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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.

Background Overdentures retained by a single implant in the midline have arisen as a minimal implant treatment for edentulous mandibles. The success of this treatment depends on the performance of a single stud attachment that is susceptible to wear-related retention loss. Recently developed biomaterials used in attachments may result in better performance of the overdentures, offering minimal retention loss and greater patient satisfaction. These biomaterials include resistant polymeric matrixes and amorphous diamond-like carbon applied on metallic components. The objective of this explanatory mixed-methods study is to compare Novaloc, a novel attachment system with such characteristics, to a traditional alternative for single implants in the mandible of edentate elderly patients. Methods/design We will carry out a randomized cross-over clinical trial comparing Novaloc attachments to Locators for single-implant mandibular overdentures in edentate elderly individuals. Participants will be followed for three months with each attachment type; patient-based, clinical, and economic outcomes will be gathered. A sample of 26 participants is estimated to be required to detect clinically relevant differences in terms of the primary outcome (patient ratings of general satisfaction). Participants will choose which attachment they wish to keep, then be interviewed about their experiences and preferences with a single implant prosthesis and with the two attachments. Data from the quantitative and qualitative assessments will be integrated through a mixed-methods explanatory strategy. A last quantitative assessment will take place after 12 months with the preferred attachment; this latter assessment will enable measurement of the attachments’ long-term wear and maintenance requirements. Discussion Our results will lead to evidence-based recommendations regarding these systems, guiding providers and patients when making decisions on which attachment systems and implant numbers will be most appropriate for individual cases. The recommendation of a specific attachment for elderly edentulous patients may combine positive outcomes from patient perspectives with low cost, good maintenance, and minimal invasiveness. Trial registration ClinicalTrials.gov, NCT03126942. Registered on 13 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2606-7) contains supplementary material, which is available to authorized users.

This Point/Counterpoint article addresses a long-standing but still-unresolved debate on the advantages and disadvantages of using live patients in dental licensure exams. Two contrasting viewpoints are presented. Viewpoint 1 supports the traditional use of live patients, arguing that other assessment models have not yet been demonstrated to be viable alternatives to the actual treatment of patients in the clinical licensure process. This viewpoint also contends that the use of live patients and inherent variances in live patient treatment represent the realities of daily private practice. Viewpoint 2 argues that the use of live patients in licensure exams needs to be discontinued considering those exams' ethical dilemmas of exposing patients to potential harm, as well as their lack of reliability and validity and limited scope. According to this viewpoint, the current presence of viable alternatives means that the risk of harm inherent in live patient exams can finally be eliminated and those exams replaced with other means to confirm that candidates are qualified for licensure to practice.

Purpose Virtual surgical planning (VSP) and custom fabricated cutting guides for maxillofacial reconstruction have been shown to improve the accuracy of bony reconstruction and overall surgical efficiency and decrease the ischemia time. Our aim was to describe an in-house VSP technique for maxillofacial reconstructive procedures. Materials and Methods We used 2 free software applications. 3DSlicer (available at: http://www.3dslicer.org ) was used to extract the bones of interest for the recipient and the donor sites from the computed tomography scan's DICOM (digital imaging and communications in medicine) data. The Autodesk Meshmixer (Autodesk Inc, San Rafael, CA) was used to perform VSP and fabrication of the cutting guides. A reconstructed jaw model was printed in-house using a commercially available fused deposition modeling-based desktop 3-dimensional (3D) printer (Qidi Technology, Zhejiang, China) and used to prebend the reconstruction plate. The cutting guides were printed using a commercially available resin-based stereolithography apparatus desktop 3D printer (Form 2, Dental SG Resin; Formlabs, Somerville, MA) to allow for sterilization of the guides. We performed this technique for 19 consecutive patients with maxillofacial benign or malignant tumors requiring microvascular bony reconstruction. We calculated the average time and associated costs using this in-house VSP technique. Results The technique was found to be simple and repeatable. The average time required for VSP was 158 minutes (2 hours, 38 minutes). The average cost for printing the reconstructed model per case was $5.21 Canadian dollars (CAD), and the average cost for printing the cutting guides per case was $12.80 CAD. Conclusions Using this technique, in-house VSP and 3D printing can be performed by the treating surgeon, without an engineering background, within a reasonable period.

While the prognosis for early-stage oral cavity cancer is relatively good; the majority of patients are still diagnosed with advanced-stage disease on presentation with an associated poorer prognosis. The aims of this review are to summarize our current understanding of delays in oral cavity cancer and their impact on stage at diagnosis and survival. The delays pathway can be subdivided into three components: patient, professional, and treatment delays. Patient delay represents the longest interval in the delays pathway usually lasting between 2 and 5 months and being most influenced by cognitive and psychosocial factors. Professional and treatment delays are shorter in most studies, but highly variable depending on the respective healthcare system. Most studies indicate that advanced stage at diagnosis, primary treatment with radiotherapy, treatment at an academic center, and transitions in care are associated with an increased treatment delay. Based on our current understanding, a delay between definitive diagnosis and treatment of 4-6 weeks seems acceptable from an oncologic perspective. Further studies are needed to better define what a 'safe' waiting time is and to understand the psychological impact of delays for patients.

Extracranial carotid artery aneurysms are rare. Treatment options for these lesions include endovascular interventions, such as coiling and stenting, or surgical reconstruction, such as resection and primary reanastomosis, or interposition bypass grafting. In this report, we describe the surgical technique used to perform surgical repair of an internal carotid artery aneurysm extending up to the base of the skull. Anterior exposure of the infratemporal fossa and distal control of the carotid artery at the level of the carotid canal was achieved through a transcervical approach, performing double mandibular osteotomies with superior reflection of the middle mandibular section.

We report the unusual occurrence of 3 cases of Laugier-Hunziker syndrome in the same family.

Two patients with primary angiosarcoma of the heart were treated. The first patient presented with spinal cord compression syndrome secondary to metastatic angiosarcoma of the lumbar spine. The primary tumour was found to be a right atrial mass. In contrast, the second patient presented with repeated episodes of pleural and pericardial hemorrhage resulting in effusive constrictive pericardial physiology. Repeated diagnostic attempts failed, and an open thoracotomy found an infiltrative type of pericardial angiosarcoma involving the right atrial wall. For both patients, the angiosarcoma proved to be rapidly fatal. The clinical spectrum of these two cases and a review of the literature suggest two major clinicopathological forms most commonly arising from the right atrium: a large obstructing mass and a less common, less symptomatic, locally infiltrative tumour, offering a greater diagnostic challenge. The prognosis is usually poor. However, a more aggressive diagnostic approach -- especially in the locally infiltrative tumours -- may offer hope for improving survival.

A new case of late bacterial endocarditis caused by Cardiobacterium hominis is reported. The infection developed on an aortic valve prosthesis and responded favourably to medical treatment. The main characteristics of the micro-organism and of the oslerian graft are reviewed in the light of published data. The problem of endocarditis with negative blood cultures is discussed since C. hominis is reputed difficult to cultivate, although this was not the case in our patient.

Mitogenic doses of membranes purified from Mycoplasma pneumoniae as well as concanavalin A (ConA) were tested for their ability to induce production of interleukin-2 (IL-2) and granulocyte-macrophage colony-stimulating activity (GM-CSA) by human peripheral blood mononuclear cells. Unlike ConA, M. pneumoniae exhibited a significantly lower mitogenic effect and lacked the ability to induce production of IL-2. On the other hand, peak levels of GM-CSA produced in the presence of M. pneumoniae and detected in colony assays of human target marrow cells were approximately 80% of those produced in the presence of ConA. Whereas ConA induced a similar time-related effect upon [3H]thymidine uptake and GM-CSA production, maximal GM-CSA production preceded the peak proliferative response to M. pneumoniae, thereby indicating that M. pneumoniae-induced production of GM-CSA is not quantitatively correlated with DNA synthesis. These findings may contribute to the understanding of the inflammatory manifestations induced by this organism.