Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be

The coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons due to an increased risk of exposure to the virus during surgical procedures of the aero-digestive tract. The objective of this survey was to evaluate how the COVID-19 pandemic affected oral and maxillofacial surgery (OMFS) training programs during the early phase of the pandemic. Methods A cross-sectional survey was sent to the program directors of 95 out of the 101 accredited OMFS training programs between April 3 rd and May 6 th , 2020. The 35- question survey designed using Qualtrics software, to elicit information about the impact of COVID-19 on OMFS residency programs and the specific modifications made to clinical care, PPE and resident training/wellness to meet the response to the COVID-19 pandemic. Results The survey response rate from OMFS program directors was 35% (33/95) with most responses from states with high incidence of COVID19. All OMFS programs (100%) implemented guidelines to suspend elective and non-urgent surgical procedures and limited ambulatory clinic visits by third week of March, with an average date of March 16 th , 2020 (Date range March 8 th -23 rd ). Programs used telemedicine (40%) and modified in-person visit (51%) protocols for dental and maxillofacial emergency triage to minimize exposure risk of HCP to SARS CoV2. PPE shortage was experienced by 51% of the programs. Almost two-thirds (63%) of the respondents recommended the use of a filtered respirator (i.e., N95 respirator) with full face shield as their preferred PPE, while 21% recommended Powered Air Purifying Respirators (PAPRs) during OMFS procedures. Only (73%) of the programs had resources for resident wellness and stress reduction. Virtual didactic training sessions conducted on digital platforms, most commonly “Zoom” formed a major part of education for all programs. Conclusion All programs promptly responded to the pandemic by making appropriate changes to suspend elective surgery and, to limit patient care to emergent and urgent services. OMFS training programs should give more consideration to provide residents with adequate stress reduction resources to maintain their wellbeing and training to minimize exposure risk during an evolving global epidemic.

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Purpose: Patients with significant dentofacial deformities undergoing aesthetic and functional orthognathic surgery may often require genioplasty to advance the position of the pogonion relative to B point. No study to date has evaluated nationally registered data pertaining to addition of osseous genioplasty to bimaxillary orthognathic surgery and its associated clinical outcomes. Methods: Data was extracted from the National Surgical Quality Improvement Program from 2010 to 2018 using current procedural terminology codes pertaining to Le Fort I osteotomy (LF), bilateral sagittal split osteotomy (BSSO), and osseous genioplasty (G) and divided into 2 cohorts: bimaxillary orthognathic surgery with and without osseous genioplasty. Thirty-day postoperative outcomes inherently recorded within National Surgical Quality Improvement Program were identified and recorded. Chi-squared analysis and unpaired 2-tail t tests were performed between the cohorts and their respective outcomes to determine significant relationships with significance set as P < 0.05. Results: There were 373 patients double-or triple-jaw patients identified from the years 2010 to 2018. The most common recorded indication for LF/BSSO was maxillary hypoplasia (27.3%) and mandibular hypoplasia (6.8%). The most common indications for LF/BSSO/G were maxillary hypoplasia (16.1%) and maxillary asymmetry (16.1%). In comparison to LF/BBSO only, LF/ BSSO/GP was not associated with any differences in the rate of surgical (0.0% versus 0.31%, P ¼ 0.72) or medical complications (0.0% versus 0.63%, P ¼ 0.60), in addition to unplanned readmissions (0.0% versus 1.56% versus P ¼ 0.41) or reoperations (0.0% versus 1.25%, P ¼ 0.46). However, osseous genioplasty addition was associated with increased overall operating time (271.77 versus 231.75 minutes, P ¼ 0.04). Conclusions: Osseous genioplasty does not alter short-term, 30-day complication rate when performed with bimaxillary orthognathic surgery. As reoperation rates remained relatively unchanged, it can be inferred that immediate adverse events or patient dissatisfaction were not apparent within 30 days. Although mean operating time is slightly longer, cardiopulmonary resuscitation without medical comorbidity was achieved at the conclusion of the procedure.

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