Dietary supplements and their associated adverse events are not uncommon in the U.S. military, and selected dietary supplements have been associated with a number of nontraumatic deaths in service members. Specific ingredients and dietary supplement products in the civilian community are often associated with multiple adverse events and some have subsequently been removed from the marketplace; the most notable in the last decade is ephedra. We present case reports for two soldiers who were taking commercially available dietary supplements containing multiple ingredients to include the sympathomimetic, 1,3-dimethylamylamine (DMAA); both collapsed during physical exertion from cardiac arrest and ultimately died. A presentation of their clinical courses and a discussion of the history and pharmacology of dietary supplement ingredients, including DMAA, are provided. Our cases highlight concerns that DMAA in combination with other ingredients may be associated with significant consequences, reminiscent of previous adverse events from other sympathomimetic drugs previously removed from the market.

Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.

Despite advances in the understanding of injury mechanics and innovations leading to early diagnosis and improved management of button battery ingestion, parental and provider education remain the most important tools to keep children well tolerated from the sequelae of these potentially fatal events. Collaboration between healthcare experts, public health and industry is essential to find a safe answer to this ongoing threat.

The goals of cleft palate repair are well-established; however, there does exist difference in practice patterns regarding the most appropriate patient age for palatoplasty. The optimal timing is debated and influenced by cleft type, surgical technique, and the surgeon's training. The objective of this study was to compare the rates of post-operative fistula formation and velopharyngeal insufficiency (VPI) in “early” versus “standard” cleft palate repair in a cohort of patients treated at a single craniofacial center. A retrospective chart review identified 525 patients treated for cleft palate from 2000 to 2017 with 216 meeting inclusion criteria. “Early repair” is defined as palatoplasty before 6-months of age (108 patients). “Standard repair” is palatoplasty at or beyond 6-months old (108 patients). Rates of fistula formation were found to be significantly higher in early repairs (Chi-square statistic 9.0536, P value = 0.0026). Development of VPI was not significantly different between the 2 groups (Chi-square statistic 1.2068, P value = 0.27196). As expected, the incidence of post-palatoplasty VPI was significantly higher in patients who had a post-operative fistula when compared to those who healed without fistula formation (Chi-square statistic 4.3627, P value = 0.0367). There is significant debate regarding the optimal timing of cleft repair to maximize speech outcomes and minimize risks. The authors’ data show that post-operative fistula formation occurs at a higher rate when performed prior to 6 months old. Furthermore, while the rate of VPI was not significantly affected by age at time of surgery, it was significantly higher in those who experienced a post-operative fistula.

Orthognathic surgery utilizing a Le Fort I osteotomy is performed regularly by oral surgeons to correct midface and dental occlusal abnormalities, yet little has been written discussing the impact these operations may have on sinonasal function. The objective of this study was to assess the incidence of objective sinonasal inflammation and subjective sinonasal symptoms following the use of Le Fort I osteotomies for maxillary advancement surgery. Thirty-eight subjects who previously underwent Le Fort I osteotomies for purposes of elective orthognathic surgery were enrolled retrospectively to assess for evidence of rhinosinusitis (RS). Post-operative and, when available, preoperative maxillofacial computed tomography (CT) scans were obtained and evaluated using Lund Mackay scoring (LMS). The Chronic Sinusitis Survey – Duration Based (CSS-D) was completed to compare subjective symptoms before and after surgery. Evaluation of the CT scans demonstrated radiographic evidence of RS and subjective worsening of symptoms in 87% and 89% respectively. The mean CSS-D pre- and post-operative scores were 7.6 and 14.8 respectively (P < 0.0001). The mean calculated LMS was 3.39 (2.38–4.40, 95% C.I.). Further sub-analyses demonstrate an increase in both radiographic LMS and subjective CSS-D for patients who had persistent inferior meatal antrostomies after Le Fort I osteotomy. Le Fort I osteotomies performed during orthognathic surgery result in a higher prevalence of post-operative RS than what has been previously described. A better understanding of sinonasal mucocilliary function and the aberrancy that may be caused following such operations deserves further evaluation in order to identify and optimize postsurgical outcomes.