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Gastrointestinal stromal tumors (GISTs) form commonly in the stomach, small intestine, colorectum, and esophagus. Metastatic GIST occurs in up to 50% of patients at presentation. The liver and peritoneal cavity are the most common (93%) metastatic sites; head and neck metastases are extremely rare. This report describes a unique case of a 77-year-old man who was diagnosed with a duodenal GIST that had been completely resected 15 years ago. Eleven years after complete resection, he presented with liver metastases and then received multiple lines of systemic therapy and ablative radiotherapy. In 2015, he presented to our oral and maxillofacial surgery department with a left exophytic maxillary mass that filled the left maxillary sinus. Incisional biopsy confirmed metastatic GIST. Further evaluation revealed extensive metastases in the patient's liver, lungs, spleen, abdominal wall, and lymph nodes. After adequate staging, the patient's condition was deemed palliative, and he was referred to the radiation oncology department for palliative treatment of the symptomatic maxillary lesion. To our knowledge, this is the first reported case of maxillary metastasis from a duodenal GIST. Inclusion of GIST in the differential diagnosis of jaw tumors in patients with nonoral malignancies is recommended. The literature on oral metastasis of GIST is reviewed and discussed in this case report.

Massive segmental bone defects (SBD) are mostly treated by removing the fibula and transplanting it complete with blood supply. While revolutionary 50 years ago, this remains the standard treatment. This review considers different strategies to repair SBD and emerging potential replacements for this highly invasive procedure. Prior to the technical breakthrough of microsurgery, researchers in the 1960s and 1970s had begun to make considerable progress in developing non autologous routes to repairing SBD. While the breaktthrough of vascularised bone transplantation solved the immediate problem of a lack of reliable repair strategies, much of their prior work is still relevant today. We challenge the assumption that mimicry is necessary or likely to be successful and instead point to the utility of quite crude (from a materials technology perspective), approaches. Together there are quite compelling indications that the body can regenerate entire bone segments with few or no exogenous factors. This is important, as there is a limit to how expensive a bone repair can be and still be widely available to all patients since cost restraints within healthcare systems are not likely to diminish in the near future. Statement of Significance This review is significant because it is a multidisciplinary view of several surgeons and scientists as to what is driving improvement in segmental bone defect repair, why many approaches to date have not succeeded and why some quite basic approaches can be as effective as they are. While there are many reviews of the literature of grafting and bone repair the relative lack of substantial improvement and slow rate of progress in clinical translation is often overlooked and we seek to challenge the reader to consider the issue more broadly.

The purpose of this paper is to outline a simple and effective digital protocol for in-house 3D-printing of orthognathic splints for use during single-jaw orthognathic surgery. Using this protocol, an intraoral scanner, and virtual planning software, computer-designed splints were fabricated by a rapid prototyping machine in-house. The protocol was utilized for 35 consecutive patients requiring single-jaw orthognathic surgery between January 2019 and March 2020. The total time from initial scan to splint fabrication for each case was between 5 and 9 hours, including 3 minutes for scanning of models, 4.5 minutes for development of the splint, and 4–8 hours for rapid prototyping and post-processing. This time varied based on the complexity of the design and the number of splints printed simultaneously. The average cost of raw materials for each splint was $0.73 Canadian dollars.

We aimed to describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT).We implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed enhanced recovery-after-surgery protocol. The primary outcome measurement was hospital length of stay (LOS). The secondary outcome variables were the duration of mechanical ventilation, intensive care unit (ICU) LOS, need for gastrostomy, and airway-related complications directly associated with either NTI or tracheostomy. Descriptive statistics and a multivariate logistic regression analysis were completed.The sample was composed of 141 patients who had undergone oral cavity FTT for both benign and malignant diseases (NTI, n = 111; tracheostomy, n = 30). Patients managed with NTI had a statistically significantly shorter hospital LOS (8 days vs 15.5 days, P .0001) and ICU LOS (1 day vs 2 days, P = .0006), as well as a decreased requirement for gastrostomy (17.1% vs 76.7%, P .0001). Airway-related complications were rare in both the tracheostomy (13.3%) and NTI (3.6%) groups. Multivariate analysis showed that patients undergoing tracheostomy were 3.14 (P = .004) times more likely to have a prolonged hospitalization and 10.4 (P .0001) times more likely to require a gastrostomy. A sensitivity analysis of only patients with malignant diagnoses had similar statistically significant results. The delayed tracheostomy rate in the NTI group was 3.6%.To date, this is the largest study to evaluate the use of NTI in patients undergoing oral cavity reconstruction with FTT. Our results suggest that in the appropriate institutional setting, most patients can be safely managed with NTI. This approach results in a decreased hospital LOS and ICU LOS and an earlier resumption of oral intake with less need for gastrostomy.

The purpose of this study was to evaluate the demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery (OMS) residents. A cross-sectional study was conducted using an anonymous online survey that was distributed via e-mail to all current Canadian OMS residents. The completion rate of this survey was 88.9%. Eighty percent of residents were satisfied with their surgical education overall. Residents were most satisfied with their training in the areas of facial trauma and orthognathic surgery. Satisfaction was lowest in the areas of facial cosmetic surgery, maxillofacial reconstructive surgery, cleft and craniofacial surgery, and dental implantology. A majority of residents, 78.1%, indicated that they would prefer to be trained in an MD-integrated OMS certificate program. Seventy-two percent of residents indicated that they would like to complete a fellowship following graduation. The most desirable career path was a combination of private practice and academic practice, with 75.0% of residents selecting this option. Overall, Canadian OMS residents were pleased with their training in the traditional scope of OMS, apart from dental implantology. Among the current generation of trainees, there appears to be a proclivity for a broader scope of practice, dual-degree training, and post-graduate fellowship training.