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Summary.-Three of the 4 groups of 3 Wistar rats each were given 40 mg, 80 mg and 120 mg cyclophosphamide/kg respectively by single intraperitoneal injections. The fourth group was given 2 ml of normal saline as control. One animal from each group was killed after 1, 4 and 8 days. The incisor teeth of all experimental animals showed evidence of cytotoxic injury, which appeared to be more severe with increasing dosage, tc the undifferentiated mesenchymal cells in the proliferating zone of the pulp close to the basal odontogenic epithelium, cessation of root growth and relative acellularity of the basal area of the pulp. Evidence of cytotoxicity to the odontogenic epithelium was seen only in the groups given 80 mg/kg and 120 mg/kg. Resolution of the cytotoxic injury and re-establishment of normal basal odontogenesis were seen in the 40 mg dose group by the eighth day but appeared to be slower with increasing dosage. It would seem that of the rapidly proliferating epithelial and mesenchymal odontogenic cells in the basal area of the rat incisor those in the mesenchyme may be most susceptible to the cytotoxicity of cyclophosphamide. The odontogenic epithelium may be resistant to the cytotoxicity of 40 mg cyclophosphamide/kg. The results may be of significance in the investigation of the mechanism of cytotoxicity of this cancer chemotherapeutic agent.

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Purpose The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. Methods Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. Results There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). Conclusion These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.