(15) Best Practices in Oral and Maxillofacial Surgery: Incorporating a Survey Model for Consensus Building and Prompting Discussion

Abstract:

Introduction: Oral and maxillofacial surgery (OMS) is a specialized surgical discipline focused on the diagnosis and treatment of diseases, injuries, and defects involving the oral cavity, jaws, facial skeleton, and associated structures. With advancements in technology and increasing emphasis on patient-centered care, there is a growing need for evidence-based best practices to ensure consistent, high-quality outcomes. Best practices help standardize procedures, reduce variability in care, and improve patient safety and satisfaction. However, defining these practices can be challenging due to the complexity of OMS procedures and the variability in clinical experience and available evidence. This abstract provides an overview of a survey reviewing current best practices in OMS and explores how a poll can be applied to develop comprehensive clinical guidelines.

Methods: A standard poll was constructed by 5 oral and maxillofacial surgeons within a single private practice to assess 6 main categories: anesthesia, third molar extractions, implants, temporomandibular joint surgery, facial trauma, and orthognathic surgery. The survey was provided with multiple choice answers and included a total of 328 questions. For the purposes of this abstract, third molars extractions, implants, and anesthesia are reviewed below. Please see the attached link for additional data on orthognathic surgery, facial trauma, and temporomandibular surgery results.

Results: A survey was distributed to 151 surgeons, yielding 108 responses (71.5%). Among respondents, 84.3% practiced in a private setting, while 10.2% worked in an academic medical center. Regarding training, 52.8% completed a 6-year integrated MD program, and 30.6% pursued fellowship training. Full survey results are provided in the attached tables, with key findings summarized below.
Anesthesia Billing & Practice Patterns
• 42% began anesthesia time at IV insertion and ended it upon IV removal, while 33.7% billed from the moment they entered the room.
• 59% utilized 2 dental assistants, 18.1% employed 1 dental assistant and 1 advanced practitioner (eg, Nurse, CRNA, PA, NP), and 15.2% worked with 3 assistants.
• 38.8% had no weight or BMI restrictions, while 29.1% set a BMI limit of 40.
• 11.5% supplemented standard monitors with a precordial stethoscope.
• Medication:
o 72% did not use intramuscular (IM) ketamine.
o 17% avoided fentanyl in sedation cases.
o 69% administered IV fluids during sedation.
o 57% did not use long-acting anesthetics such as Exparel or Enduracaine.
• Emergency Preparedness: 57% stocked dantrolene in their offices.
Surgical & Clinical Practices
• Diagnosis Coding: Agreement on a specific diagnosis code for third molar impaction based on radiographs ranged from 53.4% to 70.9% of providers.
• Preoperative Antibiotic Use: 50% had patients swish and spit an antibiotic rinse preoperatively, while 25% prescribed a single oral antibiotic dose.
• Sinus Lifts: 62% performed vertical sinus lifts with an osteotome, whereas 33.7% used densification burs.
• Implant Placement in Infection Sites: 67% avoided placing implants in areas with acute infection, while 21.6% proceeded with placement.
This summary highlights notable variations in practice patterns among respondents. Full data analysis can be found in the accompanying tables.

Discussion: The development and implementation of best practices in OMS are essential for delivering high-quality, patient-centered care. Reaching an expert consensus, particularly in areas where clinical evidence may be limited or inconsistent is critical to the success of our field.

Conclusion: Best practices in oral and maxillofacial surgery are critical for ensuring patient safety, improving outcomes, and promoting evidence-based care. By engaging a diverse group of experts and using an iterative process, this initial survey method shows that there is a significant lack of consensus between our standards of care. We hope that this survey provides a foundation in improving clinical care and enhancing patient outcomes.