John F. Helfrick

Considerations in the management of maxillofacial infections in the pregnant patient

PURPOSE The pregnant patient who presents with a maxillofacial infection requires additional management considerations. The maternal-fetal unit requires particular attention to maintain fetal viability, assure a normal pregnancy, and obtain a desirable outcome. The purpose of this article is to inform the oral and maxillofacial surgeon of the clinically relevant material that one needs to understand and consider when treating maxillofacial infections in this particular patient population.

A survey of oral and maxillofacial surgeons concerning their knowledge, beliefs, attitudes, and behavior relative to parameters of care.

In December 1990, a survey was sent to 1,296 randomly selected members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) to determine their previous experience with standards and criteria of care, their type of practice, the educational methods that influence their professional decisions, and their attitudes about the development and use of parameters of care. A 55.7% response was obtained. This article reports the results of this survey. The average age of responding surgeons was 45 years and they had been in practice an average of 15 years. The majority were in private practice, had hospital staff privileges, worked between 31 and 55 hours per week, spent 90% of their working week in direct patient care, and devoted an average of 9.16 hours per month to professional affairs outside of their practice. Forty-two percent (42%) of the practitioners were in solo practice, whereas 50% practiced in groups. Surgeons concentrated 65% of their patient care time on dentoalveolar surgery and a significant number planned increases in practice activity in implant, orthognathic, and temporomandibular joint surgery. They learned new clinical skills in various ways, there being a difference between the most convenient and effective methods of learning. A majority of surgeons had been involved with quality assurance activities in the past 5 years. They were predominantly favorable to parameters now and when they first learned about them, but few thought they had a clear understanding about how parameters of care would be used.(ABSTRACT TRUNCATED AT 250 WORDS)

The training and surgical scope of oral and maxillofacial surgeons: The international survey 1994

In 1992, the International Association of Oral and Maxillofacial Surgeons (IAOMS) published its training guidelines document. The following survey was conducted to determine the current status of the training and scope of practice of oral and maxillofacial surgeons (OMS) worldwide. Currently, 55% of OMS practice with a single degree, predominantly a dental degree (DDS), while only 16% of the responding countries require dual qualification (MD, DDS). There is a trend toward the dual degree (MD, DDS) in the remaining 29%. In general, in those countries where dual qualification is mandatory, the scope is broadest; however, the scope in a number of countries in which surgeons practice with only the DDS degree - for example, Japan - is equally broad. This baseline information will be used to monitor the growth and development of the speciality in the future.

Temporomandibular joint dysfunction in infancy

Temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders. Often, associated joint clicking or popping, aural fullness, vertigo, tinnitus, subjective hypoacusis, and nausea occur. As it has not been previously reported in infants, we would like to describe our experience with this disorder in an 11-month-old boy who was referred to our clinic with a presumed diagnosis of otitis media. The embryology of the temporomandibular joint is reviewed and appropriate treatment with anti-inflammatory analgesics, warm compresses, orthodontics, and external brace appliances is discussed. Because of referral patterns in the infant age group, the pediatric otolaryngologist should be similar with this entity and its presentation in children.

Technical considerations in mandibular ridge reconstruction with collagen/hydroxylapatite implants

A surgical technique for placement of a collagen-hydroxylapatite implant to augment severely atrophic mandibles is described.