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Poster 70: Internal Hardware Removal After Treatment of Maxillofacial Fractures
Anesthesia dure. The findings of this study warrant further investigation with a full scale study using multiple models. References: A biomechanical evaluation of mandibular angle fracture plating techniques. Journal of Oral and Maxillofacial Surgery, Volume 59, Issue 10, October 2001, Pages 1199-1210. Richard H. Haug, Tirbod T. Fattahi, Michele Goltz Superior Border Plating Technique in the Management of Isolated Mandibular Angle Fractures: A Retrospective Study of 50 Consecutive Patients. Journal of Oral and Maxillofacial Surgery, Volume 65, Issue 8, August 2007, Pages 1544-1549. Conor P. Barry, Gerard J. Kearns
POSTER 69 External Carotid Artery Dissection Secondary to Traumatic Fracture of the Hyoid Bone: Report of a Case and Review of the Literature B. Hersh: Thomas Jefferson University Hospital, R. Diecidue, L. Gold Statement of the Problem: Hyoid bone fractures secondary to blunt trauma other than strangulation are both rare and often undiagnosed. However, the potential morbidities associated with this type of fracture are significant. Most prominent is the potential for external carotid artery dissection and pseudoaneurysm. If not diagnosed properly and treated immediately, mortality can occur. Materials and Methods: Literature review of cases reported over the past 55 years. Review includes etiology of injury, diagnostics, co-morbidities, treatment, and outcome. Report of a recent case at Thomas Jefferson University Hospital. Results of Investigation: Fracture of the hyoid bone is rare, accounting for only 0.002% of all fractures. Less than 40 cases have been published over the past 55 years. Conclusion: Although rarely reported in the literature, Oral and Maxillofacial Surgeons need to be aware of the possibility of hyoid bone fractures secondary to blunt trauma due to its high mortality potential. Hyoid fracture is difficult to diagnose, especially prior to causing further damage. Most often the associated co-morbidity is external carotid artery dissection and pseudoaneurysm. If not diagnosed immediately and treated with embolization or ligation, this can lead to mortality. The incidence of this type of hyoid fracture is increased in patients who have osteoradionecrosis of the head and neck region. A thorough medical history significant for radiation therapy may give a clue that leads to efficient diagnosis and treatment of hyoid fractures.
POSTER 70 Internal Hardware Removal After Treatment of Maxillofacial Fractures M. D. Murray: Loma Linda University, J. Dean, A. Herford Statement of the Problem: Facial fractures are commonly treated by oral and maxillofacial surgeons. Many methods exist for the treatment of fractures and most fractures are treated with a type of internal fixation and rigid fixation. After the treatment of the fractures with internal rigid fixation the hardware has to be removed on occasion. The aim of this study is to identify the rates and reasons for plate removal for patients that were treated for facial fractures and to investigate for methods of prevention. Materials and Methods: This experiment was a retrospective review of patient information to identify reasons for hardware removal for patients treated for maxillofacial fractures. Patient information was gathered on facial fractures treated by the Oral and Maxillofacial Surgery Team. Patient data was collected over a 5-year period from January 1, 2006, to December 31, 2010. Data were gathered from 3 busy trauma hospitals—Loma Linda University, a level 1 trauma center, Arrowhead Regional Medical Center and Riverside County Regional Medical center, both level 2 trauma centers. Study variables included age, sex, diagnosis, type of fracture, approach to the facial skeleton, presence of teeth in the line of fracture, site of hardware, use of maxillomandibular fixation postoperatively, and reasons for plate removal. Methods of Data Analysis: There were 1,748 patients with facial fractures treated in the 5-year period in the operating room. There were 183 patients that had hardware removed during the same time period. Descriptive and quantitative statistics were undertaken. Results of Investigation: The reasons for hardware removal were gathered and included pain, palpation by the patient, temperature sensitivity, and infection. Infection was the most common cause for removal. The mandibular angle fracture was the most common location to remove the plate from. Mandible fractures treated with maxillomandibular fixation for at least 2 weeks after open reduction internal fixation had a lower incidence of plate removal. Concusion: Selection of favorable plate location, infection control, close follow-up of patients, and consideration of maxillomandibular fixation may reduce plate removal rates in patients treated for maxillofacial fractures.
References:
References:
Dalati T. Isolated hyoid bone fracture. Review of an unusual entity. Int J Oral Maxillofac Surg 2005;34;449-52 Yoo J, Rosenthal D, Mitchell K, Ginsberg L. Osteoradionecrosis of the Hyoid Bone: Imaging Findings. Am J Neuroradiol 31:761-66
Thoren, H, Snall, J, et al: Symptomatic Plate Removal After Treatment of Facial Fracture. Journal of Cranio-Maxillo-Facial Surgery (2010) 38: 505-510. Bhatt V, Langford R. Removal of Miniplates in Maxillofacial Surgery:
e-92
AAOMS • 2011
Anesthesia University Hospital Birmingham Experience. J Oral Maxillofac Surg 61:553-556, 2003.
POSTER 71 Facial Trauma Treatment of Medicare Patients by Oral and Maxillofacial Surgeons: Incidence and Financial Factors at a Level One Trauma Center in 2010 B. Lewallen: Vanderbilt University Medical Center, V. Saraiya, S. Press Statement of the Problem: Between 2007 and 2009 Medicare reimbursement of professional fees increased slightly, and the number of Medicare maxillofacial trauma patients increased from 2% to 5%. The future of Medicare will depend on recent health care legislation, the aging of the population, and the health of federal budgets. Emergency departments and trauma centers are the safety net for trauma care in the United States, and oral and maxillofacial surgeons (OMS) are on the front lines of treating facial trauma. Articulation of OMS contributions are necessary to inform organizations like the American College of Surgeons who removed “oral/maxillofacial surgery” from its 2006 publication, Resources for Optimal Care of the Injured Patient. This study is a comprehensive analysis of the Medicare facial trauma care provided by OMS with comparison to other payer groups at a level one trauma center. Materials and Methods: Deidentified data were collected for all facial trauma patients treated by the OMS department at Nashville, Tennessee’s only level one trauma center during 2010. Patients were identified by ICD-9 codes to include all maxillofacial trauma. Patients with isolated dentoalveolar injuries were excluded, but isolated soft tissue injuries were included. Data collected included patient age, race, sex, length of stay, maxillofacial injury (ICD-9 code), maxillofacial procedures performed (CPT), charges, collections, contractuals, and necessary write-offs to the patients, provider, and insurer. Methods of Data Analysis: Summary statistics were collected based on payer status and demographics and compared across different groups with the use of independent T-test where appropriate. The variance in reimbursement of professional charges across payers was calculated with a charge recovery ratio (collections/ charges). Correlation statistics and 2 tests were used as measures of association and variance between demographics, procedures, and financial variables. Results of Investigation: In 2010, 335 patients (611 procedures) were treated for facial trauma, and 29 (8.7%) of these patients were Medicare patients. Mean age was 36.01 (1.49-90.53, SD 19.23), while mean AAOMS • 2011
Medicare age was 67 (31-91, SD 19). Professional fees averaged $6,632 overall, while Medicare patient bills averaged $8,235. Average charges for individual procedures based on ICD-9 was $2,825, and average collections were $739, compared to average Medicare charges and collections of $3,227 and $475, respectively. Medicare average charge per procedure was second only to charges to workers compensation patients ($3,336 vs $3,227), and the collections were lowest of any payer group ($475). Percent reimbursement (collections/ charges) was also lowest for Medicare patients at 13.8%, nearly 3.5 times less than the highest reimbursement group. As age increased, charges decreased and collections increased, but these associations were loosely correlated. Medicare had the lowest reimbursement for midface procedures at 13% with an average of only $394 collected per procedure. Mandible (15%) and soft tissue (10%) reimbursement was also the lowest for Medicare patients. Across all patients and procedures, Medicare soft tissue procedures averaged the least at $67. In this sample hospital charges averaged $97,829 (SD $127,136) with length of stay averaging 5.35 days. Conclusion: Medicare maxillofacial trauma patients currently comprise a small percentage of overall patients at this level one trauma center; however, with expected increases in Medicare enrollment, hospitals will struggle to compensate for the alarmingly low reimbursements. Epidemiologic and financial awareness of Medicare patients will equip OMS clinicians with the information needed to advocate for Medicare financing, and ensure continued involvement for OMS at trauma centers and through residency training. References: DeLia D, Cantor J. Emergency Department Utilization and Capacity. Research Synthesis Report No. 17. Princeton, New Jersey: Robert Wood Johnson Foundation; 2009. ACS. Resources for Optimal Care of the Injured Patient: 2006.
POSTER 72 Maxillofacial Trauma Treatment of Medicaid Patients at a Level One Trauma Center: Financial and Epidemiologic Cross-Sectional Analysis for 2010 B. Lewallen, B. DeLong: Vanderbilt University Medical Center, S. Press Statement of the Problem: Last year we postulated a connection between the economic recession and a shift of maxillofacial trauma payer status patients from private and commercial to federal insurers. Medicaid patients at Vanderbilt Medical Center, treated by OMS for facial trauma increased from 10% to 18%, while the reimbursement from these patients decreased from 26% to 22% from 2007 to 2009. Medicaid cost sharing probe-93
POSTER 69 External Carotid Artery Dissection Secondary to Traumatic Fracture of the Hyoid Bone: Report of a Case and Review of the Literature B. Hersh: Thomas Jefferson University Hospital, R. Diecidue, L. Gold Statement of the Problem: Hyoid bone fractures secondary to blunt trauma other than strangulation are both rare and often undiagnosed. However, the potential morbidities associated with this type of fracture are significant. Most prominent is the potential for external carotid artery dissection and pseudoaneurysm. If not diagnosed properly and treated immediately, mortality can occur. Materials and Methods: Literature review of cases reported over the past 55 years. Review includes etiology of injury, diagnostics, co-morbidities, treatment, and outcome. Report of a recent case at Thomas Jefferson University Hospital. Results of Investigation: Fracture of the hyoid bone is rare, accounting for only 0.002% of all fractures. Less than 40 cases have been published over the past 55 years. Conclusion: Although rarely reported in the literature, Oral and Maxillofacial Surgeons need to be aware of the possibility of hyoid bone fractures secondary to blunt trauma due to its high mortality potential. Hyoid fracture is difficult to diagnose, especially prior to causing further damage. Most often the associated co-morbidity is external carotid artery dissection and pseudoaneurysm. If not diagnosed immediately and treated with embolization or ligation, this can lead to mortality. The incidence of this type of hyoid fracture is increased in patients who have osteoradionecrosis of the head and neck region. A thorough medical history significant for radiation therapy may give a clue that leads to efficient diagnosis and treatment of hyoid fractures.
POSTER 70 Internal Hardware Removal After Treatment of Maxillofacial Fractures M. D. Murray: Loma Linda University, J. Dean, A. Herford Statement of the Problem: Facial fractures are commonly treated by oral and maxillofacial surgeons. Many methods exist for the treatment of fractures and most fractures are treated with a type of internal fixation and rigid fixation. After the treatment of the fractures with internal rigid fixation the hardware has to be removed on occasion. The aim of this study is to identify the rates and reasons for plate removal for patients that were treated for facial fractures and to investigate for methods of prevention. Materials and Methods: This experiment was a retrospective review of patient information to identify reasons for hardware removal for patients treated for maxillofacial fractures. Patient information was gathered on facial fractures treated by the Oral and Maxillofacial Surgery Team. Patient data was collected over a 5-year period from January 1, 2006, to December 31, 2010. Data were gathered from 3 busy trauma hospitals—Loma Linda University, a level 1 trauma center, Arrowhead Regional Medical Center and Riverside County Regional Medical center, both level 2 trauma centers. Study variables included age, sex, diagnosis, type of fracture, approach to the facial skeleton, presence of teeth in the line of fracture, site of hardware, use of maxillomandibular fixation postoperatively, and reasons for plate removal. Methods of Data Analysis: There were 1,748 patients with facial fractures treated in the 5-year period in the operating room. There were 183 patients that had hardware removed during the same time period. Descriptive and quantitative statistics were undertaken. Results of Investigation: The reasons for hardware removal were gathered and included pain, palpation by the patient, temperature sensitivity, and infection. Infection was the most common cause for removal. The mandibular angle fracture was the most common location to remove the plate from. Mandible fractures treated with maxillomandibular fixation for at least 2 weeks after open reduction internal fixation had a lower incidence of plate removal. Concusion: Selection of favorable plate location, infection control, close follow-up of patients, and consideration of maxillomandibular fixation may reduce plate removal rates in patients treated for maxillofacial fractures.
References:
References:
Dalati T. Isolated hyoid bone fracture. Review of an unusual entity. Int J Oral Maxillofac Surg 2005;34;449-52 Yoo J, Rosenthal D, Mitchell K, Ginsberg L. Osteoradionecrosis of the Hyoid Bone: Imaging Findings. Am J Neuroradiol 31:761-66
Thoren, H, Snall, J, et al: Symptomatic Plate Removal After Treatment of Facial Fracture. Journal of Cranio-Maxillo-Facial Surgery (2010) 38: 505-510. Bhatt V, Langford R. Removal of Miniplates in Maxillofacial Surgery:
e-92
AAOMS • 2011
Anesthesia University Hospital Birmingham Experience. J Oral Maxillofac Surg 61:553-556, 2003.
POSTER 71 Facial Trauma Treatment of Medicare Patients by Oral and Maxillofacial Surgeons: Incidence and Financial Factors at a Level One Trauma Center in 2010 B. Lewallen: Vanderbilt University Medical Center, V. Saraiya, S. Press Statement of the Problem: Between 2007 and 2009 Medicare reimbursement of professional fees increased slightly, and the number of Medicare maxillofacial trauma patients increased from 2% to 5%. The future of Medicare will depend on recent health care legislation, the aging of the population, and the health of federal budgets. Emergency departments and trauma centers are the safety net for trauma care in the United States, and oral and maxillofacial surgeons (OMS) are on the front lines of treating facial trauma. Articulation of OMS contributions are necessary to inform organizations like the American College of Surgeons who removed “oral/maxillofacial surgery” from its 2006 publication, Resources for Optimal Care of the Injured Patient. This study is a comprehensive analysis of the Medicare facial trauma care provided by OMS with comparison to other payer groups at a level one trauma center. Materials and Methods: Deidentified data were collected for all facial trauma patients treated by the OMS department at Nashville, Tennessee’s only level one trauma center during 2010. Patients were identified by ICD-9 codes to include all maxillofacial trauma. Patients with isolated dentoalveolar injuries were excluded, but isolated soft tissue injuries were included. Data collected included patient age, race, sex, length of stay, maxillofacial injury (ICD-9 code), maxillofacial procedures performed (CPT), charges, collections, contractuals, and necessary write-offs to the patients, provider, and insurer. Methods of Data Analysis: Summary statistics were collected based on payer status and demographics and compared across different groups with the use of independent T-test where appropriate. The variance in reimbursement of professional charges across payers was calculated with a charge recovery ratio (collections/ charges). Correlation statistics and 2 tests were used as measures of association and variance between demographics, procedures, and financial variables. Results of Investigation: In 2010, 335 patients (611 procedures) were treated for facial trauma, and 29 (8.7%) of these patients were Medicare patients. Mean age was 36.01 (1.49-90.53, SD 19.23), while mean AAOMS • 2011
Medicare age was 67 (31-91, SD 19). Professional fees averaged $6,632 overall, while Medicare patient bills averaged $8,235. Average charges for individual procedures based on ICD-9 was $2,825, and average collections were $739, compared to average Medicare charges and collections of $3,227 and $475, respectively. Medicare average charge per procedure was second only to charges to workers compensation patients ($3,336 vs $3,227), and the collections were lowest of any payer group ($475). Percent reimbursement (collections/ charges) was also lowest for Medicare patients at 13.8%, nearly 3.5 times less than the highest reimbursement group. As age increased, charges decreased and collections increased, but these associations were loosely correlated. Medicare had the lowest reimbursement for midface procedures at 13% with an average of only $394 collected per procedure. Mandible (15%) and soft tissue (10%) reimbursement was also the lowest for Medicare patients. Across all patients and procedures, Medicare soft tissue procedures averaged the least at $67. In this sample hospital charges averaged $97,829 (SD $127,136) with length of stay averaging 5.35 days. Conclusion: Medicare maxillofacial trauma patients currently comprise a small percentage of overall patients at this level one trauma center; however, with expected increases in Medicare enrollment, hospitals will struggle to compensate for the alarmingly low reimbursements. Epidemiologic and financial awareness of Medicare patients will equip OMS clinicians with the information needed to advocate for Medicare financing, and ensure continued involvement for OMS at trauma centers and through residency training. References: DeLia D, Cantor J. Emergency Department Utilization and Capacity. Research Synthesis Report No. 17. Princeton, New Jersey: Robert Wood Johnson Foundation; 2009. ACS. Resources for Optimal Care of the Injured Patient: 2006.
POSTER 72 Maxillofacial Trauma Treatment of Medicaid Patients at a Level One Trauma Center: Financial and Epidemiologic Cross-Sectional Analysis for 2010 B. Lewallen, B. DeLong: Vanderbilt University Medical Center, S. Press Statement of the Problem: Last year we postulated a connection between the economic recession and a shift of maxillofacial trauma payer status patients from private and commercial to federal insurers. Medicaid patients at Vanderbilt Medical Center, treated by OMS for facial trauma increased from 10% to 18%, while the reimbursement from these patients decreased from 26% to 22% from 2007 to 2009. Medicaid cost sharing probe-93