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Roderick Y. Kim DDS, MD

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Updated: 1 day 11 hours ago

Substernal goiter excision in a Jehovah's Witness.

Tue, 07/21/2020 - 03:23
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Substernal goiter excision in a Jehovah's Witness.

Proc (Bayl Univ Med Cent). 2020 Jul;33(3):462-464

Authors: Kholaki O, Wentland TR, Kim RY

Abstract
Jehovah's Witnesses present a unique challenge in oral and head and neck surgery. We report a case of a substernal goiter excised on a Jehovah's Witness without the use of blood transfusion, in accordance with the patient's beliefs. Additionally, we review the literature on the care of this patient population, focusing on preoperative optimization, perioperative management, and postoperative care.

PMID: 32675989 [PubMed]

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Mon, 06/29/2020 - 23:08
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Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

J Oral Maxillofac Surg. 2019 Apr;77(4):852-858

Authors: Kim RY, Helman JI, Braun TM, Ward BB

Abstract
PURPOSE: Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between PNI, tumor location, and other known histopathologic characteristics used to define aggressive disease.
MATERIALS AND METHODS: This was a retrospective cohort study of adult patients with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded patients whose neck was previously treated with surgery or radiation therapy. Demographic and histopathologic variables of interest were obtained from patient charts. The primary outcome of interest was PNI, and the predictors of interest included tumor location, histopathologic tumor characteristics, and cervical lymph node status. For continuous variables, mean differences were compared by t tests. For categorical variables, the differences in the distribution of the proportions were analyzed with the χ2 test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at P < .05.
RESULTS: Three hundred sixty-eight patients met the study criteria. PNI showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. PNI was more likely to be seen in tumors located in the tongue or floor of the mouth. Tumors with PNI had a deeper depth of invasion: 15.9 ± 10.9 mm versus 10.2 ± 10.0 mm (P < .001). PNI tumors had a higher mean total number of positive nodes: 2.85 ± 5.23 versus 0.83 ± 1.80 (P < .001).
CONCLUSIONS: PNI is statistically correlated with tongue and floor-of-the-mouth subsites within the oral cavity, as well as larger tumors, deeper tumors, and disease that has progressed to the lymph nodes. Whether this correlation represents causation in either direction remains unknown.

PMID: 30142323 [PubMed - indexed for MEDLINE]

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

Mon, 06/01/2020 - 15:00
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Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

J Oral Maxillofac Surg. 2020 May 23;:

Authors: Moe J, Brookes C, Dyalram D, Kim R, Melville J, Quereshy F, Roser S, Salman S, Schlieve T, Steed M, Fisher E

PMID: 32473915 [PubMed - as supplied by publisher]

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

Mon, 05/18/2020 - 12:45
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Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

J Oral Maxillofac Surg. 2020 Apr 14;:

Authors: Williams FC, Hammer DA, Wentland TR, Kim RY

Abstract
PURPOSE: Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involve outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques.
MATERIALS AND METHODS: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles.
RESULTS: All 12 patients had received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses.
CONCLUSIONS: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.

PMID: 32404269 [PubMed - as supplied by publisher]

Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

Sun, 03/15/2020 - 22:12
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Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

J Oral Maxillofac Surg. 2020 Feb 12;:

Authors: Schwitzer D, Kim R, Williams F, Hammer D

Abstract
Spindle cell sarcoma (SCS) is a malignancy, with the most recent Surveillance, Epidemiology, and End Results (SEER) data citing a total of 250 reported cases occurring in the head and neck. Of these cases, none originated in the maxillofacial hard tissue. To the best of our knowledge, only 2 cases of primary osseous SCS of the maxillofacial region have been reported. These cases were not accounted for in the SEER data. The diagnosis of SCS requires its differentiation from other sarcomas and spindle cell neoplasms. Therefore, a comprehensive review to reinforce its inclusion in oral and maxillofacial surgeons' differential diagnosis for osseous neoplastic pathology is desired. In the present case report, we have described a maxillary SCS in a patient with an initial diagnosis of a spindle cell lesion of uncertain biologic behavior. We reviewed the data for SCS, including the epidemiologic data, diagnostic challenges, clinical and radiographic presentations, prognostic indicators, and treatment.

PMID: 32147227 [PubMed - as supplied by publisher]

Paramedian Forehead Flap.

Sun, 02/09/2020 - 12:56
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Paramedian Forehead Flap.

Atlas Oral Maxillofac Surg Clin North Am. 2020 Mar;28(1):23-28

Authors: Hammer D, Williams F, Kim R

PMID: 32008706 [PubMed - indexed for MEDLINE]

Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

Sat, 01/11/2020 - 11:42
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Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

J Stomatol Oral Maxillofac Surg. 2020 Jan 02;:

Authors: Patel MH, Kim RY, Aronovich S, Skouteris CA

Abstract
BACKGROUND: There is limited data available in the literature describing the utility of acellular dermal matrix (AlloDerm©) in the replacement of the temporomandibular joint disc. Few reports of clinicians using implantable AlloDerm to replace the disc do exist, however, this has been described for reconstruction after surgical resection of the entire temporomandibular joint complex to treat pathology, as opposed to isolated articular disc disorders. Moreover, there is a lack of description in the literature regarding associated perioperative outcomes after such a procedure. We sought to assess the immediate perioperative outcomes in the form of a pilot study, to determine whether this technique warrants further investigation in the form of prospective clinical studies.
METHODS: The study team conducted a retrospective review of medical records for patients who underwent temporomandibular joint discectomy and replacement with AlloDerm© at a single tertiary care center, from 2011 to 2016. Perioperative outcomes of interest including pain levels and range of motion were recorded and descriptive statistics were utilized for statistical analysis.
RESULTS: 15 patients met the inclusion criteria, of which 87% were females and 13% males. The mean age was 47.27 ± 15.93 years. Pre-operatively, 74% of the patients reported severe pain (VAS scores of 7-10); in contrast, 73% of the patients reported only mild pain (VAS scores of 1-3) during the post-operative visits, suggesting an overall reduction in pain intensity. Range of motion also improved from an average of 27.73 ± 13.04 mm, to an average of 38.60 ± 6.08 mm (p<0.01).
CONCLUSIONS: Based on our preliminary data, patients with advanced TMJ articular disc disorders showed clinical improvement from discectomy and replacement with acellular dermal matrix (AlloDerm©). Further longitudinal studies evaluating long-term outcomes need to be conducted to validate this technique, in the form of larger sample sizes with a control group, as well as radiographic assessment of long-term clinical outcomes.

PMID: 31904524 [PubMed - as supplied by publisher]

Role of Free Tissue Transfer in Facial Trauma.

Sat, 12/07/2019 - 04:09
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Role of Free Tissue Transfer in Facial Trauma.

Facial Plast Surg. 2019 Dec;35(6):584-589

Authors: Kim RY, Sokoya M, Williams FC, Shokri T, Ducic Y

Abstract
For large composite traumatic defects of the head and neck, free tissue transfer presents a reconstructive allowing for the reconstitution of both form and function. Furthermore, the ability to provide bulk, soft, and hard tissue, as well as immediate dental rehabilitation, makes free tissue transfer an efficient and attractive option for head and neck reconstruction. Herein, we discuss the utility of free tissue transfer in facial trauma, its problems, complications, and controversies.

PMID: 31783413 [PubMed - in process]

Nasal Sebaceous Carcinoma: A Case Report and Review of the Literature.

Fri, 09/20/2019 - 12:05
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Nasal Sebaceous Carcinoma: A Case Report and Review of the Literature.

J Oral Maxillofac Surg. 2019 Aug 21;:

Authors: Kholaki O, Chang D, Kim RY

Abstract
Sebaceous carcinoma arising from the nasal vestibule is exceedingly rare, with 3 cases previously reported. We have described the case of a 69-year-old man with an indolent exophytic growth on the medial aspect of his right nasal vestibule. Incisional biopsy demonstrated sebaceous carcinoma. The clinical and pathologic features, in addition to the surgical course and the postoperative outcome, are discussed. We also report our findings from a review of the reported data, focusing on the diagnosis and treatment of this rare skin malignancy.

PMID: 31526773 [PubMed - as supplied by publisher]

Free-Flap Reconstruction of the Mandible.

Wed, 03/20/2019 - 20:55
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Free-Flap Reconstruction of the Mandible.

Semin Plast Surg. 2019 Feb;33(1):46-53

Authors: Kim RY, Sokoya M, Ducic Y, Williams F

Abstract
Mandible reconstruction has evolved over the years with advances in surgical options and three-dimensional technology. Although nonvascularized bone grafting is still used, vascularized flaps show advantages with immediate reconstruction, the possibility of immediate dental implants, and the ability to reconstruct composite defects of both soft tissue and bone. This article discusses current vascularized techniques for mandible reconstruction. While each reconstructive method has advantages and disadvantages, a defect-based reconstruction focused on full rehabilitation allows surgeons to plan and counsel the patient for the best available reconstruction.

PMID: 30863212 [PubMed]

Laryngeal Spindle Cell/Pleomorphic Lipoma: A Case Report. An In-Depth Review of the Adipocytic Tumors.

Wed, 03/06/2019 - 17:13
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Laryngeal Spindle Cell/Pleomorphic Lipoma: A Case Report. An In-Depth Review of the Adipocytic Tumors.

J Oral Maxillofac Surg. 2019 Feb 07;:

Authors: Burkes JN, Campos L, Williams FC, Kim RY

Abstract
Spindle cell and pleomorphic lipomas (SC/PLs) are a rare form of lipomatous tumors. They typically occur as a slow-growing localized mass in the subcutaneous fatty tissue of the posterior neck, back, and shoulders. This benign variant represents less than 1.5% of all lipomas and is relatively uncommon in the head and neck area. A manifestation in the larynx is even rarer. Unlike other anatomic locations, laryngeal lipomas can pose life-threatening symptoms secondary to acute obstruction of the upper aerodigestive tract. This report presents a case of a large SC/PL of the larynx associated with hoarseness, dysphagia, globus sensation, and neck fullness. The tumor was successfully removed through an anterior transcervical approach with infrahyoid myotomy. The authors review the literature concerning head and neck adipocytic tumors with spindle cells and discuss the difficulties in distinguishing SC/PLs from liposarcomas. To the best of the authors' knowledge, this is the first case to be reported in the oral and maxillofacial surgery literature.

PMID: 30826392 [PubMed - as supplied by publisher]

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Wed, 01/30/2019 - 08:33
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Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]