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Supplemental Digital Content is available in the text., Summary The authors present a case of a 11-year-old girl with fibrous dysplasia involving the nasal cavity and sphenoid sinus that potentially required a tracheostomy for anesthesia. The tumor was to be approached through both supraorbital and Le Fort I osteotomies. The tumor prevented nasal intubation, and the necessity of maxillomandibular fixation to reduce the osteotomized maxilla with traditional fixation prevented oral intubation. Given the age of the patient and the desire to avoid a tracheostomy scar, a decision was made to utilize custom fixation plates. Virtual surgical planning was utilized to design custom cutting guides with splints for maxillomandibular fixation. These custom maxillary orthognathic plates ensured accurate reduction of the osteotomized maxillary segment and allowed for placement of an oral endotracheal tube. Despite the oral endotracheal tube preventing maxillomandibular fixation, use of custom plates established proper occlusion as determined immediately after extubation and at postoperative visits.

On-call services provided by physicians are critical to the function of a robust healthcare delivery system, but such services are not generally accounted for by standard physician productivity metrics, such as the work relative value unit (wRVU). There is significant diversity on how physicians are compensated, if at all, for these on-call services. Simultaneously, there exists a considerable shortage, particularly in the surgical subspecialties, for on-call coverage - most commonly in rural and underserved communities. While we agree that "call" services should undergo standardized valuation, we suggest that the wRVU is an ill-posed metric for this purpose as its primary role is to value discrete physician services provided to patients. In contradistinction, "call" is a physician service to a hospital - the disproportionate beneficiary of the service. We maintain that systemic and regulatory factors undervalue physician on-call compensation relative to the hospital's value chain and lead to call shortages that impact patient care and foster inequity. Finally, we urge subspecialty professional organizations to develop guidelines for call valuation.