Access to the mandibular ramus can be difficult. There are a number of described methods for accessing the mandibular ramus and condyle, including a transoral or transcutaneous approach. Access via a transoral approach prevents surgical scars but can result in an excessive amount of bone removal from the anterior mandibular ramus. The transparotid approach has been described and commonly used for the management of mandibular trauma. It allows for direct access to the mandibular ramus and condyle with a number of possible complications, including salivary fistula formation, sialocele and facial nerve injury. Despite these risks, this approach is commonly used in the setting of trauma. This case report describes an additional indication, the successful use of the transparotid approach for the management of benign odontogenic pathology.
Periosteum is a highly vascularized membrane lining the surface of bones. It plays essential roles in bone repair following injury and reconstruction following invasive surgeries. To broaden the use of periosteum, including for augmenting in vitro bone engineering and/or in vivo bone repair, we have developed an ex vivo perfusion bioreactor system to maintain the cellular viability and metabolism of surgically resected periosteal flaps. Each specimen was placed in a 3D printed bioreactor connected to a peristaltic pump designed for the optimal flow rates of tissue perfusate. Nutrients and oxygen were perfused via the periosteal arteries to mimic physiological conditions. Biochemical assays and histological staining indicate component cell viability after perfusion for almost 4 weeks. Our work provides the proof-of-concept of ex vivo periosteum perfusion for long-term tissue preservation, paving the way for innovative bone engineering approaches that use autotransplanted periosteum to enhance in vivo bone repair.
Breast cancer is the most common cancer affecting women in Australia, and second overall for all Australians. Molecular targets have been developed in the management of breast cancer to allow directed therapy. Complications such as nausea and vomiting can be common as well as less common such as osteonecrosis of the jaw (ONJ). While previously thought to be attributable only to bisphosphonate medications, there has been an increase in recognition of other medications that may also cause this complication. This case report demonstrates a first instance of osteonecrosis of the jaw attributable to pertuzumab and trastuzumab, indicated in the management of HER2-positive metastatic breast cancer, in a patient na€ ıve to ONJ-associated anti-resorptive medications. Following sequestrectomy, the patient had an uncomplicated postoperative healing 5 months following intervention. With increasing medications being used for a number of malignant conditions such as this, an awareness of less common complications such as ONJ among dental and medical specialties is highlighted in this case report.
Background: Digital surgical planning (DSP) has revolutionized the preparation and execution of the management of complex head and neck pathologies. The addition of virtual reality (VR) allows the surgeon to have a three-dimensional experience with six degrees of freedom for visualizing and manipulating objects. This pilot study describes the participants experience with the first head and neck reconstructive VR-DSP platform. Methods: An original VR-DSP platform has been developed for planning the ablation and reconstruction of head and neck pathologies. A prospective trial utilizing this platform involving reconstructive surgeons was performed. Participants conducted a simulated VR-DSP planning session, pre-and post-questionnaire as well as audio recordings allowing for qualitative analysis. Results: Thirteen consultant reconstructive surgeons representing three surgical backgrounds with varied experience were recruited. The majority of surgeons had no previous experience with VR. Based on the system usability score, the VR-DSP platform was found to have above average usability. The qualitative analysis demonstrated the majority had a positive experience. Participants identified some perceived barriers to implementing the VR-DSP platform. Conclusions: Virtual reality-digital surgical planning is usable and acceptable to reconstructive surgeons. Surgeons were able to perform the steps in an efficient time despite limited experience. The addition of VR offers additional benefits to current VSP platforms. Based on the results of this pilot study, it is likely that VR-DSP will be of benefit to the reconstructive surgeon. reconstruction of more complex craniofacial defects. [1][2][3] It requires the presence of an engineer and surgeon, with a three-dimensional (3D) planning session performed online with a conventional computer screen displaying 3D information on a two dimensional
Hypovitaminosis C, or scurvy, is thought to be an uncommon condition. Although prevalent in the 19th century, its ease of absorption and availability in a general diet has greatly reduced its incidence. Vitamin C is necessary for a number of physiological processes and deficiency can result in a number of complications including bleeding/bruising, anaemia and gingival hyperplasia. This case report demonstrates a case of hypovitaminosis C presenting to a tertiary hospital related to poor dietary intake in a patient with behavioural medical conditions. Treatment consisted of oral supplementation of vitamin C with almost immediate resolution of presenting symptoms.
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