Purpose: To measure oral and maxillofacial surgery (OMS) chief resident case experience, including autonomy, and discover the role of this experience in developing resident confidence and determining the scope of practice on completion of training.Materials and Methods: A cross-sectional study was conducted using an online questionnaire made available to residents near the completion of their final year of training in United States OMS training programs. Predictors were the case numbers and autonomy level. Outcomes were the anticipated frequency of practice, confidence to meet the standard of care, and changes in anticipated practice scope. Each was measured in 10 domains within the scope of OMS.Results: Eighty-four residents (44%) completed the 116-item questionnaire. All respondents were "very confident" in their ability to meet the standard of care in mandibular trauma and dentoalveolar surgery. Autonomy was associated with the confidence to meet the standard of care in midface trauma, temporomandibular joint, orthognathic, cosmetic, pathology, reconstructive, and craniofacial surgery. Associations were noted between primary surgeon cases and confidence in midface trauma, temporomandibular joint, orthognathic, cosmetic, and craniofacial surgery. Case numbers were associated with an anticipated frequency of practice within the domains of midface trauma, temporomandibular joint, cosmetic, and pathology surgery.Conclusions: Results of this study suggest an association between a resident's surgical case experience (overall exposure and autonomy) and that resident's future plans for practice and confidence to meet the standard of care in this specialty. OMS training curricula should evolve to incorporate an evaluation of competence and an appropriate transfer of responsibility and experience to residents, thus maximizing confidence and future practice opportunities. (C) 2013 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 71:448-461, 2013
A 44-year-old woman with a history of Crohn's disease presented with a 1-week history of progressive abdominal distention, nausea, and feculent vomiting and reported having lost 13.6 kg during the preceding 6 months. She had undergone ileocecostomy 20 years earlier.
A 44-year-old woman with a history of Crohn's disease presented with a 1-week history of progressive abdominal distention, nausea, and feculent vomiting and reported having lost 13.6 kg during the preceding 6 months. She had undergone ileocecostomy 20 years earlier.
Fibrodysplasia ossificans progressiva (FOP) is a rare, debilitating disease characterized by intermittent swellings within body soft tissues that progressively transform to bone. The cause of this heterotropic bone formation is not clear. Various etiologies, including a genetic mutation in bone morphogenic protein (BMP) pathways, viral infection, and other inflammatory processes, have been postulated. Therapy includes corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants, although other treatments are being explored. It is troublesome to the oral and maxillofacial surgeon that minimal manipulation and minor surgery can induce bone formation in soft tissues of the head and neck region (particularly the parapharyngeal spaces), as well as temporomandibular joint (TMJ) ankylosis. Progression of disease can endanger the airway. Survival beyond a patient's fourth decade is uncommon.
