PURPOSE:To assess the advantages and disadvantages of the stackable guided approach through a retrospective analysis of 43 edentulous arches rehabilitated with or without bone grafts using a stackable guided approach and an immediate loading protocol. MATERIALS AND METHODS:A total of 284 implants were placed with a fully digital workflow using stacked guides, which aided the design of provisional protheses loaded immediately after implant placement. The primary outcome measure was the survival rate of the implants at 4 months. RESULTS:After a 4-month follow-up period, 10 implants (3.5%) exhibited no osseointegration and were subsequently replaced, resulting in an overall success rate of 96.5%. After 1 year of follow-up, a prosthetic success rate of 100% was observed, with all patients being able to progress to the permanent fixed dentures stage. CONCLUSIONS:Our findings support the use of this protocol for all patients, whether they require bone grafting or not. However, a long term follow-up is essential for a comprehensive evaluation of these treatment outcomes.

Las comunicaciones buconasosinusales son comunicaciones patológicas entre la cavidad oral, el seno maxilar y/o las fosas nasales. La gran mayoría se producen después de la extracción de un diente maxilar. Las otras causas principales son la cirugía de resección de tumores maxilares, la enucleación de quistes maxilares y la cirugía implantológica y preimplantológica. Pueden provocar una sinusitis unilateral crónica que es discapacitante para el paciente. Esta entidad requiere un tratamiento medicoquirúrgico especializado. Las pruebas de imagen ocupan un lugar importante en el diagnóstico, la planificación de la cirugía y también en la prevención de la aparición de comunicaciones buconasosinusales. Existen diferentes técnicas quirúrgicas, que dependen de la localización y del tamaño del orificio.

Due to the location and toxicity of treatments, head and neck cancer (HNC) has a major impact on quality of life (QoL). Objective: to assess the effects of geriatric-assessment (GA)-driven interventions on QoL over 2 years in older adults with HNC.EGeSOR was a randomized study of HNC patients aged ≥65, receiving a pretreatment GA, a geriatric intervention and follow-up (intervention) or standard of care (control). The primary endpoint was QoL score using the European Organisation for Research and Treatment of Cancer's (EORTC QLQ-C30) and HNC (QLQ-HN35) QoL questionnaires over 24 months.In total, 475 patients were included (median age: 75.3; women: 31%; oral cancer: 44%). QoL scores improved over 24 months with various trajectories, without significant differences between the groups. A total of 74% of patients (interventional group) did not receive the complete intervention. Cancer characteristics, functional status, and risk of frailty were associated with change in the Global Health Status QoL score.There is a need to develop an alternative model of implementation such as patient-centered health-care pathways. TRIAL REGISTRATION:NCT02025062.

Le comunicazioni oro-naso-sinusali sono delle comunicazioni patologiche tra il cavo orale, il seno mascellare e/o la cavità nasale. La stragrande maggioranza di esse si verifica in seguito all’avulsione di un dente mascellare. Le altre cause principali sono l’intervento chirurgico per asportare tumori mascellari, l’enucleazione di cisti mascellari e la chirurgia implantare e preimpianto. Possono causare una sinusite cronica unilaterale invalidante per il paziente. Questa entità richiede un trattamento medico e chirurgico specializzato. Gli esami di imaging svolgono un ruolo importante nella diagnosi, nella pianificazione dell’intervento chirurgico ma anche nel prevenire l’insorgenza di comunicazioni oro-naso-sinusali. Esistono diverse tecniche chirurgiche che dipendono dalla posizione e dalle dimensioni dell’orifizio.

This article describes a reliable surgical alternative for the repair of wide oromandibular defects that require bone and soft tissues, which was applied in two patient cases. While microvascular free flap transfer, especially the fibula flap, is the gold standard for mandibular reconstruction, this reconstruction is challenging in patients with a vessel-depleted neck and/or severe arteriosclerosis. The pedicled osteomuscular dorsal scapular (OMDS) flap is a surgical alternative to free flap transfer in this clinical setting. The technique described involves harvesting of the OMDS flap to include a skin paddle, which is often required to close wide oral mucosal defects.

The primary objective of this retrospective study was to determine whether patients with a reported allergy to penicillin have an increased risk of postsurgical infections after sinus lifts and onlay grafts. A retrospective cohort study was performed on patients who underwent bone reconstruction procedures between October 2018 and December 2020. Data from all patients operated in one University Hospital for sinus lift or onlay grafts were collected. All surgical procedures studied were performed under preoperative and postoperative antibiotic coverage with either amoxicillin +/- clavulanic acid or clindamycin for patients with reported penicillin allergy. Bone graft-associated infections were recorded. Graft failures were also reported. In this study, 111 patients received bone reconstructions (89 sinus lift, 148 onlay grafts). Among sinus lift, infections occurred in 5 of 89 sites (5.6 %). However, the infection rate was 28.5 % (7 graft sites) for clindamycin and only 3.9 % (82 graft sites) for amoxicillin. Among onlay graft procedures, infections occurred in 25 of 148 sites (16.8 %). However, the infection rate was 56 % (18 graft sites) for clindamycin and only 12 % for amoxicillin (130 graft sites). Penicillin-allergic patients taking clindamycin had a higher risk of infection with an odd ratio of 7.8 (95 % CI 1.1-54.8, P=0.04) and 4.8 (95 % CI 1.9-12.3, P=0.001) compared with non-allergic patients taking amoxicillin for onlay grafts and sinus lift. Penicillin allergy labelling resulting in a clindamycin use after sinus lift and procedures were associated with a higher rate of infection and may be a risk factor for complications related to bone reconstruction surgery. Our data on postoperative infections are consistent with the literature. Penicillin-allergy de-labelling strategy prior to surgery may impact these infection and is now implemented in our center Aucun lien d'intérêt

The ongoing shortage in healthcare services and the increasing cancer incidence, highlight the need for new strategies to ensure optimal treatments, cares and follow-up for all patients. Digitalized healthcare, which includes various concepts (digital health, telemedicine, telemonitoring and digital therapeutics), are a promising option to meet these needs. In this scoping review, we provide an overview of the recent available research evidence on digitalized healthcare for HNC patients and caregivers. Through the interrogation of PubMed and Cochrane Library databases, a total of 32 relevant articles reporting the use of digitalized healthcare in different settings of HNC patients' care management, were analyzed. Overall, HNC patients as well as caregivers were highly satisfied, especially because digitalized healthcare allows the early detection of health disorders, improve patient's management, quality of life, self-confidence and communication. Furthermore, digitalized healthcare were significantly time- and cost-effective. While the benefits digitalized healthcare has been reported to be feasible and clinically relevant, our future efforts should focus on the demonstration of their clinical utility in well-designed clinical trials. It is tempting to anticipate that this approach will improve patients' management and quality of life and change the way patients interact with family and professional health care givers.

Las cirugías oncológicas otorrinolaringológicas (ORL) y maxilofaciales implican sobre todo a los tumores de las vías aerodigestivas superiores. Suelen ser procedimientos mayores, debido a su carácter prolongado y al traumatismo tisular que provocan. Dado que los principales factores de riesgo de estos tumores son el consumo de alcohol y de tabaco, los pacientes candidatos a este tipo de cirugía suelen presentar patologías cardiovasculares y respiratorias, así como desnutrición secundaria al proceso tumoral. Por tanto, la evaluación preoperatoria de estos pacientes es una etapa esencial del tratamiento y debe ser multidisciplinaria. Se dirige a la instauración de medidas de prehabilitación para mejorar el pronóstico de los pacientes, en particular mediante la corrección de una posible desnutrición o anemia. El manejo de las vías aéreas es la principal dificultad a la que puede enfrentarse la anestesia en el quirófano para este tipo de pacientes. La videolaringoscopia resulta útil en las situaciones de dificultades de acceso de las vías aéreas. La intubación vigil con fibroendoscopia es una técnica alternativa que deben dominar todos los anestesistas en ORL y cirugía maxilofacial. Los elementos esenciales del manejo peroperatorio son la profilaxis antibiótica, la optimización hemodinámica, el manejo de la hemorragia quirúrgica y la prevención de la hipotermia. El tratamiento postoperatorio debe realizarse por lo general en una unidad de cuidados continuos, para vigilar, por una parte, las complicaciones médicas (infección respiratoria, descompensación de patologías subyacentes, síndrome de abstinencia, enfermedad tromboembólica) y, por otra, las complicaciones quirúrgicas (infección y hemorragia del sitio quirúrgico, obstrucción de las vías aéreas, disfunción vascular de los colgajos). Por tanto, las enfermedades concurrentes frecuentes, las dificultades de acceso de las vías aéreas, la multiplicidad de procedimientos y la importancia de las tasas de complicaciones postoperatorias requieren en esta especialidad una colaboración estrecha entre los equipos de anestesia y de cirugía.

The early detection and management of oral premalignant lesions (OPMDs) improve their outcomes. Animal models that mimic histological and biological processes of human oral carcinogenesis may help to improve the identification of OPMD at-risk of progression into oral squamous cell carcinoma and to develop preventive strategies for the entire field of cancerization. No animal model is perfectly applicable for investigating human oral carcinogenesis. However, the 4-nitroquinoline 1-oxide (4-NQO) mouse model is well established and mimics several morphological, histological, genomic and molecular features of human oral carcinogenesis. Some of the reasons for the success of this model include its reproducible experimental conditions with limited variation, the possibility of realizing longitudinal studies with invasive intervention or gene manipulation, and sample availability for all stages of oral carcinogenesis, especially premalignant lesions. Moreover, the role of histological and molecular alterations in the field of cancerization (i.e., macroscopically healthy mucosa exposed to a carcinogen) during oral carcinogenesis can be easily explored using this model. In this review, we discuss the advantages and drawbacks of this model for studying human oral carcinogenesis. In summary, the 4-NQO-induced murine oral cancer model is relevant for investigating human oral carcinogenesis, including the immune microenvironment, and for evaluating therapeutic and chemoprevention agents.

La chirurgia oncologica oto-rino-laringoiatrica (ORL) e maxillofacciale riguarda principalmente i tumori delle vie aerodigestive superiori. Si tratta, generalmente, di procedure importanti, per via del loro carattere lungo e demolitivo. Dal momento che i fattori di rischio di questi tumori sono, in primo luogo, le intossicazioni etilica e da tabacco, i pazienti candidati a questo tipo di intervento chirurgico sono spesso portatori di patologie cardiovascolari e respiratorie, nonché di denutrizione derivante dal processo tumorale. La valutazione preoperatoria di questi pazienti è, dunque, una fase essenziale della gestione e deve essere multidisciplinare. Si concentra sull’attuazione di misure di preabilitazione per migliorare la prognosi dei pazienti, in particolare attraverso la correzione di eventuali denutrizione o anemia. La gestione delle vie aeree è la principale difficoltà che l’anestesista può incontrare in sala operatoria per questa tipologia di pazienti. La videolaringoscopia si rivela utile nelle situazioni in cui le vie aeree siano di accesso difficile. L’intubazione vigile sotto fibroscopia è una tecnica alternativa, che deve essere ben padroneggiata da qualsiasi anestesista in ORL e chirurgia maxillofacciale. Gli elementi essenziali della gestione intraoperatoria sono la profilassi antibiotica, l’ottimizzazione emodinamica, la gestione del sanguinamento chirurgico e la prevenzione dell’ipotermia. La gestione postoperatoria deve, generalmente, essere effettuata in un reparto di cure continue, al fine di monitorare, da un lato, le complicanze mediche (infezione respiratoria, scompenso delle patologie sottostanti, sindrome da astinenza, malattia tromboembolica) e, dall’altro, le complicanze chirurgiche (infezione e sanguinamento del sito chirurgico, ostruzione delle vie aeree, disfunzione vascolare dei lembi). Pertanto, le frequenti comorbilità, le difficoltà di accesso alle vie aeree, la molteplicità delle procedure e l’alto tasso di complicanze postoperatorie richiedono, in questo ambito, una stretta collaborazione tra le equipe di anestesia e di chirurgia.

La réforme du 3e cycle des études médicales, en vigueur depuis la rentrée 2017 au terme de 8 années de gestation, a pour principaux objectifs de rendre cohérente et équitable la formation des futurs spécialistes et de substituer à une qualification basée sur une durée, une formation basée sur l’acquisition progressive de compétences. Pour les 13 collèges de spécialités chirurgicales, cette réforme a été l’occasion, pour la première fois peut-être, de partager une réflexion sur ce qu’était un chirurgien et ce que devait être la formation aux spécialités chirurgicales. Celle-ci leur a permis de s’adapter aux contraintes du cahier des charges et de construire des maquettes de formation cohérentes entre elles. Cet article aborde l’historique de cette réforme, ce qui change dans la formation des futurs chirurgiens, ainsi que quelques points de vigilance. Cette réforme du 3e cycle a enclenché la réforme du second cycle, qui devrait entrer en vigueur pour la rentrée universitaire   2020. Son objectif sera en particulier de supprimer le couperet que constituent les épreuves de l’ECN et de permettre aux étudiants de mieux appréhender et tester leurs appétences et leurs compétences pour une spécialité donnée. Il appartiendra à ces mêmes collèges de spécialités chirurgicales de définir comment y parvenir pour les spécialités de la discipline « chirurgie ».

The main objectives of the reform of the 3rd cycle of medical studies in France that was instituted in 2017 after eight years of preparation, are to train future specialists in a consistent and equitable fashion and to replace the previous time-based qualification by training based on the progressive acquisition of skills. This reform was an opportunity for the 13 different French surgical specialty Colleges involved to share reflections on what a surgeon actually was and to define training in surgical sub-specialties. The current reform is well adapted to these specifications and has fostered training models that are consistent with each other. This article discusses the historical construction of this reform, what will change in the training of future surgeons, as well as some points that warrant caution. The third cycle reform has also triggered a reform of the second cycle, which is expected to come into force for the 2020 academic year. Its objective will be to eliminate the guillotine effect created by the National Classifying Examinations and to allow students to better understand and test their desire and skills for a given specialty. It will be up to these same surgical Colleges to determine how to do this for the sub-specialties of the “surgery” discipline.

BACKGROUND AND PURPOSE: PET/MRI with(18)F-FDG has demonstrated the advantages of simultaneous PET and MR imaging in head and neck cancer imaging, MRI allowing excellent soft-tissue contrast, while PET provides metabolic information. The aim of this study was to evaluate the added value of gadolinium contrast-enhanced sequences in the tumor delineation of head and neck cancers on(18)F-FDG-PET/MR imaging. MATERIALS AND METHODS: Consecutive patients who underwent simultaneous head and neck(18)F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included. Local tumor invasion and lymph node extension were assessed in 45 head and neck anatomic regions using(18)F-FDG-PET/MR imaging by 2 rater groups (each one including a radiologist and a nuclear medicine physician). Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1WI postcontrast sequences. The results were compared with the detailed histopathologic analysis, used as reference standard. The kappa concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated. RESULTS: Thirty patients were included. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied (Cohen kappa = 0.96, 95% CI = [0.94-0.97],P < .001). The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. For the 2 rater groups, there was good sensitivity for both contrast-free (0.83 and 0.85) and postgadolinium reading sessions (0.88 and 0.90, respectively). Moreover, there was excellent specificity (0.98) for both groups and reading sessions. CONCLUSIONS: Gadolinium chelate contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow. Consecutive patients who underwent simultaneous head and neck(18)F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included in this study. Local tumor invasion and lymph node extension were assessed by 2 rater groups in 45 head and neck anatomic regions using(18)F-FDG-PET/MR imaging. Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1-weighted postcontrast sequences. The k concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied. The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. The authors conclude that gadolinium-based contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow.

Introduction: In surgical approaches to condylar fractures, there is a risk of damage to the transverse facial artery (TFA) which may in turn account for impaired blood supply to the temporomandibular joint (TMJ). In order to investigate the risk of damage to the TFA, and prevent lesions to this artery resulting from TMJ surgical procedures, we studied the distance between the TFA and the head of the condylar process. Methodology: A dissection study was conducted on 10 fresh cadavers (20 condylar specimens dissected), involving fifty CT scans of the face with intravenous contrast. Vertical distance from the TFA to the top of the mandibular condyle head and distance from the TFA to the lateral aspect of the mandibular condyle were measured. Results: The lateral aspect of the mandibular condyle is vascularized by branches emanating from the superficial temporal artery (STA) and the TFA. The TFA was located 1.84 +/- 0.6 cm below the condylar process of the mandible and ran 1.09 +/- 0.54 mm lateral to the head of the mandibular condyle. Discussion: In order to spare the TFA in fractures involving the condylar neck, surgical approaches to the condyle should preserve the uppermost 2 cm of the lateral surface of the condyle during dissection. Due to the necessity for periosteal elevation of the lateral surface of the condyle in condylar head fractures, it is possible to spare the TFA, running lateral to the condylar neck, and the medial condylar surface in order to leave the branches that derive from the maxillary artery (MA) intact. (C) 2019 Elsevier Masson SAS. All rights reserved.

Background: Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established. Material & methods: Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed. Results: In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10(-4)), although, as in SNMM, it was not a significant prognostic predictor. Conclusion: Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control. (C) 2019 Elsevier Ltd. All rights reserved.

Introduction: Malpractice lawsuits in medicine and facial surgery are on the rise and they become an influencing factor in everyday practice for any surgeon. Aim: We aim to analyze the possible causes for litigation in an effort to avoid these claims in the future. Materials: One hundred and thirty litigation cases filed over a 10 year period (2005-2015) were evaluated. Methods: Depending on the expert's opinion, it was determined whether the lawsuit was due to actual faulty treatment or either a lack of informed consent or discrepancy between the expected and the final result. Results: A total of 136 claimswere filed and examined. Dissatisfaction about the esthetic or functional result topped the list with 47% (n = 64) of the cases followed by nerve damage with 20% (n = 27). Medical negligence and failed treatment accounted both for 9% of all cases (n = 12). The list was completed by postoperative complications (n = 11), death (n = 6) and incorrect or late diagnosis (n = 4). In the expert's opinion only in 21 (15%) cases there was actual fault and in the remaining cases litigationwas due to lack of informed consent (n = 70; 51%) or a discrepancy between the expected and achieved result (n = 45; 33%). Conclusion: A considerable portion of the lawsuits in facial surgery seem to originate out of a lack of communication between physician and patient and not faulty treatment. Efforts in informing the patient about possible side effects, complications and expectations will benefit the physician greatly by minimizing his liability and risk at prosecution. (C) 2018 Elsevier Masson SAS. All rights reserved.

BACKGROUND:Never-smokers and never-drinkers patients (NSND) suffering from oral squamous cell carcinoma (OSCC) are epidemiologically different from smokers drinkers (SD). We therefore hypothesized that they harbored distinct targetable molecular alterations. PATIENTS AND METHODS:Data from The Cancer Genome Atlas (TCGA) (discovery set), Gene Expression Omnibus and Centre Léon Bérard (CLB) (three validation sets) with available gene expression profiles of HPV-negative OSCC from NSND and SD were mined. Protein expression profiles and genomic alterations were also analyzed from TCGA, and a functional pathway enrichment analysis was carried out. Formalin-fixed paraffin-embedded samples from 44 OSCC including 20 NSND and 24 SD treated at CLB were retrospectively collected to perform targeted-sequencing of 2559 transcripts (HTG EdgeSeq system), and CD3, CD4, CD8, IDO1, and PD-L1 expression analyses by immunohistochemistry (IHC). Enrichment of a six-gene interferon-γ signature of clinical response to pembrozulimab (PD-1 inhibitor) was evaluated in each sample from all cohorts, using the single sample gene set enrichment analysis method. RESULTS:A total of 854 genes and 29 proteins were found to be differentially expressed between NSND and SD in TCGA. Functional pathway analysis highlighted an overall enrichment for immune-related pathways in OSCC from NSND, especially involving T-cell activation. Interferon-γ response and PD1 signaling were strongly enriched in NSND. IDO1 and PD-L1 were overexpressed and the score of response to pembrolizumab was higher in NSND than in SD, although the mutational load was lower in NSND. IHC analyses in the CLB cohort evidenced IDO1 and PD-L1 overexpression in tumor cells that was associated with a higher rate of tumor-infiltrating T-cells in NSND compared with SD. CONCLUSION:The main biological and actionable difference between OSCC from NSND and SD lies in the immune microenvironment, suggesting a higher clinical benefit of PD-L1 and IDO1 inhibition in OSCC from NSND.

In the area of 3D printing, more and more maxillofacial surgery departments are equipped with 3D printers to build their own anatomical models or surgical guides. Prior to be printable, the patientsu0027 DICOM imaging data has to be converted to a 3D virtual model, a 3D mesh. The file format most commonly used is the STL (Standard Tesselation Language) file format. Many programs exist that are able to convert DICOM data to STL files. Commercial software, such as Surgicase CMF© are FDA- and CE-approved whereas free programs, available online do not have the approval. However, the latter are often used anyway because of financial reasons. In this article, we investigate whether 6 of these software solutions are equivalent or not.Thin slice CT imaging data of a patientu0027s mandible (in DICOM file format) was converted to STL meshes with 6 different software solutions. One commercial program, Surgicase CMF©, was used to build the reference model. Then 5 free programs were used to create 5 models of the same mandible, specifying the same thresholding parameters: InVesalius 3.0, 3DimViewer 2.2.4, 3D Slicer, itk-Snap and Seg3D. All of these models were loaded in Netfabb Basic 6.4 to retrieve dimensional data, geometric information and the number of holes in each mesh. Finally, the models were then compared to the reference model using CloudCompare 2.6.2.All models created with free software differed from the reference model in the 3 dimensions. Mean length difference was −0.74 mm [−2.06; −0.32] (SD: 0.74), mean width difference −0.45 mm [−0.76; −0.25] (SD: 0.19) and mean height difference was 0.41 mm [0.14; 0.62] (SD: 0.18). Although the height was increased in all models, both the length and width were systematically decreased, resulting in an average decrease of volume of −7.1 cm3 [−7.45; −6.77] (SD: 0.32). The number of triangles used to create each mesh ranged from 20944 to 368244, resulting in a variation of the file size from 1023 Ko to 80462 Ko (0.16 to 12.70 times the file size of the reference model). Two of the free programs created meshes with errors, such as the presence of holes (non-watertight meshes) that could be repaired with Netfabb.Free programs able to convert volume imaging data to a printable virtual mesh do not provide equivalent results. Variations were noted in the three plane of space with a systematic difference between free programs and the commercial FDA-approved one. While the length and width were less than a millimeter different to the reference, the dimension that most varied was the length with a difference reaching −2.06 mm with itk-Snap. Geometric data also varied significantly, the number of triangles composing the meshes being much different than the reference, resulting in variable file sizes. This traduces the fact that algorithms used by the programs are not the same. In the era of 3D printing made directly accessible in surgical departments, great attention should be paid to the accuracy of the models created with free software.