A multi-centre, participant-blinded, randomized, 3-year study to compare the efficacy of Virtual Surgical Planning (VSP) to Freehand Surgery (FHS) on bony union and quality of life outcomes for mandibular reconstruction with fibular and scapular free flaps: study protocol for a randomized phase II/III trial.

Background: Advanced head and neck malignancies with underlying bony involvement often require aggressive oncological resection of large segments of the oral cavity including the mandible. These patients require vascularized donor osseous free tissue transfer to reconstruct significant defects. Traditionally, the donor bone is harvested on its vascular supply and shaped to the defect in a free hand fashion (FHS).

Efficiency of Cephalic Vein Only Anastomosis During Radial Forearm Free Flap.

Importance: The closure technique for the radial forearm free flap (RFFF), a commonly utilized flap in head and neck reconstruction, remains a debated topic as there are unique advantages and drawbacks to each technique.

Objective: The present study aims to report on the outcomes of the closure of the RFFF with the superficial cephalic vein (CV)-only system in terms of venous compromise and flap survival.

Methods (design, Setting, Participants, Intervention, Measures): A retrospective review of patients who underwent head and neck reconstruction with RFFF between January 2015 and May 2021 at the authors' institution was performed.

Scapula or Fibula?: Prospective data-driven decision criteria for flap selection in mandibular reconstruction planning.

Objectives: The objectives of the study are twofold: 1) to propose a set of criteria for virtually evaluating different types of reconstructions for mandibular defects during surgical planning, and 2) to prospectively apply the criteria to a series of mandibular reconstructions to select the optimal flap.

Materials And Methods: Clinically relevant assessment criteria were selected, including volumetric overlap, Haussdorf-95, bony contact, ramus/symphysis angles, and dental implantability. In 2021, 21 consecutive patients undergoing mandibular reconstructions were consented to the study.

Geometric Study and Clinical Case Series for Mandible Reconstruction With a Single-Piece Scapular Free Flap.

Background: Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations.

Methods: Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions.

Towards transcervical ultrasound-guided transoral robotic surgery.

Background: In the context of transoral robotic surgery (TORS) for oropharyngeal squamous carcinoma (OPSCC), preoperative imaging and intraoperative visualization plays a pivotal role in optimizing resection margins. Prior work has demonstrated the ability of transoral ultrasound (US) in identifying OPSCC margins and vascular structures. This study evaluates the effectiveness of transcervical ultrasound (TUS), as well as other preoperative imaging modalities, in evaluating OPSCC volumes and compares this to post TORS pathological OPSCC volumes.

Cost Outcomes of Virtual Surgical Planning in Head and Neck Reconstruction: A Systematic Review.

Background: Virtual surgical planning (VSP) is an emerging method in head and neck reconstruction with demonstrated benefits, however, its economic viability is supported with mixed evidence.

Methods: A structured search was performed in five electronic databases. Studies that performed an economic evaluation on VSP in head and neck reconstruction were included.

Predictors of Gastrostomy Tube Placement in Head and Neck Cancer Patients Undergoing Radiation or Chemoradiotherapy: A Systematic Review.

Background: Malnutrition is a major problem in head and neck cancer (HNC) with up to half of patients requiring gastrostomy tube (G-tube) placement. Predicting this need remains complex given mixed evidence surrounding its usage.

Methods: A comprehensive search was performed to identify studies examining risk factors associated with G-tube placement following radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) in HNC patients.

Intraoperative Real-Time Image-Guided Fibular Harvest and Mandibular Reconstruction: A Feasibility Study on Cadaveric Specimens.

Background: This study assesses the feasibility of real-time surgical navigation to plan and guide sequential steps during mandible reconstruction on a series of cadaveric specimens.

Methods: An image-guided surgical (IGS) system was designed including customized mandible and fibula fixation devices with navigation reference frames and an accompanied image-guided software. The mandibular and fibular segmental osteotomies were performed using the IGS in all five cadaveric patients.

Donor site morbidity after scapula free flap surgery of head and neck reconstruction: A systematic review and meta-analysis.

Background: The scapula free flap is becoming increasingly more utilized in head and neck reconstruction due to its natural geometry and soft tissue versatility. This study reviews the incidence rate, risk factors, and treatments of complications of scapula donor site morbidity.

Methods: A review was performed for articles published between October 1990 and November 2022 in Medline (OVID), PubMed, Web of Science, and CENTRAL.

Postoperative patient-centered multimedia education in head and neck cancer patients: A pilot study.

Objective: It is hypothesized that patients who are actively provided with more treatment-related education may report increased satisfaction and have improved overall outcomes. The aim of this study was to demonstrate the feasibility of an audiovisual education platform in patients undergoing head and neck surgery and to investigate whether patients using this module reported increased satisfaction.

Methods: This was a prospective pilot study of patients undergoing major head and neck reconstructive surgery who were randomized to either (1) control group or (2) intervention (i.

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design.

Background: The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap.

Methods: An open-source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected.

Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education.

Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study's objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates.

Azole-resistant Aspergillus fumigatus is highly prevalent in the environment of Vietnam, with marked variability by land use type.

Azole-resistant environmental Aspergillus fumigatus presents a threat to public health but the extent of this threat in Southeast Asia is poorly described. We conducted environmental surveillance in the Mekong Delta region of Vietnam, collecting air and ground samples across key land-use types, and determined antifungal susceptibilities of Aspergillus section Fumigati (ASF) isolates and azole concentrations in soils. Of 119 ASF isolates, 55% were resistant (or non-wild type) to itraconazole, 65% to posaconazole and 50% to voriconazole.

Maxillectomy defects: Virtually comparing fibular and scapular free flap reconstructions.

Background: This study virtually compares patient-specific fibular and scapular reconstructions for maxillectomies.

Methods: Nine maxillectomy defects were created on 10 maxillas and virtually reconstructed with patient-specific fibulas and scapulas. Reconstructions were compared for restoring midface cephalometrics, dental implantability, and pedicle length.

Predicting the Premorbid Shape of a Diseased Mandible.

Objectives/hypothesis: Virtual surgical planning (VSP) for reconstructions of advanced mandibular neoplasms that have distorted the contour of the mandible is challenging, as the premorbid shape of the mandible is unknown. We introduce a novel modeling technique, based on a statistical shape model (SSM), that has learned the shape of a normal mandible from a set of 84 mandibles, such that given a diseased mandible, the model can determine its premorbid shape.

Methods: Eighty-four control mandibles were used to generate an SSM.