title: Does Training Background Influence Decision-Making in the Management of Zygomaticomaxillary Complex Fractures?
abstract: OBJECTIVE
  Management of zygomaticomaxillary complex (ZMC) fractures should be based on injury patterns and not on training background. This study assessed management decisions for ZMC injuries among surgeons with different training backgrounds.
  
  
  METHODS
  This was a cross-sectional study of surgeons who evaluated 5 ZMC injury cases. The primary predictor variable was training background: plastic and reconstructive surgeons (PRSs), craniofacial PRSs (c-PRSs), and oral and maxillofacial surgeons (OMSs). Other variables were years in practice, fellowship training, practice scope, and comfort with managing facial injuries. The primary outcome variable was management of the ZMC and orbital floor (operative vs nonoperative). Secondary outcome measurements were related to surgical approaches and fixation. Descriptive, bivariate, and regression statistics were computed.
  
  
  RESULTS
  Twenty-one surgeons (7 PRSs, 7 c-PRSs, and 7 OMSs) with an average of 14.4 ± 12.6 years of experience provided a total of 105 treatment plans. There was significant agreement between c-PRSs and OMSs for management of ZMC and orbital floor injuries (rs = 0.70 and 0.76, respectively; P ≤ .001). PRSs did not have substantial agreement with c-PRSs or OMSs with regard to ZMC fractures (rs = 0.39 and 0.49, respectively; P ≤ .06), but significant agreement with regard to orbital floor injuries (rs = 0.70 and 0.76, respectively; P < .001). In a regression model, injury pattern was the only factor associated with operative management (P ≤ .001).
  
  
  CONCLUSIONS
  There is substantial agreement between OMSs and c-PRSs regarding the management of ZMC fractures and associated orbital floor injuries.
authors.affiliation: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore; Division of Plastic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD.
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.affiliation: Craniofacial Surgery Fellow/Acting Instructor, Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.affiliation: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore; Division of Plastic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD.
authors.forename: Devin
authors.initials: D
authors.lastname: O'Brien-Coon
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Dodson
authors.affiliation: Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore; Division of Plastic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Manson
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Peacock
authors.affiliation: Associate Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore; Division of Plastic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD. Electronic address: adorafs1@jhmi.edu.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
mesh_terms: D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D006801:Humans; D000066794:Oral and Maxillofacial Surgeons / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D015051:Zygomatic Fractures / Q000473:pathology / Q000601:surgery*