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Introduction: Three-dimensional (3D) printing plays a rapidly expanding role in the field of craniomaxillofacial (CMF) surgery; however, the time and costs required to efficiently utilize this technology are highly variable. To better delineate the temporal and financial resources needed to establish an efficient workflow, we conducted a systematic review and meta-analysis of studies utilizing patient-directed 3D-printed constructs in the setting of CMF surgery. Methods: A systematic review was performed using PubMed, Web of Science, and Embase. In total, 1679 articles were screened and 45 met inclusion criteria. Primary outcomes included the costs of 3D-printed constructs and the time required for virtual surgical planning (VSP), 3D printing, surgery, and hospitalization. Results: The aggregated data assessed 751 patients, 738 surgeries, and 1136 3D-printed constructs. The most common surgical indication was post-neoplastic reconstruction (n = 304), and the most common surgical procedure was mandibular reconstruction (n = 287). Printed constructs were as follows: contour models (44.1%), guides (30.9%), implants (12.5%), splints (12.1%), and prostheses (0.5%). Printing was the longest contributor to the preoperative workflow, averaging 401.6 minutes, while VSP required, on average, only 98.6 minutes. There was no significant difference in VSP time between constructs printed in-house and those contracted from commercial vendors. However, constructs printed in-house were significantly cheaper than those procured from vendors, averaging $252.20 and $2735.50, respectively ( P < .001). Of articles reporting intraoperative time (n = 19), 78.9% reported significant reductions when using 3D-printed constructs. Conclusion: 3D printing, especially in-house workflows, may reduce costs and improve efficiency for CMF surgery.

Introduction: Three-dimensional (3D) printing plays an expansive role in craniofacial surgical planning and implementation. To better understand when the benefits of this technology outweigh its environmental costs, a focused exploration of the environmental impact of 3D printing is warranted to quantify carbon emissions attributable to craniofacial surgical constructs. Methods: All invoice data from commercial vendors used at Johns Hopkins Hospital for the 2-year period from January 2020 to December 2021 were reviewed. Information on the material composition of each construct was recorded. Additionally, a total of 19 commercial printers were included. Conversion factors from the U.S. EIA were used to calculate the carbon emissions generated by the fuel consumption of each printer per hour. Results: Invoice data revealed 406 patient-specific constructs (158 contour models, 104 guides, 84 implants, and 60 splints). A total of 2644.4 printer hours and 36.1 MW of power were needed to manufacture all constructs. This is equivalent to releasing 15.71 metric tons of carbon emissions, corresponding to the emissions produced by burning 7882.1 kg of coal or 36.4 barrels of oil. Conclusion: 3D printing is a resource-intensive practice in CMF surgery. Therefore, when weighing patient benefits against environmental detriment, CMF surgeons must determine indications where 3D printing is unessential. Restricting prints to the anatomy of interest, minimizing support structures, and reusing printed constructs may all help to lessen the environmental impact of this growing practice.

Background: Associations between the use of dental appliances and oral cancer remain controversial. No studies have reported a relationship between dental appliances in the setting of cleft palate management and oral cancer. This study characterizes the correlation between dental appliances and oral cancer and includes a case report of a patient with a history of cleft palate repair who later developed oral squamous cell carcinoma (OSCC). Methods: We performed a systematic review for studies from 1980 to 2022 of patients who had dental prostheses and who were subsequently diagnosed with OSCC. Variables included the percentage of OSCC cases wearing dental appliances, intraoral cancer location, and noted associations between reported risk factors and OSCC. Results: Of the 6323 patients from the 31 articles analyzed, the most common specified locations for the neoplastic lesion were at the gingiva and lateral border of the tongue. Seventeen studies found an association between OSCC and denture use (54.8%), while 9 studies (29.0%) specifically found a positive association between oral sores and OSCC. Our case patient had complete dental extraction at the age of 12 with subsequent life-long dentures. At age 69, he presented with invasive OSCC. Conclusions: Chronic irritation from ill-fitted dental appliances are associated with oral sores and cancer. This study reports a cleft palate repair patient with lifelong use of dentures who presented with OSCC despite having no known risk factors for oral cancer.