to the emergency department from November 1, 2016 to November 30, 2017 were eligible for inclusion. The outcome variable was need for CT imaging, which was based on the location of the abscess. The potential predictor variables were demographics, history items, examination findings, and laboratory values. The association between the outcome and predictor variables was determined using classification and regression tree analysis and standard logistic regression analysis.

Results: There were 129 patients who met the inclusion criteria and consented to participation. The patients were 53.5% men and the mean age was 42.5 years. The most common fascial spaces involved were vestibular (58.2%), submandibular (18.6%), pterygomandibular (6.2%), buccal (5.4%), and lateral pharyngeal (5.4%). The classification and regression tree analysis identified mandibular inferior border blunting at the body as the best predictor for necessitating a CT scan and identified a mouth opening smaller than 25 mm as the second best predictor. These 2 predictors had an accuracy of 96.9% for needing a CT scan. The logistic regression analysis identified these 2 variables and odynophagia, floor of mouth induration, and white blood cell count as relevant predictors for needing CT imaging.

Conclusion: The 2 physical examination findings of mandibular inferior border blunting at the body and restricted mouth opening were found to be strongly associated with the need for CT imaging. Further studies should be directed at validating these criteria in larger multicenter studies.
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http://dx.doi.org/10.1016/j.joms.2018.09.022DOI Listing
February 2019

Are Emergency Medicine Physicians Able to Determine the Need for Computed Tomography and Specialist Consultation in Odontogenic Maxillofacial Infections?

J Oral Maxillofac Surg 2018 12 24;76(12):2559-2563. Epub 2018 Jul 24.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: Pain and swelling from a necrotic tooth is a common complaint in emergency departments. These patients impose substantial burdens on hospital budgets and provider time. The initial triage of odontogenic infections can be difficult without advanced knowledge and training in head and neck anatomy and odontogenic disease pathogenesis. The purpose of this study was to determine the frequency with which emergency medicine physicians correctly determine the need for computed tomography (CT) and specialist consultation in patients with odontogenic infections.

Materials And Methods: A retrospective case series was designed. Patients older than 18 years with an odontogenic infection presenting to the emergency department from August 1, 2012 to April 30, 2015 were eligible for inclusion in the study. Demographic, clinical, laboratory, and treatment data were recorded, with special attention paid to the hospital service consulted and imaging ordered. The location of the abscess and the clinical presentation of the patient were used to determine the necessity for the imaging and consultation. Descriptive statistics were used to analyze the data.

Results: Seventy-two patients met the inclusion criteria (52.9% women; mean age, 40.0 yr). The decision to order CT was made by emergency medicine physicians for 61.7% of patients with infections that did not require CT. Likewise, oral and maxillofacial surgery was consulted for 77.8% of patients with infections that did not require a specialist consultation.

Conclusion: In this study, emergency medicine physicians misinterpreted the clinical needs of a large percentage of patients with odontogenic infections. Better education, interdepartmental collaboration, and conducting and disseminating peer-reviewed research are several ways to increase efficiency of care in patients with odontogenic infections.
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http://dx.doi.org/10.1016/j.joms.2018.07.015DOI Listing
December 2018

On-Site 3-Dimensional Printing and Preoperative Adaptation Decrease Operative Time for Mandibular Fracture Repair.

J Oral Maxillofac Surg 2018 09 15;76(9):1950.e1-1950.e8. Epub 2018 May 15.

Associate Professor, Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: The purpose of this study was to compare the intraoperative time and operating room costs between patients with mandibular fractures treated with traditional adaptation and fixation and patients treated with preadapted plates created with on-site 3-dimensionally printed models.

Patients And Methods: We designed a prospective comparative cohort study for patients with mandibular fractures. The control group received traditional open reduction and internal fixation of their mandibular fractures. For the patients in the experimental group, a 3-dimensional (3D) model of the fractured mandible was made using an on-site 3D printer. The model then underwent osteotomy, if needed, and the plate was adapted to the model, submitted to sterilization, and implanted in the patient. The primary outcome variable was intraoperative plating time, and the secondary outcome variable was operating room cost. The groups were compared by the Wilcoxon signed rank test.

Results: The 38 patients included in the study had a mean age of 39.6 years, and male patients comprised 81.6%. The mean time for intraoperative plate adaptation was 22.8 ± 2.1 minutes in the control group and 6.9 ± 0.3 minutes in the experimental, 3D printed group (P < .0001). In the experimental group, 4 patients (21%) required a single intraoperative corrective bend. The calculated average cost per patient based on the average operating costs at our institution was $2,306.45 in the control group and $698.00 in the experimental group.

Conclusions: This study shows that the use of 3D printers for fabrication of models to prebend maxillofacial reconstruction plates is associated with decreased operating room time and costs. Using an on-site 3D printer requires minor start-up and use costs and results in a significant reduction in operating room time, which remains one of the most expensive aspects of facial trauma care.
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http://dx.doi.org/10.1016/j.joms.2018.05.009DOI Listing
September 2018

Risk Factors for Severe Complications of Operative Mandibular Fractures.

J Oral Maxillofac Surg 2017 Apr 11;75(4):787.e1-787.e8. Epub 2016 Dec 11.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

Purpose: The purpose of the present study was to identify the risk factors for major complications developing during the operative treatment of mandibular fractures.

Patients And Methods: We conducted a retrospective medical record review of patients who had undergone open reduction, internal fixation of mandibular fractures from August 1, 2012 to December 31, 2014 at a large, urban teaching hospital and level 1 trauma center. The outcome variable of interest was major complications, defined as the occurrence of any one of the following events: hospital readmission, return to the operating room, and a prolonged, unexpected postoperative stay. Multiple demographic, social, medical, injury-related, and treatment-related variables were recorded during the medical record review. The relationships between these variables and our outcome variable were analyzed using univariate and multivariable logistic regression analyses.

Results: A total of 317 patients met the inclusion criteria. The hospital readmission rate was 7.2%, the reoperation rate was 9.5%, and the rate of unplanned, prolonged admission was 0.6%, for a total major complication rate of 11.4%. Eight variables reached statistical significance in their association with the occurrence of major complications. These were the presence of medical comorbidities, a diagnosis of depression, a diagnosis of a psychiatric disorder, incarceration, interpersonal violence as a mechanism of injury, the presence of a left angle fracture, the removal of a tooth in the line of fracture, and patient noncompliance. On multivariable analysis, patient noncompliance, depression, the presence of a left angle fracture, and the removal of a tooth in the line of fracture continued to have statistically significant associations with the occurrence of major complications.

Conclusions: The identification of risk factors for the development of complications in mandibular trauma is a primary concern for surgeons in the modern healthcare system. The present study identified a number of variables significantly associated with an increased risk of the occurrence of major complications, and special consideration should be given to patients with these risk factors.
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http://dx.doi.org/10.1016/j.joms.2016.12.003DOI Listing
April 2017

Inaugural Survey on Practice Patterns of Orbital Floor Fractures for American Oral and Maxillofacial Surgeons.

J Oral Maxillofac Surg 2016 Jan 30;74(1):105-22. Epub 2015 Sep 30.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA. Electronic address:

Purpose: In recent years, several studies have reported on practitioners' preferences for the treatment of orbital floor fractures, showing widely varying practice patterns. The purpose of the present study was to identify the practice patterns among oral and maxillofacial surgeons involved in the management of orbital floor fractures in the United States and compare them with the available published data.

Materials And Methods: An anonymous survey was created and electronically mailed to surgeons. We also reviewed the published data on orbital floor fractures using a PubMed and MEDLINE search. The responses to the survey were analyzed using descriptive statistics.

Results: The factors that had the greatest influence on the surgeon's decision to operate were a defect size > 2 cm2, enophthalmos, entrapment, and persistent diplopia. The most common surgical approach reported was a preseptal transconjunctival approach (32.0%), followed by the subciliary (27.9%) and postseptal transconjunctival (26.2%) approaches. The most commonly reported implant for orbital reconstruction was titanium (65.4%), followed by Medpor (43.7%) and composite Medpor and titanium (26.4%). The review of the published data showed a consensus among many of the operative indications mentioned, including a large defect size, enophthalmos, clinical entrapment, and persistent diplopia.

Conclusions: Oral and maxillofacial surgeons in the United States have a wide range of practice habits in the management of orbital floor fractures. Although the quality of the available evidence is poor, it supports a consistent approach to the management of orbital floor fractures in terms of the indications and surgical approach. The choice of reconstructive material and timing of repair remain more controversial. A clear need exists for improvement in the available data to help guide and set standards of care for the specialties managing orbital floor fractures.
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http://dx.doi.org/10.1016/j.joms.2015.09.023DOI Listing
January 2016

Genetic dissection of a major anthocyanin QTL contributing to pollinator-mediated reproductive isolation between sister species of Mimulus.

Genetics 2013 May 18;194(1):255-63. Epub 2013 Jan 18.

Department of Biology, University of Washington, Seattle, Washington 98195, USA.

Prezygotic barriers play a major role in the evolution of reproductive isolation, which is a prerequisite for speciation. However, despite considerable progress in identifying genes and mutations responsible for postzygotic isolation, little is known about the genetic and molecular basis underlying prezygotic barriers. The bumblebee-pollinated Mimulus lewisii and the hummingbird-pollinated M. cardinalis represent a classic example of pollinator-mediated prezygotic isolation between two sister species in sympatry. Flower color differences resulting from both carotenoid and anthocyanin pigments contribute to pollinator discrimination between the two species in nature. Through fine-scale genetic mapping, site-directed mutagenesis, and transgenic experiments, we demonstrate that a single-repeat R3 MYB repressor, ROSE INTENSITY1 (ROI1), is the causal gene underlying a major quantitative trait locus (QTL) with the largest effect on anthocyanin concentration and that cis-regulatory change rather than coding DNA mutations cause the allelic difference between M. lewisii and M. cardinalis. Together with the genomic resources and stable transgenic tools developed here, these results suggest that Mimulus is an excellent platform for studying the genetics of pollinator-mediated reproductive isolation and the molecular basis of morphological evolution at the most fundamental level-gene by gene, mutation by mutation.
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Source
http://dx.doi.org/10.1534/genetics.112.146852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632473PMC
May 2013