Sean P. Edwards

Computer-assisted craniomaxillofacial surgery.

Computer-assisted surgery (CAS) describes all forms of surgery planning or execution that incorporate various forms of advanced imaging, software, analysis, and planning and, in some cases, rapid prototyping technology, robotics, and image-guidance systems. Innovation is progressing rapidly, and new forms of technology continue to be incorporated and evaluated for their value in improving daily operations. This article reviews imaging, enhanced three-dimensional diagnostics, tactile models, CAS concepts, reconstructive surgery, bone flap shaping, distraction osteogenesis, and orthognathic surgery in relation to craniomaxillofacial surgery.

AXIN2-Associated Autosomal Dominant Ectodermal Dysplasia and Neoplastic Syndrome

We describe a family with a novel, inherited AXIN2 mutation (c.1989G>A) segregating in an autosomal dominant pattern with oligodontia and variable other findings including colonic polyposis, gastric polyps, a mild ectodermal dysplasia phenotype with sparse hair and eyebrows, and early onset colorectal and breast cancers. This novel mutation predicts p.Trp663X, which is a truncated protein that is missing the last three exons, including the DIX (Disheveled and AXIN interacting) domain. This nonsense mutation is predicted to destroy the inhibitory action of AXIN2 on WNT signaling. Previous authors have described an unrelated family with autosomal dominant oligodontia and a variable colorectal phenotype segregating with a nonsense mutation of AXIN2, as well as a frameshift AXIN2 mutation in an unrelated individual with oligodontia. Our report provides additional evidence supporting an autosomal dominant AXIN2‐associated ectodermal dysplasia and neoplastic syndrome.

Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report.

BackgroundApart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon.Case PresentationWe report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible.ConclusionsClinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

Choosing Academia Versus Private Practice: Factors Affecting Oral Maxillofacial Surgery Residents' Career Choices

PURPOSE This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. MATERIALS AND METHODS Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. RESULTS Residents who considered academia were more likely to be women (29% vs 8%; P < .001), from non-European American backgrounds (37% vs 20%; P = .006), were less likely to be married (43% vs 71%; P < .001), and were less likely to have children (17% vs 40%; P < .001) than residents who planned to become private practitioners. A larger percentage of residents with interest in private practice reported having debts of

Optimized Cell Survival and Seeding Efficiency for Craniofacial Tissue Engineering Using Clinical Stem Cell Therapy

301,000 to

The temporalis muscle flap in contemporary oral and maxillofacial surgery

400,000 compared with the percentage of residents interested in academia. No differences were found in the way they financed their education or in their financial considerations. However, the 2 groups differed in the importance they placed on different characteristics of their professional lives and in their job-related satisfaction. Residents interested in academia responded less positively to the statement that they are extremely satisfied with their career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. CONCLUSIONS These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia.

Prenatal Diagnosis and Treatment of Craniomaxillofacial Anomalies

Traumatic injuries involving the face are very common, yet the clinical management of the resulting craniofacial deficiencies is challenging. These injuries are commonly associated with missing teeth, for which replacement is compromised due to inadequate jawbone support. Using cell therapy, we report the upper jaw reconstruction of a patient who lost teeth and 75% of the supporting jawbone following injury. A mixed population of bone marrow‐derived autologous stem and progenitor cells was seeded onto β‐tricalcium phosphate (β‐TCP), which served as a scaffold to deliver cells directly to the defect. Conditions (temperature, incubation time) to achieve the highest cell survival and seeding efficiency were optimized. Four months after cell therapy, cone beam computed tomography and a bone biopsy were performed, and oral implants were placed to support an engineered dental prosthesis. Cell seeding efficiency (>81%) of the β‐TCP and survival during the seeding process (94%) were highest when cells were incubated with β‐TCP for 30 minutes, regardless of incubation temperature; however, at 1 hour, cell survival was highest when incubated at 4°C. Clinical, radiographic, and histological analyses confirmed that by 4 months, the cell therapy regenerated 80% of the original jawbone deficiency with vascularized, mineralized bone sufficient to stably place oral implants. Functional and aesthetic rehabilitation of the patient was successfully completed with installation of a dental prosthesis 6 months following implant placement. This proof‐of‐concept clinical report used an evidence‐based approach for the cell transplantation protocol used and is the first to describe a cell therapy for craniofacial trauma reconstruction.

Obstructive sleep apnea pretreatment and posttreatment in symptomatic children with congenital craniofacial malformations

The continued use of the temporalis muscle flap in maxillofacial surgery for over a century serves as a testament to its versatility and reliability. The technical ease of its procurement and the amount and quality of tissue available make this flap a valuable tool in the armamentarium of the reconstructive surgeon.

A Case of Imperforate Wharton Duct

Many advances in health care are built on the evolution of technology. An entirely new patient has emerged in fetal medicine, with these advances in prenatal imaging allowing one to see and diagnose disease not previously appreciated. Clinicians can better plan for the delivery of the neonate, with identified anomalies being optimally managed and the impact on the neonates health minimized. The oral and maxillofacial surgeon offers expertise in the management of craniomaxillofacial anomalies, including congenital tumors, facial clefts, craniosynostosis, micrognathia, and other congenital abnormalities. The techniques for perinatal care of the patient with craniofacial abnormalities continue to evolve as the technology improves. The authors describe their experience and some of the more common abnormalities with their management considerations that may be encountered by the oral and maxillofacial surgeon on the fetal diagnosis and treatment team.

Effect of mandibular advancement on the natural position of the head: A preliminary study of 3-dimensional cephalometric analysis

STUDY OBJECTIVES Obstructive sleep symptoms are common in children with craniofacial malformations (CFM). However objective data about obstructive sleep apnea (OSA) is still limited. The aims of this study were to investigate the frequency of OSA in symptomatic children with CFM and to determine improvement in severity of OSA after treatment. METHODS Symptomatic children with CFM referred for a diagnostic polysomnogram (PSG) were identified. Obstructive sleep apnea was defined as an apnea/hypopnea index (AHI) ≥ 1, with moderate/severe OSA as an AHI ≥ 5. RESULTS Overall, 151 symptomatic children were identified; 87% were diagnosed with OSA, of whom 24% had moderate-to-severe OSA. Children with syndromic CFM, compared to non-syndromic CFM, were more likely to have an AHI ≥ 5 (syndromic 33% vs. non-syndromic 15%, p = 0.02). Of the 131 children with OSA, 64 were treated and 32 returned for a posttreatment PSG, with 22 treated with either positive airway pressure (PAP) or adenotonsillectomy (AT). Children treated with PAP demonstrated a decrease in AHI from 6.2 to 3.5 (p = 0.057) and an increase in SpO2 from 89.1% to 91.1% (p = 0.091). There were no significant improvements for those in the AT group for either AHI (2.5 to 1.8, p = 0.19) or SpO2 (90.4% to 91.3%, p = 0.46). Normalization of the AHI (AHI < 1) occurred in only one child in each group (7% and 14% of the PAP and AT groups, respectively). CONCLUSIONS The vast majority of children with CFM referred for OSA evaluation are found to have objective evidence of OSA and a quarter of children have moderate-to-severe OSA. It is likely that many children with underlying OSA are not identified and referred for evaluation. Residual OSA after treatment is common in children with CFM.