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3D Sequencing and Protocols in Head and Neck Reconstructive Surgery: Delivering Predictable Results Hussein Mohamedbhai Abigail Chan Bhavin Visavadia Dental Update 2024 49:4, 707-709.
The complex nature of head and neck anatomy poses a significant challenge in facial reconstruction, both in functional and aesthetic outcomes. This necessitates that any resection of disease and reconstruction should not only consider the defect, but also the changes in appearance, speech and swallow. High-fidelity 3D planning improves both the outcomes of the resection and the reconstruction. This article presents an up-to-date review of the literature of the role of 3D planning, the stages and requirements of how to sequence head and neck reconstructions, and the future role of 3D planning. We outline the advantages that 3D sequencing affords both the patient and the surgeon, alongside a case report.
CPD/Clinical Relevance: The latest advances in oral cancer planning and reconstruction are described and a step-by-step guide to 3D sequencing and planning reconstruction is provided.
Article
Head and neck cancer is the sixth most common cancer worldwide, and its incidence is increasing.1 Despite advancements in medical treatments, the stalwart of management remains ablative surgery and primary reconstruction. The most challenging of these is free flap reconstruction. Free flap reconstruction is not just confined to reconstruction of malignancy, but its role extends to other pathologies, including ameloblastoma, and reconstruction following the sequela of radiotherapy, osteoradionecrosis. However, management of these cases still poses numerous and interplaying obstacles that affect surgical outcomes. Arguably, the most significant are the presence of tumour at the margins of the resection, and failure of the flap reconstruction. This article, alongside other published evidence, demonstrates that both of these major adverse outcomes can be mitigated with the advent of three-dimensional (3D) planning and sequencing.2
The advent of high-quality pre-operative imaging and computing power to enable reconstruction of these images, combined with advances in bioengineering, mean that is now possible to plan with a high level of accuracy and reliability both the resection of the tumour and the reconstruction of the defect. Through such detailed planning it can be possible to mitigate the risks of surgical failure, and at the same time push the envelope of what can be possible in head and neck reconstruction.3
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