Journal of Oral and Maxillofacial Surgery最新文献

Background: Patients with facial fractures are disproportionately uninsured or underinsured, creating a substantial economic burden for trauma systems. Although the Affordable Care Act (ACA) significantly expanded Medicaid eligibility, its effect on insurance coverage among adults with facial trauma remains poorly defined.

Purpose: The purpose of the study was to evaluate the association between ACA implementation and Medicaid coverage among adults presenting with isolated facial fractures.

Study design, setting sample: This was a retrospective cohort study using the American College of Surgeons National Trauma Data Bank from 2008 to 2019. Adults with isolated facial fractures were included. Patients with polytrauma or missing data were excluded.

Predictor variable: The primary predictor was time period relative to ACA implementation, defined as pre-ACA (2008 to 2013) or post-ACA (2014 to 2019).

Main outcome variable: The primary outcome was insurance payor at the time of encounter (Medicaid vs non-Medicaid).

Covariates: Covariates included demographic (age, sex), clinical (Charlson comorbidity index), injury-related (injury severity score, fracture location), and hospital characteristics (teaching status, bed size).

Analyses: Descriptive, bivariate, and multivariable logistic regression statistics were performed to evaluate the association between ACA implementation and Medicaid coverage. A threshold of P < .001 was considered significant for all analyses.

Results: A total of 187,803 subjects were included of which 47,315 (25%) were treated pre-ACA and 140,488 (75%) were treated post-ACA. The cohort had a mean age of 44.8 ± 20.2 years, was 73% male (n = 137,408), and 64% White (n = 119,674). Medicaid coverage increased from 16% pre-ACA to 24% post-ACA, with a corresponding decrease in self-pay from 30 to 20% (P < .001). After adjustment for demographic, clinical, injury-related, and hospital covariates, post-ACA treatment was associated with significantly higher odds of Medicaid coverage (odds ratio [OR]: 1.93, 95% CI: 1.88 to 1.99, P < .001). The relative increase in Medicaid coverage was greater at non-level 1 centers (OR: 1.93, 95% CI: 1.82 to 2.04, P < .001) compared to level 1 centers (OR: 1.34, 95% CI: 1.29 to 1.40, P < .001).

Conclusions and relevance: ACA implementation was associated with increased Medicaid coverage and reduced uninsured status. Medicaid expansion improved access to care; similar efforts may enhance the sustainability of facial trauma services within modern trauma systems.

Background: Temporomandibular disorders (TMDs) and obstructive sleep apnea (OSA) are prevalent conditions that frequently co-occur. It remains unclear if the presence of TMD is more likely to be associated with an increased risk of OSA.

Purpose: The purpose of the study was to measure the association between TMD and OSA.

Study design, setting, and sample: The researchers implemented a prospective cross-sectional study. Patients presenting to the Department of Oral and Maxillofacial Surgery at Mashhad Dental School diagnosed with a Diagnostic Criteria for Temporomanibular Disorder (DC/TMD)-confirmed diagnosis of TMD patients were screened and enrolled. Control subjects were identified from the same clinical setting and were age- and sex-matched individuals seeking routine dental care who did not meet the DC/TMD criteria for any TMD diagnosis.

Predictor/exposure/independent variable: The primary predictor variable was the TMD status, coded as present (TMD group) or absent (control group).

Main outcome variable(s): The primary outcome was the risk of OSA, measured as a continuous score (range 0 to 8) using the STOP-BANG questionnaire.

Covariate(s): The covariates included demographics (age, sex), anthropometric (body mass index, neck circumference), medical history (hypertension), maximum mouth opening, the presence of joint sounds, and the occurrence of mandibular deviation during movement.

Analyses: Nonparametric tests (Mann-Whitney U and χ² tests) compared groups. Multiple linear regression-independent predictors of the STOP-BANG score within the TMD group. The results report effect sizes with 95% CI. P < .05 was considered statistically significant.

Results: The sample was composed of 100 subjects with a mean age of 35.5 ± 13.8 years; 46 (46%) were male. There were 50 subjects in the TMD group and 50 subjects in the non-TMD group, respectively. The TMD group had a significantly higher mean STOP-BANG score than the non-TMD group (3.1 ± 1.9 vs 1.6 ± 1.9; mean difference: 1.5, 95% CI: 0.9 to 2.1, P < .001). High OSA risk, defined as a STOP-BANG score of ≥3, was significantly more prevalent in the TMD group (24 vs 4%; odds ratio = 7.6, 95% CI: 1.6 to 35.1, P = .004).

Conclusions and relevance: Subjects with TMD demonstrate a substantially elevated risk for OSA. These findings support integrating routine sleep apnea screening, using tools like the STOP-BANG questionnaire, into standard TMD clinical evaluation.

Background: The incidence of medication-related osteonecrosis of the jaw (MRONJ) is increasing, and maxillary MRONJ is frequently complicated by maxillary sinusitis, which may lead to severe complications if not adequately controlled.

Purpose: The purpose of the study was to evaluate the incidence and time to resolution of maxillary sinusitis in patients with MRONJ involving the posterior maxilla following surgical treatment and perioperative management and identify factors associated with the resolution process.

Study design, setting, and sample: This retrospective cohort study included subjects treated for MRONJ-associated maxillary sinusitis at Nanjing Stomatological Hospital between January 2013 and January 2025. Exclusion criteria included metastatic malignant tumors of the maxillofacial region, severe systemic disease contraindicating surgical treatment, and incomplete clinical data.

Predictor variable: The predictor variable was a set of heterogeneous factors including age, sex, MRONJ stage, primary disease, type and duration of antiresorptive therapy, preoperative grade of maxillary sinusitis, preservation of the maxillary sinus mucosa, maxillary sinus irrigation, and closure technique for oroantral communication.

Main outcome variable: The primary outcome variable was time to resolution of maxillary sinusitis, defined as complete radiographic resolution of maxillary sinus inflammation.

Covariates: N/A.

Analyses: Kaplan-Meier analysis and Cox proportional hazards regression were used to assess factors associated with time to resolution (P < .05).

Results: The sample included 28 subjects (mean age, 66.89 ± 10.99 years; seven male, 25%). During follow-up, 13 subjects (46.43%) achieved complete radiographic resolution. The 12-month cumulative incidence of resolution was 63.5%, with a median time to resolution of 9 months (interquartile range, 6.5 to 17.5 months). Kaplan-Meier analysis demonstrated a significant difference in resolution time according to preoperative sinusitis grade (P = .016). Cox regression identified preoperative sinusitis grade as an independent factor associated with delayed resolution (hazard ratio = 0.218; 95% CI, 0.056 to 0.851; P = .028).

Conclusion: Surgical treatment combined with perioperative management was associated with radiographic resolution of MRONJ-associated maxillary sinusitis in more than half of the subjects within 12 months. A higher preoperative sinusitis grade was associated with delayed resolution.