First record in Europe of the Asian gobiid, shimofuri (marbled) goby Tridentiger bifasciatus Steindachner, 1881.

In November 2022, two shimofuri (marbled) gobies Tridentiger bifasciatus Steindachner, 1881 were caught in the Gent-Terneuzen shipping canal, Belgium. It is the first record of the species in Europe. Outside its native distribution area in Japan, China and South Korea, thus far the shimofuri goby has been observed only on the West Coast of the USA, where established populations exist. The introduction vector potentially was ballast water exchange.

Glass eel (Anguilla anguilla L. 1758) feeding behaviour during upstream migration in an artificial waterway.

The transition from marine to fresh water is a challenging task for juvenile eels. This critical step in the early eels' life is preceded by a metamorphosis from the oceanic larval to the continental glass eel stage, requiring major energy-demanding morphological, physiological and behavioural modifications during which time these animals do not feed. The success of the glass eels' inland migration after metamorphosis will largely depend on remaining energy levels, which can be supplemented only by resuming food uptake. Although it is crucial for their survival and the maintenance of the population, the feeding behaviour of glass eels is still an understudied aspect of the eels' complex life cycle. Many uncertainties about the phenology, diet, potential prey preferences and their relation with migration modus (migratory vs. sedentary) still remain. In this study, the authors analysed the stomach and gut contents of 458 European glass eels (Anguilla anguilla L. 1758) captured in a drainage canal connecting a small mesotidal estuary with an adjacent polder area during the spring migration seasons of 2016 and 2017. They demonstrated that although glass eels started feeding briefly upon arrival in the estuary, food uptake for early arrivals was restricted to a minority that sparsely feed on detritus and some worm-like benthic invertebrates. Along the season, food uptake intensified eventually engaging all glass eels and their dietary palette diversified including a wide array of planktonic and benthic organisms. Crustacean plankton (mainly cyclopoid copepods) was an important part of the glass eel diet, whereas benthic oligochaetes were less abundant as food source in spite of their high presence in the sediments. No clear differences in feeding behaviour could be observed between migratory and sedentary glass eels. This study showed that glass eels can use highly artificial and dynamic drainage canals as feeding ground during their critical marine/freshwater transition. This outcome is also a plea to improve the accessibility of alternative (unnatural) migration routes between the ocean and suitable freshwater growth habitats for the European eel.

Impaired Callus Formation in Pathological Mandibular Fractures in Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis.

PURPOSE: Nonsurgical treatment of mandibular fractures secondary to medication-related osteonecrosis of the jaw (MRONJ) or osteoradionecrosis (ORN) mostly results in nonunion, whereas nonsurgical fracture treatment of atrophic fractures can achieve favorable results in selected cases. The aim of this study was to compare callus formation in pathological mandibular fractures due to MRONJ, ORN, or extreme mandibular atrophy. METHODS: A retrospective cohort study reviewing the medical records of all MRONJ-, ORN-, or atrophy-related fractures treated at the departments of maxillofacial surgery in the Leuven or Lille university hospitals between 2010 and 2019 was undertaken. The primary predictor variable in this study was disease state (MRONJ, ORN, or extreme mandibular atrophy). The primary outcome variable was callus formation after 1 month of follow-up (present, absent). Additional study variables measured included patient age and gender. T-tests, Fisher exact tests, and multiple logistic regression were used for statistical analysis. The significance level was set at P < .05. RESULTS: Seventy patients were analyzed (12 MRONJ cases, 54 ORN fractures, 4 atrophic fractures). The callus formation prevalence in nonsurgically approached fractures secondary to ORN and MRONJ after 1 month of follow-up was 3.03% (2/66 cases). In contrast, callus was detected in all patients in the mandibular atrophy-related fracture group. Osteonecrosis was statistically correlated with impaired callus formation (P = .0121). CONCLUSION: Whereas one would expect indirect fracture healing and thus callus formation to occur in all non-surgically treated fractures, our data demonstrate its absence in the majority of MRONJ- and ORN-related fractures. Multiple plausible explanations for this phenomenon were identified: periosteal damage with loss of callus-forming cells, compromised vasculature, and bacterial colonization.

Burrowing behaviour of the European eel (Anguilla anguilla): Effects of life stage.

The European eel (Anguilla anguilla) is a fascinating species, exhibiting a complex life cycle. The species is, however, listed as critically endangered on the IUCN Red List due to an amalgam of factors, including habitat loss. This study investigated the burrowing behaviour and substrate preference of glass, elver and yellow stages of A. anguilla. Preference was determined by introducing eels in aquaria with different substrates and evaluating the chosen substrate for burrowing. In addition, burrowing was recorded using a camera in all substrate types and analysed for kinematics. The experiments showed that all of these life stages sought refuge in the sediments with particle sizes ranging from sand to coarse gravel. Starting from a resting position, they shook their head horizontally in combination with rapid body undulations until half of their body was within the substrate. High-speed X-ray videography revealed that once partly in the sediment, eels used only horizontal head sweeps to penetrate further, without the use of their tail. Of the substrates tested, burrowing performance was highest in fine gravel (diameter 1-2 mm; lower burrowing duration, less body movements and/or lower frequency of movements), and all eels readily selected this substrate for burrowing. However, glass eels and elvers were able to use coarse gravel (diameter >8 mm) because their smaller size allowed manoeuvring through the spaces between the grains. Further, burrowing performance increased with body size: glass eels required more body undulations compared to yellow eels. Interestingly, the urge to hide within the sediment was highest for glass eels and elvers. Documentation of substrate preference and burrowing behaviour of A. anguilla provides new information about their potential habitat use. Considering that habitat alterations and deteriorations are partly responsible for the decline of the eel, this information can contribute to the development of more effective conservation measures.

Surgical Management of an Aggressive Multifocal Squamous Odontogenic Tumor.

Squamous odontogenic tumor is a rare benign epithelial odontogenic tumor of the jaw. Most are solitary lesions, although rare multifocal lesions have been described. Maxillary lesions have more aggressive behavior. Because of their benign character, these lesions are usually treated using a conservative surgical approach with curettage and surgical enucleation. This report describes the case of a 29-year-old woman with multifocal lesions who was initially treated with conservative surgical therapy. Early recurrence 6 months after surgery prompted more aggressive resection. This case is discussed in the context of current evidence related to the epidemiology, etiology, diagnosis, and therapy of squamous odontogenic tumors.

Surgical treatment of the Anterior Cruciate Ligament Rupture : where do we stand today?

The rupture of the anterior cruciate ligament is one of the most common orthopaedic injuries. This review gives an overview of the surgical treatment of the ACL rupture. A correct knowledge of the anatomy of the ACL is crucial in treating this injury. Recent studies describe the ACl as flat rather than divided in distinct structural bundles. Reconstructive and primary repair techniques can be used to approach this native anatomy. Reconstructive surgery of the ACL still is the golden standard in ACL surgery. An individualized approach is key and should be used. However, ACL reconstruction is not always a success. Return to preinjury of sports only reaches 65% and ACL-reconstructed knees are prone to osteoarthritis. Previous attempts at the primary repair of the ACL were archaic and had disappointing results. Modern diagnostics, operative and biological techniques and strict patient selection could initiate a revival of this technique.

Elucidating the migrations of European seabass from the southern north sea using mark-recapture data, acoustic telemetry and data storage tags.

The movement ecology of European seabass, Dicentrarchus labrax, remains poorly understood, especially in the northern ranges of its distribution. To investigate migration patterns of seabass from the southern North Sea, we combined data from different projects from four countries using various tagging techniques. This resulted in 146 recaptures (out of 5598 externally marked seabass), 138 detected animals (out of 162 seabass fitted with an acoustic transmitter) and 76 archived depth and temperature series (out of 323 seabass with an archival tag). Using geolocation modelling, we distinguished different migration strategies, whereby individual fish migrated to the eastern English Channel (15.1%), the western English Channel (28.3%), the Celtic Sea and the norther part of the Bay of Biscay (17.0%), or stayed in the North Sea (39.6%). A high number of seabass exhibited fidelity to the North Sea (90.5% of recaptures, 55.3% for acoustic transmitters and 44.7% of archival tags). Although seabass are generally considered to migrate southwards in winter, a large number of individuals (n = 62) were observed in the southern North Sea, where spawning might potentially occur in a particular deep location along the coast of Norfolk in the UK. Our results highlight the need to consider fine-scaled population structuring in fisheries assessment, and indicate that current seasonal fisheries closures are not aligned with the ecology of seabass in the North Sea.

Tidal and circadian patterns of European eel during their spawning migration in the North Sea and the English Channel.

Technological advances in tracking methods enable the mapping of anguillid eel migration routes from continental habitats to their spawning sites in the ocean. However, the behaviour and orientation abilities of anguillids are still poorly understood, and have only rarely been studied on the continental shelf. Here we present the results of a study into the vertical and horizontal movement behaviour of 42 European eels (Anguilla anguilla L.) tagged with electronic tags that migrated through the North Sea and English Channel towards and into the Atlantic Ocean during their spawning migration. We used actograms, periodograms and linear mixed effects models to determine the periodicity and significance of the timing and pattern of vertical movement and activity. Overall, eels had a complex behavioural repertoire that included classical diel vertical migration (DVM), reverse DVM and vertical movement behaviours that synchronized with tidal patterns. All of the eels that were tracked showed one or more of these behaviours during their time at liberty, and many exhibited all of them. We also observed that the eels had a higher horizontal migration speed when the current in the favourable direction was stronger. This, together with the vertical movement synchronized with the tides, suggests the eels adopt selective tidal stream transport. Finally, tracked eels had a higher vertical movement range at night compared to daytime. We hypothesize that these behaviours are driven by bio-energetic efficient movement, navigation and predator avoidance.

Morphological characteristics of coronoid process and revisiting definition of coronoid hyperplasia.

The aim of this study was to assess the morphological characteristics of the coronoid process (CP) and define coronoid hyperplasia (CH) using cadaveric mandibles of a Caucasian population. A sample of 151 adult dry cadaveric mandibles (302 CPs) was acquired. Three distances were measured, which included the width, height, and length of CP. The surface area measurements involved area A: above the width distance line; area B: between incisura mandibulae-Alveolar ridge line and width distance line; area C: between distance lines of width and height. Finally, angulations of the CP and gonial angles were identified. Both length and surface area A + B acted as hyperplastic indicators. Based on the selection criteria, a sample of 197 CPs was included. The hooked shape (59%) was most commonly observed. No significant difference existed between left and right sides (p > 0.05). The mean values of length and surface area A + B were 2.2 ± 0.3 cm and 3.3 ± 0.8 cm2, and any values above 2.7 cm (n = 5 CPs- 2.5%) and 5.0 cm2 (n = 9 CPs- 4.6%) were described as hyperplastic, respectively. The presented data could act as quantitative reference for differentiating between normal and hyperplastic conditions.

The impact of CBCT-head tilting on 3D condylar segmentation reproducibility.

OBJECTIVES: To investigate whether variations in head positioning may influence the reproducibility of cone-beam CT (CBCT) three-dimensional (3D) segmented models of the mandibular condyle. METHODS: Five fresh frozen cadaver heads were scanned in four different positions: reference position (RP) and a set of three tilted alternative head positions (AP) in anteroposterior direction (AP1: 2 cm anterior translation, AP2: 5° pitch rotation, AP3: 10° pitch rotation). Surface models of mandibular condyles were constructed and compared with the condylar reference position using voxel-based registration. Descriptive statistics and a linear mixed-effects model were performed to compare condylar volumetric differences and root mean square (RMS) distance between surfaces of AP vs RP. RESULTS: The mean differences in condylar volumes of AP vs RP were 14.1 mm³ (95% CI [-79.3, 107.4]) for AP1, 1.0 mm³ (95% CI [-87.2, 89.2]) for AP2 and 0.1 mm³ (95% CI [-88.3, 88.4]) for AP3. Mean and absolute volumetric differences did not exceed earlier reported intraoperator differences of 30 mm³. The RMS distance values obtained per group were 0.12 mm (95% CI [0.05,0.20]) for AP1, 0.17 mm (95% CI [0.10, 0.22]) for AP2 and 0.17 mm for AP3 (95% CI [0.10,0.22]). The confidence intervals (CI) for RMS distance remained far below the threshold for clinical acceptability (0.5 mm). CONCLUSIONS: Within the limits of the present study, it is suggested that tilted head positions may affect the reproducibility of 3D condylar segmentation, thereby influencing outcome in repeated CBCT scanning. Nevertheless, observed differences are unlikely to have a meaningful impact on clinical patient diagnosis and management.

Mapping silver eel migration routes in the North Sea.

Recent developments in tracking technology resulted in the mapping of various marine spawning migration routes of the European eel (Anguilla anguilla). However, migration routes in the North Sea have rarely been studied, despite many large European rivers and hence potential eel growing habitat discharge into the North Sea. In this study, we present the most comprehensive map to date with migration routes by silver European eels in the North Sea and document for the first time successful eel migration through the English Channel. Migration tracks were reconstructed for 42 eels tagged in Belgium and 12 in Germany. Additionally, some eels moved up north to exit the North Sea over the British Isles, confirming the existence of two different routes, even for eels exiting from a single river catchment. Furthermore, we observed a wide range in migration speeds (6.8-45.2 km day-1). We hypothesize that these are likely attributed to water currents, with eels migrating through the English Channel being significantly faster than eels migrating northward.

Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study.

BACKGROUND: Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage. METHODS: This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy. RESULTS: A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474). CONCLUSION: To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

Layered deep learning for automatic mandibular segmentation in cone-beam computed tomography.

OBJECTIVE: To develop and validate a layered deep learning algorithm which automatically creates three-dimensional (3D) surface models of the human mandible out of cone-beam computed tomography (CBCT) imaging. MATERIALS & METHODS: Two convolutional networks using a 3D U-Net architecture were combined and deployed in a cloud-based artificial intelligence (AI) model. The AI model was trained in two phases and iteratively improved to optimize the segmentation result using 160 anonymized full skull CBCT scans of orthognathic surgery patients (70 preoperative scans and 90 postoperative scans). Finally, the final AI model was tested by assessing timing, consistency, and accuracy on a separate testing dataset of 15 pre- and 15 postoperative full skull CBCT scans. The AI model was compared to user refined AI segmentations (RAI) and to semi-automatic segmentation (SA), which is the current clinical standard. The time needed for segmentation was measured in seconds. Intra- and inter-operator consistency were assessed to check if the segmentation protocols delivered reproducible results. The following consistency metrics were used: intersection over union (IoU), dice similarity coefficient (DSC), Hausdorff distance (HD), absolute volume difference and root mean square (RMS) distance. To evaluate the match of the AI and RAI results to those of the SA method, their accuracy was measured using IoU, DSC, HD, absolute volume difference and RMS distance. RESULTS: On average, SA took 1218.4s. RAI showed a significant drop (p<0.0001) in timing to 456.5s (2.7-fold decrease). The AI method only took 17s (71.3-fold decrease). The average intra-operator IoU for RAI was 99.5% compared to 96.9% for SA. For inter-operator consistency, RAI scored an IoU of 99.6% compared to 94.6% for SA. The AI method was always consistent by default. In both the intra- and inter-operator consistency assessments, RAI outperformed SA on all metrics indicative of better consistency. With SA as the ground truth, AI and RAI scored an IoU of 94.6% and 94.4%, respectively. All accuracy metrics were similar for AI and RAI, meaning that both methods produce 3D models that closely match those produced by SA. CONCLUSION: A layered 3D U-Net architecture deep learning algorithm, with and without additional user refinements, improves time-efficiency, reduces operator error, and provides excellent accuracy when benchmarked against the clinical standard. CLINICAL SIGNIFICANCE: Semi-automatic segmentation in CBCT imaging is time-consuming and allows user-induced errors. Layered convolutional neural networks using a 3D U-Net architecture allow direct segmentation of high-resolution CBCT images. This approach creates 3D mandibular models in a more time-efficient and consistent way. It is accurate when benchmarked to semi-automatic segmentation.

Automatic 3D dense phenotyping provides reliable and accurate shape quantification of the human mandible.

Automatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC's for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

Saving the European Eel: How Morphological Research Can Help in Effective Conservation Management.

The European eel (Anguilla anguilla) is a critically endangered species, whose recruitment stocks have declined to nearly 1% compared to the late 70s. An amalgam of factors is responsible for this, among them migration barriers, pollution, habitat loss, parasite infection, and overfishing. A lot of recent studies focus on aspects that can increase the mature silver eel escapement rate, such as identifying migration barriers and developing passageways or addressing the impact of pollution on the eel's health. However, little attention is given to the eel's morphology in function of management measures. Worryingly, less than 50% of the currently installed management plans reach their goals, strongly indicating that more information is needed about the eel's ecology and behavior. Functional morphological studies provide insights on how species perform behaviors crucial for survival, such as feeding and locomotion, but also in how environmental changes can affect or limit such behaviors. Consequently, functional morphology represents an important biotic component that should be taken into account when making conservation decisions. Hence, here, we provide an overview of studies on the eel's morphology that do not only demonstrate its relation with ecology and behavior, but also provide information for developing and installing proper and more specific management measures.

Pitfalls and Promise of 3-dimensional Image Comparison for Craniofacial Surgical Assessment.

Three-dimensional (3D) photography is becoming widely used in plastic surgery. It provides an accurate and reproducible record of the facial surface anatomy and could be a versatile tool for treatment planning and assessment. However, the existing software tools available for the assessment of 3D facial imaging often give highly misleading results. The goal of this special topic article is to give clinicians an insight into methods of 3D image assessment and explain the reasons why results may be misleading. We point toward the advantages of an alternative approach using "nonrigid surface registration" for the comparison of pre- and postsurgical images. This approach is compared with the regular rigid surface registration, and this is illustrated by the assessment of a child with Crouzon syndrome before and after LeFort III osteotomy and distraction. Findings of the standard method imply that changes have occurred that are anatomically not possible, whereas the alternative approach indicates realistic changes. Furthermore, we demonstrate an exciting capacity of 3D image analysis to construct reference populations of normal head size and shape. These can be used to assess the parts of the head that are normal and abnormal pre- and posttreatment of the same child. We conclude that, while 3D image analysis has great potential in surgical assessment, existing software does not always give an adequate assessment. Collaboration among surgeons and engineering and computer science specialists should be encouraged. This way, more comprehensive and accurate techniques in patient assessment and surgical planning can be developed and applied in clinical practice.

Validation of a 3D CBCT-based protocol for the follow-up of mandibular condyle remodeling.

OBJECTIVES: Three-dimensional models of mandibular condyles provide a way for condylar remodeling follow-up. The overall aim was to develop and validate a user-friendly workflow for cone beam CT (CBCT)-based semi-automatic condylar registration and segmentation. METHODS: A rigid voxel-based registration (VBR) technique for registration of two post-operative CBCT-scans was tested. Two modified mandibular rami, with or without gonial angle, were investigated as the volume of interest for registration. Inter- and intraoperator reproducibility of this technique was tested on 10 mandibular rami of orthognathic patients by means of intraclass correlation coefficients (ICC's) and descriptive statistics of the transformation values from the VBR. The difference in reproducibility between the two modified rami was evaluated using a paired t-test (p < 0.05). For the segmentation, eight fresh frozen cadaver heads were scanned with CBCT and micro-CT. These data were used to test the inter- and intraoperator reproducibility (ICC's) and accuracy (Bland-Altman plot) of a newly designed workflow based on semi-automated contour enhancement. RESULTS: Excellent ICC's (0.94-0.99) were obtained for the voxel-based registration technique using both modified rami. If the gonial angle was not included in the volume of interest, there was a trend of increased operator error suggested by significant higher interoperator differences in translation values (p = 0,0036). The segmentation workflow proved to be highly reproducible with excellent ICC's (0.99), low absolute mean volume differences between operators (23.19 mm3), within operators (28.93 mm3) and low surface distances between models of different operators (<0.20 mm). Regarding the accuracy, CBCT-models slightly overestimate the condylar volume compared to micro-CT. CONCLUSIONS: This study provides a validated user-friendly and reproducible method of creating three-dimensional-surface models of mandibular condyles out of longitudinal CBCT-scans.

The Biomechanical Effect of the Sagittal Split Ramus Osteotomy on the Temporomandibular Joint: Current Perspectives on the Remodeling Spectrum.

The sagittal split ramus osteotomy is a key approach for treating dentofacial deformities. Although it delivers excellent results, the sagittal split ramus osteotomy is believed to induce stress to the temporomandibular joint. Potential stress inducers could be classified as intra- and postoperative factors resulting in an inflammatory response and molecular cascades, which initiate physiological remodeling. Occasionally, this process exceeds its capacity and causes pathological remodeling, through either degenerative joint disease or condylar resorption. Hard evidence on how orthognathic surgery causes inflammation and how this inflammation is linked to the spectrum of remodeling remains scarce. Current concepts on this matter are mainly based on clinical observations and molecular mechanisms are extrapolated from fundamental research in other body parts or joints. This perspective study provides an overview of current knowledge on molecular pathways and biomechanical effects in temporomandibular joint remodeling. It provides research directions that could lead to acquiring fundamental evidence of the relation of orthognathic surgery and inflammation and its role in remodeling. Performing osteotomies in animal models and identifying inflammatory mediators as well as their effect on the joint seem promising. Patients affected by pathological remodeling can also provide samples for histological as well as molecular analysis. Individual susceptibility analysis by linking certain suspect phenotypes to genetic variation could identify the cause and molecular pathway responsible for degenerative joint disease and condylar resorption, ultimately leading to clinically applicable treatment and prevention strategies.

Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting.

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care. A retrospective analysis was conducted of all FFFs performed over a 20-year period at a low-volume single tertiary center to identify risk factors and postoperative complications. A total of 129 FFFs were included (122 mandible, 7 maxilla). Complete flap failure occurred in 12.4% and partial flap failure in 7.8% of patients. A significant relation was found between younger age and flap failure, and most failures were associated with venous thrombosis. In-hospital surgical complications occurred in 60.5%, in-hospital medical complications in 49.6%, and out-of-hospital complications in 77.5% of patients. The in-hospital reintervention rate was 27.1%, and including salvaged flaps, flap survival rate was 87.6%. Osteomyocutaneous FFF failure (complete 12.4%; partial 7.8%) is an important clinical reality in a low-volume head and neck reconstruction center resulting in an in-hospital reintervention rate of 27.1%. Postoperative complications are frequent, both surgical and out-hospital complications. These results provide a better understanding of the limitations of the FFF in a low-volume center and can be used to optimize care in this kind of setting.

Metal debris after dental implant placement: A proof-of-concept study in fresh frozen cadavers using MRI and histological analysis.

PURPOSE: This report originated from the finding of metal artefacts on magnetic resonance images (MRI) which were not detected on panoramic radiography or cone beam computed tomography (CBCT) imaging. It was hypothesised that drills or implants might release metal particles during surgical procedures in the jawbones. Therefore, the aim was to assess whether dental implants or surgical drills might cause metal debris in the surrounding tissues. MATERIALS AND METHODS: The experiment consisted of a postmortem and an antemortem model. A split-mouth design was carried out in a postmortem fresh frozen cadaver head. In the left mandible only the drill preparation sequence was performed, whereas in the right mandible, the drill sequence was followed by implant placement. Before surgery, the postmortem model underwent a baseline MRI acquisition. A second MRI (MRI2) was acquired after performing the osteotomies on both sides and implant placement on the right side. Finally, the implants were carefully removed, and a final MRI (MRI3) was acquired. Bone blocks containing the implant and osteotomy sites were isolated. For the antemortem model, a fresh frozen cadaver head was selected that already had implants in place. An implant in the anterior maxilla was removed and the surrounding bone block was isolated as well. A histological analysis was prepared for both models. RESULTS: In the antemortem model, histological analysis showed irregular-shaped dark particles near the bone-implant interface consistent with metal debris. Additionally, in the postmortem model, both sites showed metal artefacts on MRI2 and MRI3, and by using a balanced fast field echo sequence, and histological analysis, the suspected particles of metal debris were confirmed on both sides of the mandible. CONCLUSIONS: Further studies should investigate the origin and extent of the metal debris following implant placement, as well as its clinical significance, possible risk factors and preventive measures.