Scholars@Duke
David Bryan Powers

David Bryan Powers

Professor of Surgery
Surgery, Plastic, Maxillofacial, and Oral Surgery
david.powers@duke.edu
DUMC 2955, Durham, NC 27710
DUMC 2955, Durham, NC 27710

Selected Publications

Necrotizing Fasciitis of the Head and Neck

Conference Journal of Oral and Maxillofacial Surgery · September 1, 2024 Abstract: Statement of the problem Necrotizing fasciitis of the head and neck is a rare but devastating condition that carries a high morbidity and mortality. Most cases reported in the literature are of odontogenic origin and occur in immunocompromised pa ... Full text Cite

Pearls and pitfalls in orbital fracture repair

Chapter · May 17, 2024 The position and movement of the globe are affected by the osseous confines of the orbit, multiple supporting ligaments, and the intraorbital fat. Orbital fractures can disrupt these structures leading to diplopia Orbital fractures diplopia and cosmetic de ... Full text Cite

Soft Tissue Trauma: Critical Recognition and Timing of Intervention in Emergency Presentations.

Journal Article Otolaryngol Clin North Am · December 2023 The facial trauma surgeon will see a variety of facial injuries. Recognition of emergency cases and proper intervention is and this article aims to highlight those cases and the respective proper interventions. ... Full text Link to item Cite

Synovial chondromatosis: a case series and review of the literature.

Journal Article Oral Surg Oral Med Oral Pathol Oral Radiol · September 2023 This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy ... Full text Link to item Cite

Osteoblastoma of the orbit: A rare case report and review of the literature

Journal Article Oral and Maxillofacial Surgery Cases · September 1, 2023 Osteoblastoma is a benign tumor of bone representing less than 1% of all primary bone tumors [1]. Osteoblastomas are primarily reported in long bones and the spinal column, with craniofacial cases representing about 15% of the literature (Meli et al., 2008 ... Full text Cite

Closed reduction of nasoseptal fractures: key concepts for predictable results.

Journal Article Br J Oral Maxillofac Surg · June 2023 Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of cl ... Full text Link to item Cite

Distribution of wounding patterns in casualties from mass shooting events

Journal Article Trauma (United Kingdom) · April 1, 2023 Introduction: The incidence and severity of public mass shootings, and mass casualty incidents (MCI), continues to rise. Understanding the wounding pattern and incidence of potentially preventable death after these incidents is key not only to Health Syste ... Full text Cite

Contemporary Maxillofacial Fixation Techniques

Chapter · January 1, 2023 Maxillomandibular fixation (MMF) is critical to successful reconstruction and rehabilitation in craniomaxillo-facial trauma and pathology. Indications for MMF include reduction of facial fractures in conjunction with internal fixation. Local or regional an ... Full text Cite

A unique case of primary focal hyperhidrosis and treatment

Journal Article Oral and Maxillofacial Surgery Cases · September 1, 2022 Primary hyperhidrosis is idiopathic and results in excessive sweating beyond the body's requirement to maintain thermoregulation. Here, we describe a unique case presentation of a patient with gustatory-induced hyperhidrosis of the bilateral occiput, crown ... Full text Cite

Sugammadex-associated asystole in young obese patient: Case report

Journal Article Oral and Maxillofacial Surgery Cases · September 1, 2022 Sugammadex is a neuromuscular blocking (NMB) reversal agent that has quickly become popular among anesthesia providers since its FDA approval in 2015 due to its favorable properties. There are rare but significant and increasingly reported adverse cardiac ... Full text Cite

Maxillofacial Firearm Injuries

Chapter · August 23, 2022 The fourth edition of Peterson’s Principles of Oral and Maxillofacial Surgery is a truly exceptional resource for clinicians and students alike. ... Cite

Current Concepts in Cranial Reconstruction: Review of Alloplastic Materials.

Journal Article Plast Reconstr Surg Glob Open · August 2022 UNLABELLED: Cranioplasty for acquired cranial defects can be complex and challenging. Benefits include improved cosmesis, protection of intracranial structures, and restoration of neurocognitive function. These defects can be reconstructed with preserved c ... Full text Link to item Cite

Vascularized Fibula TMJ Reconstruction: A Report of Five Cases featuring Computerized Patient-specific Surgical Planning.

Journal Article Plast Reconstr Surg Glob Open · August 2022 BACKGROUND: Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint because it requires precise bone graft alignment, or alloplastic materials, for complete restorat ... Full text Open Access Link to item Cite

Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions.

Journal Article BMJ Mil Health · June 2022 INTRODUCTION: Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to incre ... Full text Link to item Cite

Clinical Competency Committees in Plastic Surgery Residency.

Journal Article Plast Reconstr Surg Glob Open · September 2021 BACKGROUND: Clinical competency committees (CCCs) are now an Accreditation Council on Graduate Medical Education (ACGME) requirement for plastic surgery training programs. They serve to monitor resident progress and make formal recommendations to program d ... Full text Link to item Cite

The Impact of COVID-19 on the Treatment of Craniomaxillofacial Trauma and Head and Neck Infections.

Journal Article Surg J (N Y) · October 2020 There is no shortage of news, information, and guidelines with regards to novel coronavirus (COVID-19). However, there is none yet that is specific to the treatment of patients who have sustained trauma or active head and neck infections-frequently encount ... Full text Link to item Cite

Current opinion in the assessment and management of ballistic trauma to the craniomaxillofacial region.

Journal Article Curr Opin Otolaryngol Head Neck Surg · August 2020 PURPOSE OF REVIEW: Ballistic trauma represents a small proportion of injuries to the craniomaxillofacial (CMF) region, even in societies where the availability of firearms is more prevalent. The aim of this article is to review current opinion in the asses ... Full text Link to item Cite

Outcomes following penetrating neck injury during the Iraq and Afghanistan conflicts: A comparison of treatment at US and United Kingdom medical treatment facilities.

Journal Article J Trauma Acute Care Surg · May 2020 INTRODUCTION: The United States and United Kingdom (UK) had differing approaches to the surgical skill mix within deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. METHODS: The US and UK combat traum ... Full text Link to item Cite

Comparing the Management of Eye Injuries by Coalition Military Surgeons during the Iraq and Afghanistan Conflicts.

Journal Article Ophthalmology · April 2020 PURPOSE: To compare incidences, ocular injury types, and treatment performed on United States and United Kingdom military service members and host nation civilians within the Iraq and Afghanistan conflicts to inform future military surgical training requir ... Full text Link to item Cite

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts.

Journal Article J Neurol Neurosurg Psychiatry · April 2020 INTRODUCTION: Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our a ... Full text Link to item Cite

Maxillary Prosthetics, Speech Impairment, and Presidential Politics: How Grover Cleveland Was Able to Speak Normally after His "Secret" Operation.

Journal Article Surg J (N Y) · January 2020 In the summer of 1893, President Grover Cleveland discovered a mass on the roof of his mouth. Two physicians examined it, determined that it was a neoplasm, and recommended resection. In an effort to avoid revealing the illness to the public, the President ... Full text Link to item Cite

Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study.

Journal Article BMJ Open · November 25, 2019 OBJECTIVES: To perform the first direct comparison of the facial injuries sustained and treatment performed at USA and UK deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. SETTING: The US and UK Join ... Full text Link to item Cite

Avulsive Soft Tissue Injuries.

Journal Article Atlas Oral Maxillofac Surg Clin North Am · September 2019 Full text Link to item Cite

Characteristics of Ballistic and Blast Injuries

Chapter · January 1, 2019 Ballistic injury patterns to the craniomaxillofacial region present a unique, and challenging, dilemma for the facial trauma surgeon. The tissue disruption associated with ballistic injury to the head and neck region can be daunting, and the identification ... Full text Cite

Surgical Correction of Panfacial Trauma

Chapter · 2019 "A new addition to the best-selling Operative Techniques series, Operative Techniques in Plastic Surgery provides superbly illustrated, authoritative guidance on operative techniques along with a thorough understanding of how to select the ... ... Cite

The Utility of Polyether-Ether-Ketone Implants Adjacent to Sinus Cavities After Craniofacial Trauma.

Journal Article J Oral Maxillofac Surg · November 2018 PURPOSE: Polyether-ether-ketone (PEEK) implants have become increasingly popular for use in reconstructive procedures. It is imperative to understand the consequences of using this biomaterial in anatomic sites that can pose a risk of infection. Specifical ... Full text Link to item Cite

Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate?

Journal Article J Oral Maxillofac Surg · September 2018 PURPOSE: An increasing number of patients with end-stage heart failure are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Pre-emptive extraction of carious teeth in these pa ... Full text Link to item Cite

A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient.

Journal Article Craniomaxillofac Trauma Reconstr · September 2018 Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While s ... Full text Link to item Cite

How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment?

Journal Article J R Army Med Corps · July 2018 INTRODUCTION: The conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge ... Full text Link to item Cite

Penetrating Neck Trauma

Chapter · October 18, 2017 This book utilises the knowledge and experience acquired by those dealing with ballistic trauma on a regular basis to help those who manage these patients less regularly. ... Cite

Orbitocerebral Impalement: Case Discussion and Management Algorithm.

Journal Article Craniomaxillofac Trauma Reconstr · September 2017 Orbitocerebral impalement by inanimate objects is a relatively uncommon event. If orbitocerebral impalement is suspected, management entails prompt referral to a trauma facility with neurosurgical, neuroanesthesiological, craniomaxillofacial, and ophthalmo ... Full text Link to item Cite

A Technique for Reduction of Edentulous Fractures Using Dentures and SMARTLock Hybrid Fixation System.

Journal Article Plast Reconstr Surg Glob Open · September 2017 Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery. In this study, we report a novel method for the reduction of the edentulous mandible fracture, via fabrication ... Full text Link to item Cite

Trauma Surgery.

Journal Article J Oral Maxillofac Surg · August 2017 Full text Link to item Cite

Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures.

Journal Article Craniomaxillofac Trauma Reconstr · June 2017 The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on pl ... Full text Link to item Cite

Classification of Mandibular Condylar Fractures.

Journal Article Atlas Oral Maxillofac Surg Clin North Am · March 2017 Full text Link to item Cite

Zygomatic Intraosseous Hemangioma: Case Report and Literature Review.

Journal Article Craniomaxillofac Trauma Reconstr · March 2017 Intraosseous hemangiomas are uncommon intrabony lesions, representing approximately 0.5 to 1% of all intraosseous tumors. Their description varies from "benign vasoformative neoplasms" to true hamartomatous proliferations of endothelial cells forming a vas ... Full text Link to item Cite

Optimising ballistic facial coverage from military fragmenting munitions: a consensus statement.

Journal Article Br J Oral Maxillofac Surg · February 2017 VIRTUS is the first United Kingdom (UK) military personal armour system to provide components that are capable of protecting the whole face from low velocity ballistic projectiles. Protection is modular, using a helmet worn with ballistic eyewear, a visor, ... Full text Link to item Cite

A Rare Case of Malignant Transformation of Oral Lichen Planus of the Mandible.

Journal Article Plast Reconstr Surg Glob Open · December 2016 Oral lichen planus (OLP) is an immune-mediated mucocutaneous disease associated with an increased risk in oral squamous cell carcinoma (OSCC). Nearly all cases of malignant transformation have been reported in patients >40 years old. We report the case of ... Full text Open Access Link to item Cite

Transorbital endotracheal intubation: a nonstandard approach to a difficult airway.

Journal Article J Clin Anesth · November 2016 We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for ... Full text Link to item Cite

Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications.

Journal Article Arch Plast Surg · January 2016 The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, incl ... Full text Open Access Link to item Cite

Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm.

Journal Article Ann Plast Surg · November 2015 BACKGROUND: Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between ... Full text Open Access Link to item Cite

Comminuted Mandible Fractures

Chapter · March 15, 2015 This practical guide, written by respected international contributors and edited by OMS experts Deepak Kademani and Paul Tiwana, offers detailed, step-by-step instructions and over 2,000 full-color illustrations that demonstrate how to plan ... ... Cite

Custom facial reconstruction for osteosarcoma of the jaw.

Journal Article J Oral Maxillofac Surg · November 2014 Osteosarcoma accounts for most primary bone cancers in children and young adults. High-grade lesions are typically managed with a combination of chemotherapy and wide-margin surgical excision. Although this malignancy typically affects the metaphyseal regi ... Full text Link to item Cite

Mandibular mass. Focal cemento-osseous dysplasia (FCOD).

Journal Article JAMA Otolaryngol Head Neck Surg · October 2014 Full text Link to item Cite

Characteristics of ballistic and blast injuries.

Journal Article Atlas Oral Maxillofac Surg Clin North Am · March 2013 Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, wit ... Full text Link to item Cite

A review of the surgical treatment options for the obstructive sleep apnea/hypopnea syndrome patient.

Journal Article Mil Med · September 2010 Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a medical condition that has received significant attention within the medical community and mainstream media due to its potentially serious physiological consequences and relatively frequent occurrence ... Full text Link to item Cite

Systemic lupus erythematosus and discoid lupus erythematosus.

Journal Article Oral Maxillofac Surg Clin North Am · November 2008 The management of a patient with SLE presents the OMS with a challenging array of decisions to make in regards to treatment sequencing. Careful reviews of the patient's medical history, the presentation of the illness, and the medication profile, and an op ... Full text Link to item Cite

Oral and maxillofacial surgery careers in the military and department of veterans affairs.

Journal Article Oral Maxillofac Surg Clin North Am · February 2008 Within the Federal Services, a myriad of career opportunities exist for the oral and maxillofacial surgeon. The Department of Veterans Affairs and the Department of Defense, consisting of the Army, Navy, and Air Force, have the greatest number of positions ... Full text Link to item Cite

The role of the Oral and Maxillofacial Surgeon in wartime, emergencies, and terrorist attacks

Other Oral and Maxillofacial Surgery Clinics of North America · January 1, 2005 Full text Cite

Maxillofacial trauma treatment protocol

Journal Article Oral and Maxillofacial Surgery Clinics of North America · January 1, 2005 The management of complex maxillofacial injuries sustained in modern warfare or terrorist attack has presented military surgeons with a new form of injury pattern previously not discussed in the medical literature. The unique wounding characteristics of th ... Full text Cite

Ten common myths of ballistic injuries

Journal Article Oral and Maxillofacial Surgery Clinics of North America · January 1, 2005 The science of ballistics can be confusing. Specific treatment dogmas regarding ballistic injuries should be examined to ensure that they are supported by scientific data. If determined to be unfounded, these dogmas should be discontinued from the teaching ... Full text Cite

Middle cerebral artery aneurysm misdiagnosed as a temporomandibular disorder: Report of a case

Journal Article Journal of Oral and Maxillofacial Surgery · 1998 Cite

Stereolithography: a historical review and indications for use in the management of trauma.

Journal Article J Craniomaxillofac Trauma · 1998 BACKGROUND: Stereolithography (SL) is a new adjunct for treatment planning in complex maxillofacial trauma. It uses an argon/ion laser to polymerize acrylic resin models of reformatted computerized tomographic radiographs. SL provides superior anatomical d ... Link to item Cite