BACKGROUND:Sickle cell anemia (SCA) is an autosomal recessive disorder characterized by a point mutation in the β-globin chain of the hemoglobin protein, causing abnormal folding. This can lead to sickling of red blood cells, agglutination, and ultimately vascular obstruction, which rarely occurs in the cervicofacial region. CASE DESCRIPTION:This report reviews a rare case of vaso-occlusive crisis (VOC) in the cervical vertebrae and mandible, manifesting as severe mandibular pain of unknown origin in a patient with SCA. The patient experienced diffuse body pain, 3 days in duration, and most prominent in the right hemimandible. Symptoms were refractory to hydration and analgesics, requiring intensive care unit admission. Jaw pain persisted, and magnetic resonance imaging of the face was significant for enhancement in the right posterior hemimandible with surrounding soft-tissue inflammatory changes. Differential diagnoses included osteonecrosis, osteomyelitis, odontogenic infection, extramedullary hematopoiesis, and VOC. The patient lacked signs and sequelae of infection or hematopoiesis; therefore, the pain was attributed to bone infarcts secondary to VOC. The patient was placed on a multimodal analgesic regimen with resolution of symptoms and was discharged in stable condition. PRACTICAL IMPLICATIONS:This case illustrates an unusual manifestation of severe jaw pain of unknown origin that was determined to be caused by VOC of the mandible. This highlights the need for dentists to understand SCA pathophysiology and their integral role in the diagnosis of atypical facial pain in patients with SCA. Dentists may be the first to recognize manifestations of SCA, emphasizing their role in patient education and interdisciplinary care.

Each year, 1 in every 700 babies is born with an orofacial cleft in the USA. Despite a well-established protocol for early cleft repair, the alveolar cleft persists during craniofacial growth. Current surgical treatments with bone grafts for alveolar cleft often provide inadequate nasal base support and insufficient alveolar bone volume for permanent tooth eruption. Here, we developed 3-dimensionally printed polycaprolactone scaffolds with controlled delivery of icariin (ICA) to facilitate bone reconstruction. After establishing a reliable fabrication process, we determined the optimal loading dose and release kinetics of ICA for induced osteogenic differentiation of bone marrow mesenchymal stem/progenitor cells and mineralized tissue formation in vitro. Then, the ICA-releasing polycaprolactone scaffolds with the preoptimized dose were implanted into rats with full-thickness maxillary defects. Up to 8 weeks, micro-computed tomography analyses demonstrated significantly accelerated bone healing and defect closure with an ICA-releasing scaffold compared to scaffold alone and defect controls. Histology consistently confirmed the formation of dense woven bone with ICA-releasing scaffolds in contrast to unclosed gaps and soft tissue infiltration in controls. Our findings suggest the significant potential of ICA-releasing 3-dimensionally printed scaffolds to serve as a patient-focused and custom-built bone graft to improve the clinical outcome of alveolar cleft reconstruction.

Each year, 1 in every 700 babies is born with an orofacial cleft in the USA. Despite a well-established protocol for early cleft repair, the alveolar cleft persists during craniofacial growth. Current surgical treatments with bone grafts for alveolar cleft often provide inadequate nasal base support and insufficient alveolar bone volume for permanent tooth eruption. Here, we developed 3-dimensionally printed polycaprolactone scaffolds with controlled delivery of icariin (ICA) to facilitate bone reconstruction. After establishing a reliable fabrication process, we determined the optimal loading dose and release kinetics of ICA for induced osteogenic differentiation of bone marrow mesenchymal stem/progenitor cells and mineralized tissue formation in vitro. Then, the ICA-releasing polycaprolactone scaffolds with the preoptimized dose were implanted into rats with full-thickness maxillary defects. Up to 8 weeks, micro-computed tomography analyses demonstrated significantly accelerated bone healing and defect closure with an ICA-releasing scaffold compared to scaffold alone and defect controls. Histology consistently confirmed the formation of dense woven bone with ICA-releasing scaffolds in contrast to unclosed gaps and soft tissue infiltration in controls. Our findings suggest the significant potential of ICA-releasing 3-dimensionally printed scaffolds to serve as a patient-focused and custom-built bone graft to improve the clinical outcome of alveolar cleft reconstruction.

Background: Cherubism is most commonly caused by rare heterozygous gain-of-function (GOF) missense variants in SH3BP2, which appear to signal through phospholipase C gamma 2 (PLCG2) to cause excessive osteoclast activity leading to expansile lesions in facial bones in childhood. GOF variants in PLCG2 lead to autoinflammatory PLCG2- associated antibody deficiency and immune dysregulation (autoinflammatory PLAID, or PLAID-GOF), characterized by variably penetrant autoinflammatory, autoimmune, infectious, and atopic manifestations. Cherubism has not been reported in PLAID to date. Objective: We determined whether GOF PLCG2 variants may be associated with cherubism. Methods: Clinical, laboratory, and genomic data from 2 patients with cherubism and other clinical symptoms observed in patients with PLCG2 variants were reviewed. Primary B-cell receptor-induced calcium flux was assessed by flow cytometry. Results: Two patients with lesions consistent with cherubism but no SH3BP2 variants were found to have rare PLCG2 variants previously shown to be GOF in vitro, leading to increased primary B-cell receptor-induced calcium flux in one patient's B cells. Variable humoral defects, autoinflammatory rash, and other clinical and laboratory findings consistent with PLAID were observed as well. Conclusion: GOF PLCG2 variants likely represent a novel genetic driver of cherubism and should be assessed in SH3BP2- negative cases. Expansile bony lesions expand the phenotypic landscape of autoinflammatory PLAID, and bone imaging should be considered in PLAID patients. (J Allergy Clin Immunol 2024;154:1554-8.)

OBJECTIVE:The purpose of this study was to identify factors associated with the management of the cleft dental gap after alveolar bone grafting. METHODS:This was a retrospective cohort study of patients with unilateral cleft lip and alveolus or palate who had successful alveolar bone grafting. Our primary study outcome was alveolar cleft management (orthodontic closure or space maintenance). Our secondary study outcome was the rate of fixed dental rehabilitation. Univariate comparisons were made with SAS 9.4. RESULTS:The final study sample consisted of 54 patients. Most patients were treated with orthodontic closure (55.6%). Patients missing multiple teeth ( P < 0.01) were less likely to receive orthodontic closure. Orthodontic closure was not associated with differences in intermaxillary midline coincidence ( P = 0.22) or the need for LeFort advancement ( P = 0.15). Only 41.7% of patients who were managed with space maintenance obtained a fixed prosthesis. Hispanic ethnicity ( P < 0.01) and Medicaid insurance ( P < 0.01) were associated with lower rates of fixed dental rehabilitation. CONCLUSIONS:Orthodontic closure was the most common approach, and it did not result in significant maxillary midline distortion. Less than half of patients treated with space maintenance obtained fixed restorations. Socioeconomic barriers are likely preventing access to definitive dental rehabilitation in patients with unilateral cleft lip and alveolus or palate.

Maxillomandibular advancement is a common orthognathic surgical procedure in the treatment of obstructive sleep apnea. Although rare, pseudoaneurysms may form following orthognathic surgery, which includes maxillomandibular advancement. Iatrogenic pseudoaneurysms from orthognathic surgery typically occur in the branches of the maxillary artery (sphenopalatine and descending palatine branches) or the facial artery, but uncommonly affect the inferior alveolar artery. We present a unique case of a pseudoaneurysm hemorrhage of the inferior alveolar artery on postoperative day 10 following maxillomandibular advancement diagnosed by computed tomographic angiography and successfully treated with fluoroscopy-guided endovascular embolization. Pseudoaneurysm hemorrhages of the inferior alveolar artery following orthognathic surgery are rare, with only 1 known published case report which occurred with significant intraoperative pulsatile bleeding. This is the only known case of a delayed inferior alveolar artery pseudoaneurysm bleed in the absence of significant intraoperative hemorrhage.

Objective:The pandemic caused by SARS-CoV-2 virus continues to have a profound effect worldwide. However, COVID-19 induced oral facial manifestations have not been fully described. We conducted a prospective study to demonstrate feasibility of anti-SARS-CoV-2 IgG and inflammatory cytokine detection in saliva. Our primary objective was to determine whether COVID-19 PCR positive patients with xerostomia or loss of taste had altered serum or saliva cytokine levels compared to COVID-19 PCR positive patients without those oral symptoms. Our secondary objective was to determine the correlation between serum and saliva COVID-19 antibody levels.Materials and methods:For cytokine analysis, saliva and serum were obtained from 17 participants with PCR-confirmed COVID-19 infection at three sequential time points, yielding 48 saliva samples and 19 paired saliva-serum samples from 14 of the 17 patients. For COVID-19 antibody analyses, an additional 27 paired saliva-serum samples from 22 patients were purchased.Results:The saliva antibody assay had 88.64% sensitivity [95% Confidence Interval (CI) 75.44%, 96.21%] to detect SARS-CoV-2 IgG antibodies compared to serum antibody. Among the inflammatory cytokines assessed - IL-6, TNF-α, IFN-γ, IL-10, IL-12p70, IL-1β, IL-8, IL-13, IL-2, IL-5, IL-7 and IL-17A, xerostomia correlated with lower levels of saliva IL-2 and TNF-α, and elevated levels of serum IL-12p70 and IL-10 (p < 0.05). Loss of taste was observed in patients with elevated serum IL-8 (p < 0.05).Conclusions:Further studies are needed to construct a robust saliva-based COVID-19 assay to assess antibody and inflammatory cytokine response, which has potential utility as a non-invasive monitoring modality during COVID-19 convalescence.

A 6-month-old infant arrived with parents for evaluation of an anterior floor of mouth swelling. The birth history was unremarkable, and the parents stated that the swelling had been present since birth. During the past few months, the oral swelling had enlarged progressively; however, the parents denied observing any difficulties with feeding or breathing. The parents noted no other medical abnormalities. On examination, a large, distensible mass was palpated at the anterior floor of the mouth.

BACKGROUNDA small radiolucent lesion is challenging for radiologists to make an accurate diagnosis, especially if it is asymptomatic and an incidental finding. It could go under the umbrella of the odontogenic or nonodontogenic cyst or tumor. We present a well-defined, corticated, expansile, unilocular radiolucency in the ramus of the mandible at the mandibular foramen level that proved to be a simple bone cyst.CASE REPORTAn 18-year-old female patient presented to our clinic following referral by her orthodontist for an incidental finding of a radiolucency in the left mandibular ramus. A panoramic radiograph and cone beam computed tomography (CBCT) were taken. No changes in size were noted on panoramic radiographs 3 months apart. On CBCT, the lesion was well-defined, corticated, ellipsoidal, mildly expansile, unilocular, and uniformly radiolucent. It was located in the left ramus, below the sigmoid notch, buccal and superior to the inferior alveolar canal and displacing the canal and the mandibular foramen with dissipation of the canal wall. The medial and lateral cortices of the ramus were thinned and expanded. The findings were consistent with less aggressive, slowly growing lesions including odontogenic keratocyst, ameloblastoma, and neurovascular lesions. On surgical exploration, the lesion was devoid of any epithelial lining and was completely empty.DISCUSSION/CONCLUSIONSSimple bone cysts are nonneoplastic “pseudocysts” that are found in the mandible. Only 2% are found in the maxilla and a very small number have been reported in the condyle toward the ramus, and no radiographic images located solitary in the ramus. This is the first report showing a simple bone cyst in the middle of the ramus of the mandible. A small radiolucent lesion is challenging for radiologists to make an accurate diagnosis, especially if it is asymptomatic and an incidental finding. It could go under the umbrella of the odontogenic or nonodontogenic cyst or tumor. We present a well-defined, corticated, expansile, unilocular radiolucency in the ramus of the mandible at the mandibular foramen level that proved to be a simple bone cyst. An 18-year-old female patient presented to our clinic following referral by her orthodontist for an incidental finding of a radiolucency in the left mandibular ramus. A panoramic radiograph and cone beam computed tomography (CBCT) were taken. No changes in size were noted on panoramic radiographs 3 months apart. On CBCT, the lesion was well-defined, corticated, ellipsoidal, mildly expansile, unilocular, and uniformly radiolucent. It was located in the left ramus, below the sigmoid notch, buccal and superior to the inferior alveolar canal and displacing the canal and the mandibular foramen with dissipation of the canal wall. The medial and lateral cortices of the ramus were thinned and expanded. The findings were consistent with less aggressive, slowly growing lesions including odontogenic keratocyst, ameloblastoma, and neurovascular lesions. On surgical exploration, the lesion was devoid of any epithelial lining and was completely empty. Simple bone cysts are nonneoplastic “pseudocysts” that are found in the mandible. Only 2% are found in the maxilla and a very small number have been reported in the condyle toward the ramus, and no radiographic images located solitary in the ramus. This is the first report showing a simple bone cyst in the middle of the ramus of the mandible.

Maxillomandibular ablation and reconstruction includes a series of procedures that can be disfiguring and emotionally traumatic for a patient while treating maxillofacial disease. Often times, the process of regaining full form and function may take months to years for a patient. With the advent of modern day technology and virtual surgical planning, some patients may benefit from a single operation that includes disease ablation, microvascular reconstruction, and immediate dental rehabilitation, also known as “Jaw in a Day”.

Purpose: Underlying psychiatric conditions are thought to influence the presentation, management, and outcomes of facially injured patients. Our study sought to determine if psychiatric diagnoses were associated with the decision to repair facial fractures during the index hospitalization. Methods: This was a cross-sectional review of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of a facial fracture were included in the study. The primary study predictor was the presence of a documented psychiatric illness. Covariates included patient age, insurance, injury mechanism, primary fracture location, other concomitant injuries, and Injury Severity Score. The study outcome was facial fracture treatment status (reduction or no reduction). A multiple logistic regression model was created to identify and measure independent factor associations for fracture treatment. Results: The final sample included 59,378 patients of whom 10,485 (17.7%) had a documented psychiatric illness. Most of these diagnoses involved substance use (62.5%). Patients with psychiatric illness had significantly higher rates of extra-nasal primary fracture location (56.2 vs 47.1%, P < .01) and a greater mean Injury Severity Score (5.0 vs 3.8, P < .01). In the unadjusted analysis, patients with psychiatric illness had higher rates of fracture repair during their index hospitalization (RR = 2.42, P < .01). After adjusting for covariates in the multiple logistic regression model, psychiatric illness became negatively associated with fracture repair (OR = 0.82, P < .01). Conclusions: Patients with psychiatric illness experienced higher rates of hospitalization and suffered more severe patterns of injury but had lower odds of fracture repair during their index hospitalization after controlling for injury characteristics. (C) 2021 The American Association of Oral and Maxillofacial Surgeons.

Healthcare, particularly the specialty of surgery, is characterized by higher levels of occupational stress and burnout when compared to other professions. 1 LaPorta LD Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers. ORAL MAXIL SURG CLIN. 2010; 22: 495-502 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar Occupational stress is the interplay between an individual and his/her environment. One of the primary factors in the extent of occupational stress an individual experiences is how much control he/she possesses over his/her job, the duties of his/her job, and the fashion in which the duties are performed to completion. 1 LaPorta LD Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers. ORAL MAXIL SURG CLIN. 2010; 22: 495-502 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar

Healthcare, particularly the specialty of surgery, is characterized by higher levels of occupational stress and burnout when compared to other professions. 1 LaPorta LD Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers. ORAL MAXIL SURG CLIN. 2010; 22: 495-502 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar Occupational stress is the interplay between an individual and his/her environment. One of the primary factors in the extent of occupational stress an individual experiences is how much control he/she possesses over his/her job, the duties of his/her job, and the fashion in which the duties are performed to completion. 1 LaPorta LD Occupational stress in oral and maxillofacial surgeons: tendencies, traits, and triggers. ORAL MAXIL SURG CLIN. 2010; 22: 495-502 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar

OBJECTIVE:The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden.MATERIALS AND METHODS:This was a retrospective cohort study of the Kids' Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome.RESULTS:The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures.CONCLUSIONS:Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.

The term “transgender” describes a discordance between an individual's identity and assigned birth sex. Transsexual patients constitute the subset who have made changes either in social adherence and/or to their physical characteristics. The transgender community is often the target of prejudice, which manifests as harassment, discrimination, and violence. As a result, these individuals frequently face social and legal marginalization that erodes their physical and emotional health. The goal of gender-affirming surgery is to improve the form and function of the person's sexual traits such that they resemble those of the identified gender. This group of cosmetic and reconstructive procedures has proved to be an integral tool for reducing gender dysphoria and improving overall well-being. Although the history of genital surgery for transgender individuals is long, it was not until the 1980s that Douglas Ousterhout, MD, DDS, first pioneered facial gender affirmation surgery.1Ousterhout D.K. Deschamps-Braly J.C. Special edition on transgender facial surgery.J Craniofac Surg. 2019; 30: 1326Crossref PubMed Scopus (7) Google Scholar His dental background and training in cephalometrics assisted him in developing normative data for the cranial and facial skeletons of males and females. Both facial feminization surgery (FFS) and facial masculinization surgery (FMS) involve altering the skeletal structure. FFS for transwomen has dominated most of these cases, and FMS has only been described and attempted more recently. Currently, oral and maxillofacial surgery (OMS) is in the midst of an unprecedented period of growth in both scope and eminence. Our specialty is also becoming increasingly diverse and constantly seeking out new methods to help different patient groups. OMS training uniquely equips our providers with the skills and abilities to perform facial affirmation surgery. Performing facial affirmation surgery does not require additional microvascular training, and many of the facial analysis and craniofacial principles are core to OMS. Orthognathic surgeons routinely adapt their surgical plan to a patient's ethnicity and gender. Familiarity with the remainder of the facial skeleton is learned through treating facial trauma. The most important adjustments in FFS and FMS are performed to the forehead and mandible. Even in the absence of other procedures, corrections to the forehead contour and hairline will be most frequently requested by patients because these results will be the most noticeable. In FFS, the brow ridge can be set back with an anterior table osteotomy or cranioplasty. The feminized brow is generally more arched than the flat male brow; this effect can be achieved with botulinum toxin type A injections or through a brow lift. The hairline itself can be advanced or retracted through modifications to a standard coronal approach. Mandibular feminization involves softening the gonial angles and chin through reduction osteotomies. Access can be obtained through the intraoral incisions that our surgeons routinely use.2Shams M.G. Motamedi M.H. Case report: Feminizing the male face.Eplasty. 2009; 9: e2PubMed Google Scholar FMS largely involves a set of opposing augmentation techniques. The frontal bone, gonial angles, and chin can be advanced or augmented with custom alloplastic implants. The eyebrow can likewise be modified with botulinum toxin injections, taking care to reduce the frontalis pull laterally so that the brow line dips and flattens. Many oral-maxillofacial surgeons also already provide other auxiliary procedures, such as submalar fat grafting and laser hair removal, to their cosmetic patients. Compared with its feminine counterpart, the male nose will typically be larger, with a more prominent dorsal hump. Also, female nasal tips will usually be tilted superiorly with a greater nasolabial angle. Either open rhinoplasty or fillers can be used to flatten the dorsal hump and rotate the nasal tip to obtain a more feminine morphology. In summary, all the techniques that have been described for facial affirmation surgery are well within the scope of OMS. Furthermore, our surgeons are in a unique position to address the diverse needs of this patient population because of our knowledge of facial anatomy and fluency with virtual surgical planning. The steepest challenge to OMS involvement is, therefore, determining how to insert ourselves into the conversation. Helping patients who are experiencing gender dysphoria requires a multidisciplinary team not dissimilar to that used to treat patients with craniofacial differences. At present, gender surgery is dominated by a small concentration of plastic and reconstructive surgeons. In addition, the care for these patients has been tightly confined to a few centers of excellence. The reported data also reflect this landscape, because none of the US OMS departments have reported any studies evaluating the outcomes or techniques in this young field. A recent study found that OMS trainees appreciate the importance of transgender care, despite their limited clinical exposure.3Ludwig D.C. Dodson T.B. Morrison S.D. U.SOral and maxillofacial residents' experience with transgender people and perceptions of gender-affirmation education: A national survey.J Dent Educ. 2019; 83: 103Crossref PubMed Scopus (4) Google Scholar This is reassuring because the need to improve access to these services is increasing. Although most plastic surgery residents will obtain adequate exposure to chest and genital surgery, only one third will have sufficient exposure to facial procedures.4Morrison S.D. Chong H.J. Dy G.W. et al.Educational exposure to transgender patient care in plastic surgery training.Plast Reconstr Surg. 2016; 138: 944Crossref PubMed Scopus (45) Google Scholar The demand for gender surgery will continue to increase owing to the greater cultural acceptance and expanding insurance coverage.5Canner J.K. Harfouch O. Kodadek L.M. et al.Temporal trends in gender-affirming surgery among transgender patients in the United States.JAMA Surg. 2018; 153: 609Crossref PubMed Scopus (148) Google Scholar The expertise of oral-maxillofacial surgeons places our specialty in a unique position to fill this future void. Previous advances in our specialty, such as the dual-degree pathway and the creation of a maxillofacial oncologic and reconstructive subspecialty, seemed equally daunting at their beginning. Those victories relied on the successful enterprises of a few exceptional individuals and institutions to open the doors for the rest of the specialty. Likewise, any future advances in gender surgery will need to follow a similar model. We are confident that oral-maxillofacial surgeons can serve the transgender community well, and we are hopeful that future opportunities will arise for our specialty to contribute its expertise to this important cause.

Purpose: This study sought to compare radiographic outcomes and resource utilization between recombinant human bone morphogenetic protein-2 (rhBMP-2) and anterior iliac crest bone graft (AICBG) when used for secondary alveolar grafting. Materials and Methods: This is a 14-year retrospective study of patients with alveolar clefts treated at the Morgan Stanley Children's Hospital of New York-Presbyterian/Columbia University Irving Medical Center between January 2006 and January 2020. Patients who had alveolar grafting with either rhBMP-2 or AICBG were included in this study. The primary study predictor was the graft material. The study outcomes were bone height, operating room time, and the number of scrubbed personnel (surgeon and assistants). Graft survival was measured at a minimum of 6 months postoperatively. Bone height was scored according to the Bergland scale, and radiographic success was defined as Bergland types 1 or 2. Results: The study sample included a total of 115 patients with 130 alveolar clefts. Overall, 13.0% of patients had bilateral repairs, and 17.4% were retreatments. The cumulative success rate was 89.5%. There were no differences in success between materials (rhBMP: 90.3%; AICBG: 89.1%; P = .85). Patients presenting for retreatment were more likely to receive rhBMP-2 than AICBG (48.6 vs 3.8%, P < .01). After controlling for other significant confounders, the rhBMP-2 group required less personnel (P < .01) and operating room time (P < .01). Only 1 patient in the rhBMP-2 group was admitted, whereas all AICBG patients were admitted a minimum of 1 night. Conclusions: Compared with AICBG, rhBMP-2 produced a similar height of bone but required less hospital resources. The decision to use harvested ilium or rhBMP-2 is not limited by outcome data at this time. More studies will need to be performed to identify the particular advantages of each graft material. The choice of material is currently both surgeon specific and patient specific and requires thorough informed consent. (C) 2020 American Association of Oral and Maxillofacial Surgeons

Joint disorders can be detrimental to quality of life. There is an unmet need for precise functional reconstruction of native-like cartilage and bone tissues in the craniofacial space and particularly for the temporomandibular joint (TMJ). Current surgical methods suffer from lack of precision and comorbidities and frequently involve multiple operations. Studies have sought to improve craniofacial bone grafts without addressing the cartilage, which is essential to TMJ function. For the human-sized TMJ in the Yucatan minipig model, we engineered autologous, biologically, and anatomically matched cartilage-bone grafts for repairing the ramus-condyle unit (RCU), a geometrically intricate structure subjected to complex loading forces. Using image-guided micromilling, anatomically precise scaffolds were created from decellularized bone matrix and infused with autologous adipose-derived chondrogenic and osteogenic progenitor cells. The resulting constructs were cultured in a dual perfusion bioreactor for 5 weeks before implantation. Six months after implantation, the bioengineered RCUs maintained their predefined anatomical structure and regenerated full-thickness, stratified, and mechanically robust cartilage over the underlying bone, to a greater extent than either autologous bone-only engineered grafts or acellular scaffolds. Tracking of implanted cells and parallel bioreactor studies enabled additional insights into the progression of cartilage and bone regeneration. This study demonstrates the feasibility of TMJ regeneration using anatomically precise, autologous, living cartilage-bone grafts for functional, personalized total joint replacement. Inclusion of the adjacent tissues such as soft connective tissues and the TMJ disc could further extend the functional integration of engineered RCUs with the host.

Purpose: The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. Materials and Methods: This is a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in this study if they involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. Results: A total of 11,916 records were included in the present study, of which 9.5% involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries occurred more often in older individuals (24.0 vs 8.5 years; P < .01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P < .01) and resulted in concussion (11.5 vs 5.6%; P < .01), fractures (6.7 vs 2.0%; P < .01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P < .01). Motorized scooter injuries had more than triple the admission rate compared to nonmotorized injuries (13.9 vs 3.7%; P < .01). After controlling for potential confounders, injuries from motorized scooters still had double the odds of hospital admission (odds ratio, 2.03; P < .01). Conclusions: Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters may pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles. (C) 2020 American Association of Oral and Maxillofacial Surgeons