The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

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European Position Paper on Rhinosinusitis and Nasal Polyps 2020

http://media.onj.nu/2013/08/AAOMS-Position-paper-ONJ_2014.pdf

American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update.

The inorganic part of hard tissues (bones and teeth) of mammals consists of calcium phosphate, mainly of apatitic structure. Similarly, most undesired calcifications (i.e. those appearing as a result of various diseases) of mammals also contain calcium phosphate. For example, atherosclerosis results in blood-vessel blockage caused by a solid composite of cholesterol with calcium phosphate. Dental caries result in a replacement of less soluble and hard apatite by more soluble and softer calcium hydrogenphosphates. Osteoporosis is a demineralization of bone. Therefore, from a chemical point of view, processes of normal (bone and teeth formation and growth) and pathological (atherosclerosis and dental calculus) calcifications are just an in vivo crystallization of calcium phosphate. Similarly, dental caries and osteoporosis can be considered to be in vivo dissolution of calcium phosphates. On the other hand, because of the chemical similarity with biological calcified tissues, all calcium phosphates are remarkably biocompatible. This property is widely used in medicine for biomaterials that are either entirely made of or coated with calcium phosphate. For example, self-setting bone cements made of calcium phosphates are helpful in bone repair and titanium substitutes covered with a surface layer of calcium phosphates are used for hip-joint endoprostheses and tooth substitutes, to facilitate the growth of bone and thereby raise the mechanical stability. Calcium phosphates have a great biological and medical significance and in this review we give an overview of the current knowledge in this subject.

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Biological and medical significance of calcium phosphates.

Selective Laser Melting (SLM) is a particular rapid prototyping, 3D printing, or Additive Manufacturing (AM) technique designed to use high power-density laser to melt and fuse metallic powders. A component is built by selectively melting and fusing powders within and between layers. The SLM technique is also commonly known as direct selective laser sintering, LaserCusing, and direct metal laser sintering, and this technique has been proven to produce near net-shape parts up to 99.9% relative density. This enables the process to build near full density functional parts and has viable economic benefits. Recent developments of fibre optics and high-power laser have also enabled SLM to process different metallic materials, such as copper, aluminium, and tungsten. Similarly, this has also opened up research opportunities in SLM of ceramic and composite materials. The review presents the SLM process and some of the common physical phenomena associated with this AM technology. It then focuses on the following a...

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Review of selective laser melting : materials and applications

The future of dental devices is digital.

Reconstruction of craniofacial bone defects by intraoperative modelling of autogenous or alloplastic materials may cause undesirable results concerning the implant shape or the long-term maintenance of this shape. Furthermore, the use of alloplastic materials to be modelled intraoperatively may result in an inflammatory tissue response. Therefore the question is raised whether CAD/CAM-techniques may be used for the pre-operative geometric modelling of the implant based on helical computed tomography data. A numerically based 3-dimensional model of the skull defect serves as the basis for a freeform-surfaces design of the implant shape, position and thickness, using modelling tools and programmes developed for industrial CAD/CAM. The precise and individual fit of the implant results from generating its margins by the borders of the defect, whereas the implant surface is generated by the geometry of the non-affected neighbouring bone contours. The implant data run a numerically controlled milling machine to fabricate the individual implant. The reconstruction of post-traumatic defects of the forehead, of post-surgical temporal defects after intracranial haemorrhage, and of a parieto-occipital defect due to ablative tumour surgery are presented as the first clinical experiences of this new method.

Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data

The invention pertains to a process for producing endoprostheses wherein the data block of a three-dimensional actual model (10) of the existing bone structure of a patient is acquired using CT scanning; in a computer the actual model (10) thus determined is subtracted from the data block of an existing or CT scan-generated three-dimensional command model (14), and from the difference a computer-internal model for the endoprosthesis is formed. With this process, to reduce the work required for making the corrective adaptation of the endoprosthesis and to avoid faulty adaptations, the invention proposes that the data blocks of the actual model (10) and reference model (14) are converted into the data of a CAD free form surface geometry describing the limiting surfaces of the models through spline and Bezier functions oriented to points of support and are imaged, superimposed, on the computer monitor, and that this imaging is used to take back segments of the interface (11) of the actual model (10) by displacing points of support toward the volume of the command model (14).

Process for producing endoprostheses

The reconstruction of craniofacial bone defects by intraoperative modeling of implants restricts the choice of material and its biocompatibility and also reduces the predictability of the aesthetic result. These shortcomings go hand in hand with a prolonged surgical procedure time and increased stress on the patient. In contrast, modern industrial computer-aided design and computer-aided manufacturing systems allow the prefabrication of titanium implants, i.e., individual computer-based three-dimensional models of the bone defect are generated after acquisition, transfer, and evaluation of helical computed tomographic data. Based on these data, the individual shape of the implant is designed using freeform-surfaces geometries and is fabricated by a numerically controlled milling machine in a direct fashion. The conical margins of this implant are designed with a precision of 0.25 mm to the borders of the defect, and the surface contours are generated harmonically to the nonaffected neighboring contours with a constant thickness of 1.5 mm. Individual constructions for fixation with the dimensions of microplates are integrated in this process if screw holes cannot be drilled in thin overlapping implant margins. The reconstruction of 22 posttraumatic, postoperative, or primary cranial and craniofacial defects measuring up to 18 cm was performed using this new method. Wound healing was uneventful in all but one case, although some of the patients had been operated on several times before. The result was always predictable and constant using this highly precise technique, and duration of surgery was reduced dramatically.

Individual prefabricated titanium implants in reconstructive craniofacial surgery: clinical and technical aspects of the first 22 cases.

Donor site morbidity after bone harvesting still remains a crucial problem in alveolar cleft osteoplasty. This study focuses on ilium donor site morbidity comparing two different techniques. A series of 52 consecutive patients was divided in half. All had anterior iliac crest bone grafts. In the study group the harvesting was performed with a closed osteotomy using a cylindrical Shepard osteotome. The control group underwent the traditional open osteotomy. In the open osteotomy group the short-term morbidity at the donor site was slightly greater than in the closed harvesting group. The low short-term morbidity in the closed harvesting group was reflected in the analgesic consumption which was three times higher in the open osteotomy group (p < 0.008). The most striking difference occurred in the appearance of the mature scar: a length of 24.2 mm (mean) in the closed harvesting group against 60.3 mm in the open osteotomy group (p < 0.0001), and a width of 4.9 mm (mean) versus 7.7 mm, respectively (p < 0.003). The long-term morbidity was negligible in both groups. Based on these findings we suggest that bone harvesting from the anterior iliac crest remains the preferred method, provided that closed harvesting is undertaken.

Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty.

Objective Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate (BP) medication. Tooth extractions are the most frequent causes for BRONJ. In some cases BRONJ is observed spontaneously, with some anatomic sites carrying a higher risk. Sunitinib, a tyrosine kinase inhibitor, is established in renal cell carcinoma and is known to lead to oral mucositis as a side effect, which in BP patients may additionally raise the risk of BRONJ. Study design We present 3 patients with renal cell carcinoma under BP medication who developed BRONJ during and after sunitinib medication. Results In 2 patients, BRONJ was linked to the occurrence of mucositis after sunitinib intake. The third patient showed relapse of completely healed BRONJ lesions shortly after resumption of a sunitinib therapy. Conclusions Oral mucositis during chemotherapy may raise the risk of BRONJ in cancer patients with BP medication. Especially in renal cell carcinoma patients under sunitinib therapy and intravenous BP medication, oral mucositis should be observed closely because it could be a risk factor for BRONJ.

Harald Eufinger

Papers

Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data

Process for producing endoprostheses

Individual prefabricated titanium implants in reconstructive craniofacial surgery: clinical and technical aspects of the first 22 cases.

Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty.

Sunitinib may raise the risk of bisphosphonate-related osteonecrosis of the jaw: presentation of three cases.