Airway injury, Ocular injury and neurovascular tissue damage, burns is all a spectrum of pediatric soft tissue injury complex. Soft tissue injuries to the head and neck area in children are challenging to manage, because these injuries significantly affect the child’s overall health and development. Management of such injuries requires a multidisciplinary approach involving surgical and nonsurgical interventions and close collaboration among health care professionals, parents, and caregivers. This article reviews the various causes of injuries, specific considerations for each region of the head and neck, and approaches to the surgical management of soft tissue injuries in pediatric patients, including surgical and adjuvant therapies. Specific anatomic regions reviewed include the scalp/forehead, periorbital region, nose, cheeks, lips, ears, and neck/airway.Laceration repair in the growing pediatric populations may require revisions in the future. Facial soft tissue injuries are prone to poor cosmesis as in many occasions as may be constrained by available surgical specialists, thus proper multispecialty team approach along with surgical alignment and symmetry should be considered comprehensively.

PURPOSE:Oral and maxillofacial surgery (OMS) applicant Comprehensive Basic Science Examination (CBSE) scores are scrutinized by residency programs and medical schools because of their perceived predictive value for United States Medical Licensure Examination (USMLE) Step 1 performance. The purpose of this study was to answer the following question: Is there a correlation between the OMS applicant's CBSE score and his or her later USMLE Step 1 score? MATERIALS AND METHODS:We e-mailed all current 45 dual-degree OMS residency programs to request participation in the study. Participating programs submitted residents' CBSE scores and USMLE Step 1 scores. RESULTS:Of 45 United States-based, dual-degree OMS residency programs, 23 (51%) enrolled in the study, including data for 152 residents from 2012 to 2018. The mean CBSE score was 71 (range, 47 to 99). The mean USMLE Step 1 score was 220 (range, 177 to 266). The Pearson correlation coefficient for the relationship between the CBSE and USMLE Step 1 scores was 0.36. The overall USMLE pass rate was 97%. On the USMLE Step 1, OMS residents outperformed their translated CBSE score by an average of 15 points. Of the 50 residents (33%) with a translated CBSE score below the passing level, 94% passed the USMLE Step 1. Residents who had a translated passing CBSE score outscored residents with a translated failing score by 14 points when taking the USMLE Step 1 (225 vs 211). CONCLUSIONS:Although no statistically significant difference in the USMLE Step 1 pass rates was found between OMS residents with a translated passing CBSE score and those with a translated failing CBSE score, a weak positive correlation was noted between CBSE and USMLE Step 1 scores. These data do not support the use of a certain cutoff CBSE score for OMS applications by OMS program directors, especially as it pertains to interview offers.

Purpose: Over the years, a few types of combined oral and maxillofacial surgery (OMS)-MD residency curricula have evolved that differ in how the MD is integrated. The purpose of this study was to look for a difference in United States Medical Licensure Examination (USMLE) Step 1 pass rates among these different curricula. Materials and Methods: An anonymous electronic survey was e-mailed to the directors of all 46 United States-based OMS-MD-integrated programs, querying OMS curriculumtype and USMLE Step 1 results over the years 2007-2017. Programs were then characterized by the curriculum sequence, whether USMLE Step 1 was taken before or after starting medical school, and the amount of dedicated test preparation time. Results: Of 46 OMS-MD program directors, 32 (70%) responded. No statistically significant difference in the USMLE Step 1 pass rate was found among the 4 main types of OMS-MD curricula (range, 89 to 95%; P =.06). Completing some part of medical school before taking USMLE Step 1 also had no effect on OMS residents' pass rates (94% vs 92%, P =.23). However, an increasing number of weeks of dedicated test preparation time was significantly correlated with increasing USMLE Step 1 pass rates (87% with no dedicated test preparation time, increasing to 96% with >= 6 weeks of dedicated test preparation time; P =.05). Finally, only 7 of 806 total residents (0.9%) dropped out of a program because of the inability to pass USMLE Step 1. Conclusions: The data show a high overall USMLE Step 1 pass rate with a direct correlation between the duration of dedicated test preparation time and pass rate. No difference in USMLE Step 1 pass rates was observed based on the sequence of OMS-MD-integrated curricula or the completion of some pre-USMLE medical school before USMLE Step 1 among OMS residents. (C) 2019 American Association of Oral and Maxillofacial Surgeons

BACKGROUND:A significant amount of clinical information captured as free-text narratives could be better used for several applications, such as clinical decision support, ontology development, evidence-based practice, and research. The Human Phenotype Ontology (HPO) is specifically used for semantic comparisons for diagnostic purposes. All these functions require quality coverage of the domain of interest. The authors used natural language processing to capture craniofacial and oral phenotype signatures from electronic health records and then used these signatures for evaluation of existing oral phenotype ontology coverage.METHODS:The authors applied a text-processing pipeline based on the clinical Text Analysis and Knowledge Extraction System to annotate the clinical notes with Unified Medical Language System codes. The authors extracted the disease or disorder phenotype terms, which were then compared with HPO terms and their synonyms.RESULTS:The authors retrieved 2,153 deidentified clinical notes from 558 patients. Finally, 2,416 unique diseases or disorders phenotype terms were extracted, which included 210 craniofacial or oral phenotype terms. Twenty-six of these phenotypes were not found in the HPO.CONCLUSIONS:The authors demonstrated that natural language processing tools could extract relevant phenotype terms from clinical narratives, which could help identify gaps in existing ontologies and enhance craniofacial and dental phenotyping vocabularies.PRACTICAL IMPLICATIONS:The expansion of terms in the dental, oral, and craniofacial domains in the HPO is particularly important as the dental community moves toward electronic health records.

Is it advisable for students to enroll in dual degree Medical Degree/Oral Maxillofacial Surgery (MD/OMS) programs without a clear path to medical licensure in the US? And how can we educate the OMS of the future in fewer months than we had in the past? These difficult questions lie on 2 sides of the same coin. In 2017, almost half of American OMS residents are enrolled in dual degree programs. For these programs, increasing medical licensure requirements are beginning to strain the time available to learn the full contemporary scope of the field. The MD provides useful undergraduate medical education, but also creates a unique burden on the postgraduate surgical curriculum of dual degree OMS programs that isn't felt by single degree programs or other surgical specialties. This is largely because OMS programs are Commission on Dental Accreditation (CODA) accredited, but medical licensure in the US requires ACGME accredited training (Accreditation Council for Graduate Medical Education is the main US graduate medical accrediting agency). Most OMS programs can offer one year of ACGME credit by doing the first year of a general surgery curriculum which, until recently, usually sufficed. But now states are increasing licensure requirements - up to 2 ACGME years in 15 states and 3 years in 2 states. The Medical Board of California has recently recommended a 3-year minimum for year 2020. In response to these increases, OMS program directors usually have to divert OMS surgical training time to non-OMS rotations that can offer more ACGME credit. A vascular surgery rotation has learning benefits for the OMS resident, but not if it comes at the expense of proficiency in orthognathic surgery. Other surgery specialties are fully accredited by ACGME, so licensure isn't an issue, allowing them more time to teach state-of-the-art surgery. Otolaryngology, Orthopedics and Neurosurgery have been able to decrease general surgery requirements down to 5 months in the face of duty hour restrictions, while increasing core specialty training to 54 months. In contrast, to fit a dual degree OMS curriculum into 6 years and get enough ACGME credit for medical licensure, most dual degree programs do about twice as much general surgery with something close to the minimum required 30 months of core OMS rotations. OMS program directors would welcome more months of OMS training, but medical licensure creates pressures to spend extra resident time on general surgery rotations instead. These issues are already affecting current and former residents. One of our current senior residents is planning to practice in the 2-year ACGME state of Washington. Our program officially provided one year of ACGME but, like other programs, we had some unofficial backdoors that were willing to grant additional ACGME credit when needed. But backdoors are unreliable and can be closed at any time, as they were for us this year. So, with a fresh hard-earned MD in hand, but only 1 year of ACGME credit, this resident suddenly faced the prospect of no license or legal way to display his MD in Washington after graduation. We scrambled to create additional ACGME rotations for him, but at great cost to his OMS experience. In another case, recently one of our graduates from several years ago moved to a 2-year state and asked us for verification of training. He was able to get only one year of ACGME credit from our general surgery department, so now he may be unable to display his MD in the new state. Because of these instances, we have added more general surgery to our curriculum so we can qualify for two years ACGME, but this means even less OMS training for our residents. OMS has been successful at integrating undergraduate medical education into dual degree programs and now we need to find a way to do the same with postgraduate surgical training. Both of the main strategies that could address this problem will require strong leadership over time. The first strategy is lobbying for OMS-friendly licensing statutes in all 50 states. In California, Oral and Maxillofacial Surgeons (CALAOMS) is working with the medical board to carve out special language that accepts CODA training from dual degree programs for medical licensure. This is a great model, but it'll take a coordinated push in many other states if we're to avoid leaving geographic islands of ‘un-licensability’ for dual degree OMS graduates. The second is to pursue ACGME accreditation for OMS programs. This path is more challenging because OMS is not a medical specialty and ACGME accreditation would involve difficult changes. There's little incentive for single degree programs to go through such a process, so we'd have to consider separate standards for dual and single degree programs, which would be problematic to say the least. Until recently, dual degree OMS programs have been able to reliably produce licensed physicians without medical accreditation of our training programs. It's obvious that medicine will continue to evolve, so doing nothing may eventually put the licensed MD beyond our reach. Some of our adaptations may be difficult or slow to implement, so OMS has to act now, or risk losing our special bridge to medicine. There is no easy fix. At a minimum, we must create accreditation standards that ensure dual degree OMS graduates are fully licensable in medicine in the US. Until such standards exist, we should be helping our students to decide if a second professional degree is the right choice for them and to understand the full ramifications of licensure. The MD offers many advantages, but undergraduate medical education is not a substitute for surgical training, and an academic degree without a license may not justify the hundreds of thousands of dollars in tuition, loans, and opportunity costs it takes to get an MD these days. If we are going to continue to offer the MD, we must work to ensure that OMS residents are graduating as first class physicians who can be reliably licensed by standard processes, like any other medical graduate. Residents shouldn't have to choose between medical licensure and sufficient OMS experience. The MD comes at too great a cost, financially and otherwise, to accept anything less for our future colleagues.

— In rare or undiagnosed diseases, physicians rely upon genotype and phenotype information in order to compare abnormalities to other known cases and to inform diagnoses. Patients are often the best sources of information about their symptoms and phenotypes. The Human Phenotype Ontology (HPO) contains over 12,000 terms describing abnormal human phenotypes. However, the labels and synonyms in the HPO primarily use medical terminology, which can be difficult for patients and their families to understand. In order to make the HPO more accessible to non-medical experts, we systematically added new synonyms using non-expert terminology (i.e., layperson terms) to the existing HPO classes or tagged existing synonyms as layperson. As a result, the HPO contains over 6,000 classes with layperson synonyms.

The principles of genetics apply across the whole tree of life: on a cellular level, we share mechanisms with species from which we diverged millions or even billions of years ago. We can exploit this common ancestry at the level of sequences, but also in terms of observable outcomes (phenotypes), to learn more about health and disease for humans and all other species. Applying the range of available knowledge to solve challenging disease problems requires unified data relating genomics, phenotypes, and disease; it also requires computational tools that leverage these multimodal data to inform interpretations by geneticists and to suggest experiments. However, the distribution and heterogeneity of databases is a major impediment: databases tend to focus either on a single data type across species, or on single species across data types. Although each database provides rich, high-quality information, no single one provides unified data that is comprehensive across species, biological scales, and data types. Without a big-picture view of the data, many questions in genetics are difficult or impossible to answer. The Monarch Initiative (https://monarchinitiative.org) is an international consortium dedicated to providing computational tools that leverage a computational representation of phenotypic data for genotype-phenotype analysis, genomic diagnostics, and precision medicine on the basis of a large-scale platform of multimodal data that is deeply integrated across species and covering broad areas of disease.

Purpose: To estimate the screening test value of routine radiography after arch bar wire removal by assessing the incidence of retained wires and the importance of their sequelae.Materials and Methods: This was a retrospective medical record review. Records of arch bar removal procedures were examined and divided into those screened with radiography after removal (screen group) and those that were not screened (comparison group). The incidence of retained wire was calculated for each group. Study variables included wire-related radiographic or clinical findings.Results: Records of 546 mandible fractures were reviewed; 95 met the study criteria. Most exclusions were due to lack of arch bars, missing postoperative radiographs, or insufficient postoperative documentation. Of the 55 records in the screen group, 1 wire was detected (2%); of the 40 records in the comparison group, 1 wire was detected (3%). The total incidence of retained wire findings was not statistically different between the 2 groups and there were no adverse wire-related sequelae reported by any of the 95 patients.Conclusion: Because of the low incidence of retained wires and wire-related sequelae, routine imaging after wire removal is probably not an effective screening test for retained wire and should be limited to situations in which there is clinical suspicion of retained wire. (C) 2016 American Association of Oral and Maxillofacial Surgeons

The principles of genetics apply across the entire tree of life. At the cellular level we share biological mechanisms with species from which we diverged millions, even billions of years ago. We can exploit this common ancestry to learn about health and disease, by analyzing DNA and protein sequences, but also through the observable outcomes of genetic differences, i.e. phenotypes. To solve challenging disease problems we need to unify the heterogeneous data that relates genomics to disease traits. Without a big-picture view of phenotypic data, many questions in genetics are difficult or impossible to answer. The Monarch Initiative (https://monarchinitiative.org) provides tools for genotype-phenotype analysis, genomic diagnostics, and precision medicine across broad areas of disease.

Many diseases present with distinct phenotypes, making descriptions of phenotypes valuable for identifying and diagnosing human diseases. The Human Phenotype Ontology (HPO) was developed to provide a structured vocabulary containing textual and logical descriptions of human phenotypes. The HPO is used for phenotype-genotype alignment in systems like the Monarch Initiative to provide disorder prediction, variant prioritization, and patient matching between known diseases and model organisms. Here we describe recent work to extend the utility of the HPO through the systematic addition of approximately 6,000 synonyms. Until now, most of the HPO synonyms were composed of clinical terms unfamiliar to patients. For example, a patient may know they are ‘color-blind’, but may not be familiar with its official phenotype term ‘Dyschromatopsia’. Therefore, our goals is to add synonyms in “layperson-ese” so that HPO can be used by patients as well as basic research scientists and clinicians to help improve disease characterization and diagnosis. We systematically reviewed current HPO classes (approximately 12,000) and assigned layperson synonyms to each class where applicable. The layperson synonyms refer to colloquial terms used to describe phenotypic features associated with medical conditions. Each layperson synonym was annotated to indicate its special status, then classified as either exact (precise); broad (more general); narrow (more specific); or related (associated). The review process included various methods of identifying and validating possible layperson synonyms. We first queried the HPO to avoid duplicate terms. We then batched similar kinds of terms together, such as those related to bone abnormalities, to maintain consistent synonym terminology. For example, the phenotypes of the femur were assigned layperson synonym ‘of thigh bone’ and morphological abnormalities were described as ‘abnormal shape of ’. We consulted online resources (e.g., Wikipedia, Mayo Clinic) as well as specialized resources (e.g., Uberon, Gene Ontology) to find additional synonyms. As a quality control measure, we reviewed each other’s work, consulted with clinical experts when necessary, and queried Google for the assigned layperson term to verify that it retrieved the appropriate medical term and was in use. Some challenges of assigning layperson synonyms involved reconciling lay terms with the logic and structure of the HPO and determining the best mechanism to validate the lay synonyms. Additionally, not every term has a lay synonym or it may already exist in the HPO, such as ‘widow’s peak’ or ‘hitch hiker’s thumb’. Finally, some terms have complicated medical terminology, like ‘short distal phalanx of first finger’, for which a single layperson term is difficult to establish without using the definition of the term. The addition of layperson synonyms increases the usability of the HPO, making it useful for data interoperability across clinicians and patients. Additionally, this work will enable crowdsourcing by citizen scientists. The layperson synonyms are available in the latest release of the HPO.

Deep phenotyping has been defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described. The three components of the Human Phenotype Ontology (HPO; www.human-phenotype-ontology.org) project are the phenotype vocabulary, disease-phenotype annotations and the algorithms that operate on these. These components are being used for computational deep phenotyping and precision medicine as well as integration of clinical data into translational research. The HPO is being increasingly adopted as a standard for phenotypic abnormalities by diverse groups such as international rare disease organizations, registries, clinical labs, biomedical resources, and clinical software tools and will thereby contribute toward nascent efforts at global data exchange for identifying disease etiologies. This update article reviews the progress of the HPO project since the debut Nucleic Acids Research database article in 2014, including specific areas of expansion such as common (complex) disease, new algorithms for phenotype driven genomic discovery and diagnostics, integration of cross-species mapping efforts with the Mammalian Phenotype Ontology, an improved quality control pipeline, and the addition of patient-friendly terminology.

The purpose of this study was to determine if Hounsfield unit (HU) data can be used to differentiate between two lesions commonly found in the posterior mandible.

Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

We thank the authors for their comments and pointing out the omission of Wittkampf and Mourits from our bibliography. 1 Wittkampf A.R. Mourits M.P. A simple method for medial canthal reconstruction. Int J Oral Maxillofac Surg. 2001; 30: 342-343 Abstract Full Text PDF PubMed Scopus (16) Google Scholar Similar techniques have been described. 2 Howard G.R. Nerad J.A. Kersten R.C. Medial canthoplasty with microplate fixation. Arch Ophthalmol. 1992; 110: 1793-1797 Crossref PubMed Scopus (34) Google Scholar We agree that with such techniques, transnasal wiring is rarely needed in the reconstruction of the naso-orbito-ethmoid complex. 3 Engelstad M.E. Bastodkar P. Markiewicz M.R. Medial canthopexy using transcaruncular barb and miniplate: technique and cadaver study. Int J Oral Maxillofac Surg. 2012; 41: 1176-1185 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar

Traditional medial canthopexy techniques require transnasal access, periorbital skin incision, and/or direct canthal suturing, often yielding unpredictable outcomes. The transcaruncular canthal barb and miniplate technique is a simplified method of canthopexy that avoids these manoeuvres. 10 transcaruncular medial canthopexies were performed on cadavers with simulated naso-orbito-ethmoid (NOE) injury. Differences in mean pre-injury and post-canthopexy intercanthal distance (ICD) and palpebral aperture width (PAW) measurements were compared using a matched paired t test. Reliability between pre-injury and post-injury intercanthal distance and PAW was compared with intraclass correlation coefficients. Canalicular distortion and final implant position were assessed with post-canthopexy computed tomography (CT). There was no difference in mean palpebral aperture width (32.32 and 32.43mm) or mean intercanthal distance (29.18 and 29.06mm) between pre-injury and post-canthopexy groups (both p>0.05). All intercanthal distance and PAW intraclass correlation coefficients were >0.97 (p<0.05). Post-canthopexy, CT scans showed canaliculus distortion in 4/10 of upper and 0/10 of lower canaliculi with all canthal barbs in the correct position relative to the plate. In a cadaver telecanthus model, medial canthopexy using the transcaruncular barb and miniplate technique reliably reduces the medial canthus and did not distort the lower lacrimal canaliculus, but may distort the upper canaliculus.

Purpose: The management of some mandible fractures requires maxillomandibular fixation (MMF) intraoperatively but not postoperatively. Intraoperative MMF with arch bars has significant disadvantages, including duration of application and risk of disease transmission. Some surgeons have sought to minimize these disadvantages, improve efficiency, and decrease cost by omitting formal MMF altogether and manually stabilizing the occlusion. Embrasure wires are a method of intraoperative MMF with significant potential advantages. The purpose of this investigation was to compare embrasure wires with Erich arch bars (Karl Leibinger Co, Mulheim, Germany) for intraoperative stabilization of mandible fractures.Patients and Methods: This retrospective case review comprised 50 patients with a primary diagnosis of mandible fracture requiring open reduction-internal fixation with intraoperative MMF. Patients were categorized into 2 groups: intraoperative MMF using embrasure wires (group A) or intraoperative MMF using arch bars (group B). In each group the time required to place the MMF was recorded in whole minutes. The success or failure of the technique to maintain stable MMF throughout the procedure was assessed.Results: Intraoperative MMF was used with embrasure wires in 27 of 50 patients (54%) and with arch bars in 23 of 50 (46%). The mean time required for placement of embrasure wire MMF (2.51 minutes) was significantly (P < .001) less than the mean time required for placement of arch bar MMF (25.47 minutes). The quality of MMF was judged to be stable for the duration of fixation in 24 of 27 patients (89%) in the embrasure wire MMF group and 22 of the 23 patients (96%) in the arch bar group. This difference was not significant (P = .61).Conclusion: Embrasure wires can be placed in significantly less time than arch bars, and they provide a reliable form of intraoperative MMF during mandible fracture repair. For intraoperative MMF, embrasure wires offer significant advantages compared with arch bars by reducing application time. In addition, embrasure wires may reduce the risk of disease transmission by decreasing the number of wires required for MMF. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:120-124, 2011