Journal of Oral and Maxillofacial Surgery最新文献

{"title":"Foreign Language Syndrome Following Extraction of Wisdom Teeth Under General Anesthesia: A Case Report","authors":"Andrew T. Mathis DDS ,&nbsp;Jakub F. Pietrowski DDS ,&nbsp;David Y. Ahn DMD","doi":"10.1016/j.joms.2024.08.009","DOIUrl":"10.1016/j.joms.2024.08.009","url":null,"abstract":"<div><div>Foreign language syndrome (FLS) is a rare phenomenon described as transient fixation on a second language following anesthesia administration. There have only been 12 previously reported cases of FLS and none involving female patients or oral and maxillofacial surgery (OMS). While volatile anesthetics were administered during at least 2 cases, at minimum 5 cases occurred without volatile anesthetics - instead manifesting with IV sedation medications commonly used with OMS outpatient procedures (ie, midazolam, fentanyl, and propofol). In our case, a healthy 21-year-old female underwent extraction of wisdom teeth under general anesthesia and developed FLS. Our purpose is not to elucidate the poorly understood pathophysiology of FLS but raise awareness of its potential following OMS procedures. FLS may be difficult to diagnose but appears to be self-limiting and typically resolves within approximately 24 hours. No stroke workup is warranted, and discharge home is likely appropriate with phone follow-up the following day.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1515-1518"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Morphological Changes in the Upper Airway After Maxillary Reconstruction With an Anterolateral Thigh Flap","authors":"Hui Zhu MD ,&nbsp;Yao Yu MD ,&nbsp;Shuo Liu MD ,&nbsp;Wen Du MD ,&nbsp;Wenbo Zhang MD ,&nbsp;Xin Peng MD, DDS","doi":"10.1016/j.joms.2024.08.003","DOIUrl":"10.1016/j.joms.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Reconstruction of maxillary defects may lead to changes in the upper airway. These changes may cause postoperative airway obstruction issues.</div></div><div><h3>Purpose</h3><div>The purpose was to evaluate the postoperative changes in the upper airway following maxillary reconstruction with an anterolateral thigh flap (ALTF) and to identify the factors associated with these changes.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study involved 26 patients who underwent maxillectomy for maxillary tumors, followed by reconstruction using an ALTF. Patients with a history of upper respiratory system disease and sleep-disorder breathing were excluded.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was the residual rate of ALTF volume (ALTF-RS), calculated as the ratio of ALTF volume at 6 months postsurgery (T2) to that at 2 weeks postsurgery (T1).</div></div><div><h3>The Outcome Variables</h3><div>The outcome variables were the upper airway parameters. The upper airway was assessed at 3 time points: 1 week preoperatively (T0), T1, and T2. Ratios were used to represent airway changes over time.</div></div><div><h3>Covariates</h3><div>The covariates are age, sex, Brown classification, body mass index, hypertension, neck dissection, and tracheostomy, etc.</div></div><div><h3>Analyses</h3><div>Airway measurement differences between the three time points were analyzed by one-way analysis of variance. Pearson correlation and Spearman correlation analysis were used to analyze the correlation coefficients between airway changes and ALTF-RS. Statistical significance was established at a <em>P</em> value &lt; .05.</div></div><div><h3>Results</h3><div>The sample included 26 subjects with a mean age of 55.6 ± 15.2 years and 15/26 (57.7%) were male. Compared to T0, the nasopharyngeal and retropalatal airway volumes at T1 significantly decreased (<em>P</em> &lt; .05) but recovered or surpassed preoperative levels by T2. The minimum cross-sectional airway area significantly decreased by T1 (<em>P</em> &lt; .05), but increased by T2 (<em>P</em> &lt; .05). The narrowest airway section was predominantly in the palatopharyngeal airway. The airway changes of T2/T1 and ALTF-RS were not correlated (<em>P</em> &gt; .05) except for anterior-inferior point of the 4th cervical vertebra cross-sectional area (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion and Relevance</h3><div>The volumetric changes in the airway were not associated with ALTF-RS. The substantial narrowing of minimum cross-sectional airway area at T1 emphasized the need for vigilant airway management in these patients.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1627-1637"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Implants in Fibulas: Does the Implant to Fibula Osteotomy Distance Impact Early Implant Failure?","authors":"Timothy W. Neal DDS, MD ,&nbsp;Fayette C. Williams DDS, MD ,&nbsp;Brian R. Carr DMD, MD ,&nbsp;Taylor Pankey DDS ,&nbsp;Kari Teigen MPH ,&nbsp;Roderick Y. Kim DDS, MD, MBA","doi":"10.1016/j.joms.2024.09.001","DOIUrl":"10.1016/j.joms.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>When placing dental implants in the free fibula flap, the osteotomy cut edge poses a unique challenge in that an optimal distance has not yet been established.</div></div><div><h3>Purpose</h3><div>The study aimed to measure the association between implant-to-fibula osteotomy edge distance and early implant failure in patients who received free fibula flap reconstruction with immediate implants.</div></div><div><h3>Study Design, Setting, Sample</h3><div>A retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer with immediate dental implant placement for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022 at John Peter Smith Hospital. Subjects were excluded if the implant was in the middle of the free flap bordered by adjacent implants, was &gt;10 mm from the osteotomy edge, or had insertional torque values of ≤30 Ncm.</div></div><div><h3>Predictor Variable</h3><div>Primary predictor variable was the implant distance in millimeters from the fibula osteotomy edge.</div></div><div><h3>Main Outcome Variable</h3><div>Primary outcome variable was early implant failure, defined as implant exfoliation noted by the patient or failure due to implant movement or pain necessitating explantation within 6 months of placement.</div></div><div><h3>Covariates</h3><div>The covariates were age, sex, diabetes diagnosis, American Society of Anesthesiologists classification, smoking status, history of head and neck radiation, pathology treated, and if postoperative radiation treatment was received.</div></div><div><h3>Analyses</h3><div>A generalized estimating equations model was used to assess the relation between the primary predictor and outcome. A <em>P</em> value of &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>The sample was composed of 48 subjects who had 130 implants placed, with early failures occurring in 5 implants (3.9%) in 3 subjects. The mean age of the sample was 49 years (standard deviation [SD] 20) and 29 (60%) were male. The mean implant distances for early failures and nonfailures were 3.5 mm (SD 1.04) and 4.3 mm (SD 1.5), respectively. There was a statistically significant relation between implant distance and early implant failure (<em>P</em> = .005, odds ratio 0.6, 95% confidence interval 0.39 to 0.85).</div></div><div><h3>Conclusion and Relevance</h3><div>This study found that shorter distances between the implant and the edge of the fibula osteotomy are associated with early implant failure.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1620-1626"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Third Molar Extractions in Patients With Developmental Disabilities","authors":"Michael C. Britt ,&nbsp;Elise A. Sepe ,&nbsp;Mark A. Green DDS, MD","doi":"10.1016/j.joms.2024.08.012","DOIUrl":"10.1016/j.joms.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Patients with developmental disabilities may exhibit behavioral problems or be unable to maintain proper hygiene, potentially placing them at greater risk for infection following the extraction of third molars.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to estimate and compare the risk for surgical site infection after third molar removal between patients with and without developmental disabilities.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This was a retrospective cohort study of patients who underwent extraction of all four-third molars at Boston Children's Hospital from August 1, 2021, to July 31, 2023. Patients were excluded if all four-third molars were not present or if all four-third molars were not extracted during one visit.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor variable was developmental disability status. Subjects were grouped by developmental disability, coded as present or absent.</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome variable was diagnosis of a postoperative surgical site infection. Secondary outcomes included time to follow-up and infection treatment.</div></div><div><h3>Covariates</h3><div>Covariates included age, sex, race, ethnicity, procedure setting, anesthesia type, and impaction status.</div></div><div><h3>Analyses</h3><div>Independent Samples T-tests, χ² tests, and Fisher's Exact tests were used for analysis.</div></div><div><h3>Results</h3><div>A total of 1,896 subjects were evaluated. There were 236 subjects in the developmental disability group (72.5% male [n = 171] mean age of 19.3 ± 2.7 years) and 1,660 in the nondevelopmental disability group (53.4% female [n = 887] mean age of 19.0 ± 2.3 years). Subjects in the developmental disability group more frequently underwent their extractions in the operating room under general anesthesia (57.6% [n = 136] <em>P</em> &lt; .001). The overall postoperative infection rate was 2.7% (n = 52). There was no statistically significant difference in the rate of infection between the developmental disability group (0.8% [n = 2]) and the nondevelopmental disability group (3.0% [n = 50]) (<em>P</em> = .057). There was no significant difference in time to follow-up between subjects who were and were not diagnosed with an infection (6.26 ± 9.39 weeks vs 4.69 ± 10.95 weeks, <em>P</em> = .434) or for subjects in the developmental disability and nondevelopmental disability group who had an infection (2.64 ± 0.30 weeks vs 6.43 ± 9.76 weeks, <em>P</em> = .588).</div></div><div><h3>Conclusion and Relevance</h3><div>Patients with a developmental disability do not exhibit higher rates of postoperative infections following third molar extractions when compared to patients without developmental disabilities.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1569-1575"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Better Way to Select Oral and Maxillofacial Surgery Residents?","authors":"Gary F. Bouloux DDS, MD, MDSc","doi":"10.1016/j.joms.2024.08.065","DOIUrl":"10.1016/j.joms.2024.08.065","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1507-1508"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"December 2024: AAOMS News and Announcements","authors":"","doi":"10.1016/j.joms.2024.09.004","DOIUrl":"10.1016/j.joms.2024.09.004","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1638-1642"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Use of Injectable Platelet-Rich Fibrin Following Arthrocentesis for Disc Displacement Without Reduction Alleviate Pain?","authors":"Tahsin Tepecik DDS,&nbsp;Mehmet Zahit Baş DDS","doi":"10.1016/j.joms.2024.09.002","DOIUrl":"10.1016/j.joms.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>The role of adjunctive injection agents at the end of temporomandibular joint (TMJ) arthrocentesis remains controversial.</div></div><div><h3>Purpose</h3><div>This study aims to compare pain reduction in patients with disc displacement without reduction treated with arthrocentesis alone (AO), arthrocentesis with injectable platelet-rich fibrin (iPRF), and arthrocentesis with hyaluronic acid (HA).</div></div><div><h3>Study Design, Setting, and Sample</h3><div>A single-center, retrospective cohort study was conducted at the affiliated hospital of Health Sciences University, Hamidiye Faculty of Dentistry. Inclusion criteria were female subjects aged 18-65, who underwent TMJ unilateral arthrocentesis, and diagnosed with disc displacement without reduction. Exclusion criteria were prior use of occlusal splints, accompanying diagnosis of myalgia and bilateral arthralgia which both of the joints exceeds or equal to 50 mm visual analogue scale for pain (pVAS) value.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor variable was the adjunctive injection agent: iPRF, HA, or no injection (AO as control).</div></div><div><h3>Main Outcome Variables</h3><div>Primary and secondary outcomes were measured preoperatively (T0), and at 1 month (T1) and 6 months (T2) postoperatively. The primary outcome was pain (pVAS) at T2. Secondary outcomes were pVAS at T1 and maximum interincisal opening at T1 and T2.</div></div><div><h3>Covariates</h3><div>Demographics, preoperative and perioperative data were collected.</div></div><div><h3>Analyses</h3><div>Descriptive, bivariate, and multivariate analyses were conducted. The <em>P</em> value was set at ≤.05.</div></div><div><h3>Results</h3><div>A total of 88 subjects completed the study. The mean age of the subjects in the AO (n = 30), HA (n = 29) and iPRF (n = 29) groups was 36.8 (±10.2), 34.8 (±8.9) and 37.6 (±11.6) respectively (<em>P</em> &gt; .05). The mean pVAS scores at T0 for the AO, HA and iPRF groups were 63.2 (±8.7), 66.7 (±9.6) and 66.2 (±9.6) respectively (<em>P</em> &gt; .05). The mean pVAS scores at T1 were 36.5 (±10.8), 29.0(±11.5) and 35.9 (±9.8) respectively (<em>P</em> &lt; .05). The mean pVAS scores at T2 were 34.8 (±16.3), 24.7 (±12.7) and 25.3 (±13.4) respectively (<em>P</em> &lt; .05). There were no differences in maximum interincisal opening between the groups at any timepoint (<em>P</em> &gt; .05).</div></div><div><h3>Conclusion and Relevance</h3><div>iPRF and HA injections are associated with greater pain relief compared to AO. No significant difference was observed between iPRF and HA, suggesting that the choice between them can be based on cost-effectiveness.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1519-1527"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Insurance Payor Associated With Hospital Admission of Emergency Department Adult Patients With Odontogenic Infections?","authors":"Lang Liang BS ,&nbsp;Tim T. Wang DMD, MD, MPH ,&nbsp;Cameron C. Lee DMD, MD ,&nbsp;Zachary S. Peacock DMD, MD","doi":"10.1016/j.joms.2024.08.062","DOIUrl":"10.1016/j.joms.2024.08.062","url":null,"abstract":"<div><h3>Background</h3><div>Patients who present to the emergency department (ED) with severe odontogenic infections are often hospitalized for surgical drainage and medical management. However, inpatient management of these patients can be financially burdensome. While medical indications for hospital admission are well established, it remains unclear if patient insurance status is associated with admission.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to determine the nationally representative estimates of the incidence of hospital admission for patients with odontogenic infections and the association with insurance payor.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study used the 2018 Nationwide Emergency Department Sample. Patients with odontogenic infections (based on International Classification of Diseases, 10th Revision codes) were included. Patients aged &lt;18 years or who had missing data were excluded.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor variable was primary payor (private insurance, Medicare, Medicaid, self-pay, and other).</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome variable was hospital admission (yes/no).</div></div><div><h3>Covariates</h3><div>Covariates included sociodemographic, medical, infection, and hospital variables.</div></div><div><h3>Analyses</h3><div>Descriptive, bivariate, and multivariable logistic regression analyses were used to determine national estimates and predictors of admission. Odds ratios and 99% confidence intervals were computed. Discharge weights were accounted for in all analyses to provide nationally representative estimates.</div></div><div><h3>Results</h3><div>This study included 31,221 weighted ED encounters, of which 10,451 (33.5%) were admitted. In the study cohort, 7,687 (24.6%) had private insurance, 5,046 (16.2%) had Medicare, 10,070 (32.3%) had Medicaid, 7,436 (23.8%) were self-pay, and 982 (3.1%) had other. Bivariate analysis suggested that payor status was significantly associated with hospital admission (<em>P</em> &lt; .01). The multivariable analysis showed that self-pay patients had significantly lower odds of hospital admission compared to those with private insurance (odds ratio, 0.54; 99% confidence interval, 0.42-0.70). Other independent predictors of hospital admission included infection in more than 1 location based on International Classification of Diseases, 10th Revision code, higher Charlson comorbidity index, and alcohol/substance use disorders.</div></div><div><h3>Conclusion and Relevance</h3><div>Approximately one-third of patients presenting to the ED with odontogenic infections were admitted. Patients with no insurance were less likely to be admitted compared to those with private insurance. This finding may reflect multiple possibilities, including hospital financial incentives.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1576-1584"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REPLY: The Risk of Medication-Related Osteonecrosis of the Jaw in Children: Guidance for Antiresorptive Use in Pediatric Patients","authors":"Sasha Lasky BS,&nbsp;Tayla Moshal BS,&nbsp;Pasha Shakoori MD, DDS,&nbsp;Idean Roohani BS,&nbsp;Marah Jolibois MS,&nbsp;Simon Youn MD, DDS,&nbsp;Eloise Stanton MD,&nbsp;Mark M. Urata MD, DDS,&nbsp;Jeffrey A. Hammoudeh MD, DDS","doi":"10.1016/j.joms.2024.08.061","DOIUrl":"10.1016/j.joms.2024.08.061","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Page 1514"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Dental Specialty Referral Associated With Earlier Presentation of Oral Cavity Squamous Cell Carcinoma?","authors":"Kevin C. Lee MD, DDS ,&nbsp;Jae Gardella BA ,&nbsp;Robert Balsiger DO ,&nbsp;Anurag K. Singh MD ,&nbsp;Wesley L. Hicks Jr. MD, DDS ,&nbsp;Michael R. Markiewicz MD, DDS, MPH ,&nbsp;Ayham Al Afif MD, MSc","doi":"10.1016/j.joms.2024.08.004","DOIUrl":"10.1016/j.joms.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Oral cavity squamous cell carcinoma (OSCC) may mimic other more common odontogenic processes such as infection, trauma, and benign pathology. Delays in diagnosis and treatment are known to result in poorer survival outcomes.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between referral type and OSCC stage at time of presentation.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This was a retrospective cohort study composed of newly diagnosed OSCC patients treated with surgical resection from 2014 to 2023 at Roswell Park Comprehensive Cancer Center. Patients who presented with self-referrals or had surgical treatment outside of Roswell Park Comprehensive Cancer Center were excluded.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor was referral source (dental vs medical specialty).</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome was pathological T stage (pT stage). The secondary outcome was overall survival (OS).</div></div><div><h3>Covariates</h3><div>Covariates included demographic data and cancer-related variables (symptomatology, subsite, and risk factors).</div></div><div><h3>Analyses</h3><div>A multivariate logistical regression model for pT stage was constructed using all significant covariates as well as preoperative patient and tumor characteristics. For OS, Kaplan-Meier survival curves were constructed and compared with the log-rank test. A <em>P</em> &lt; .05 was considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 215 subjects were included in the study sample. The majority were referred by a dental provider (n = 132, 62.3%). Dental referrals presented with significantly earlier T stage disease (RR_pT3/T4 0.65, <em>P</em> &lt; .01) and had lower rates of cervical nodal positivity (RR_pN1-N3 0.62, <em>P</em> = .01). Dental referral independently increased the odds of early pT stage presentation (odds ratio 5.10, <em>P</em> &lt; .01) after controlling for age, sex, oral pain symptoms, social history (smoking and drinking), head neck cancer history, and tumor subsite. Dental referrals had significantly improved OS (<em>P</em> = .03) and were also associated with lower rates of oral pain symptoms (RR_{oral pain} 0.80, <em>P</em> = .02), lymphovascular invasion (RR_LVI 0.50; <em>P</em> = .04), and perineural invasion (RR_PNI 0.63, <em>P</em> = .04).</div></div><div><h3>Conclusions and Relevance</h3><div>Among subjects with similar risk factors, those referred from dental providers were found to have earlier stage disease. Unfortunately, over half of dental referrals still presented with pain symptoms and more than a third presented with locally advanced disease. Dental providers appear to be positioned to detect earlier OSCC; however, there is room for improvement.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1610-1619"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}