Bridging the knowledge-Practice gap: Insights from a survey of Belgian dental professionals on diagnosis and supportive oral cancer treatment in comparison with international guidelines.

OBJECTIVE: Early detection significantly improves the prognosis of oral cancer patients, contingent upon the knowledge of dental professionals. This study aimed to assess and compare the knowledge, practices and perceptions regarding oral cancer among dental professionals in Belgium. MATERIALS AND METHODS: A cross-sectional survey was distributed via Qualtrics to general dentists, dental specialists, dental hygienists, and oral and maxillofacial surgeons. The self-administered questionnaire comprised three sections: demographics (4 questions), knowledge (9 questions) and clinical practices (19 questions) related to oral cancer detection and treatment. Descriptive statistics were employed for data analysis, with Chi-square tests assessing responses by specialization, gender, years of experience and number of oral cancer patients treated. RESULTS: A total of 262 questionnaires were completed, with the majority of respondents being general dentists (61%) followed by dental specialists (25%), oral hygienists (8%) and oral and maxillofacial surgeons (6%). 70% of the respondents reported treating fewer than four oral cancer patients throughout their careers. 5 out of the 9 knowledge questions achieved over 50% correct responses, with an average correct answer rate of 54%. Oral and maxillofacial surgeons and dental professionals who have treated more than four oral cancer patients, demonstrated significantly higher scores on multiple knowledge questions. Responses to clinically oriented questions showed less diversity across professions, and generally aligning with guidelines from professional oncological societies. CONCLUSION: This survey highlights the need for enhanced education on oral cancer among Belgian dental professionals. Knowledge levels were notably higher among more experienced respondents. The development and implementation of comprehensive guidelines tailored to dentists and oral hygienists for oral cancer prevention and patient care are warranted to optimize clinical practice standards.

CD4+ T cell activation distinguishes response to anti-PD-L1+anti-CTLA4 therapy from anti-PD-L1 monotherapy.

Cancer patients often receive a combination of antibodies targeting programmed death-ligand 1 (PD-L1) and cytotoxic T lymphocyte antigen-4 (CTLA4). We conducted a window-of-opportunity study in head and neck squamous cell carcinoma (HNSCC) to examine the contribution of anti-CTLA4 to anti-PD-L1 therapy. Single-cell profiling of on- versus pre-treatment biopsies identified T cell expansion as an early response marker. In tumors, anti-PD-L1 triggered the expansion of mostly CD8+ T cells, whereas combination therapy expanded both CD4+ and CD8+ T cells. Such CD4+ T cells exhibited an activated T helper 1 (Th1) phenotype. CD4+ and CD8+ T cells co-localized with and were surrounded by dendritic cells expressing T cell homing factors or antibody-producing plasma cells. T cell receptor tracing suggests that anti-CTLA4, but not anti-PD-L1, triggers the trafficking of CD4+ naive/central-memory T cells from tumor-draining lymph nodes (tdLNs), via blood, to the tumor wherein T cells acquire a Th1 phenotype. Thus, CD4+ T cell activation and recruitment from tdLNs are hallmarks of early response to anti-PD-L1 plus anti-CTLA4 in HNSCC.

OrthoCalc: The six degrees of freedom measurement workflow of rotational and displacement changes for maxilla positioning evaluation.

BACKGROUND: This study is undertaken to establish the accuracy and reliability of OrthoCalc, a 3D application designed for the evaluation of maxillary positioning. METHODS: We registered target virtual planned models, maxillary models from pre-operative and post-operative CT scans, and post-operative intra-oral scans to a common reference system, allowing for digital evaluation. To assess rotational changes, we introduced a novel measurement method based on virtual cuboid models. Displacement errors were calculated based on proposed registration matrices. We also compared OrthoCalc to established commercial medical software as a benchmark. RESULTS: Statistical significance calculated showed no significant differences between OrthoCalc and commercial software. the biggest error of 0.04 degree in rotation change was found in the yaw. A maximum displacement change of 0.75 mm was found in the X direction. CONCLUSIONS: Our study validates OrthoCalc as a precise and reliable tool for assessing maxillary position changes with six degrees of freedom in orthognathic surgery, endorsing its clinical utility.

Exploring long-term responses to immune checkpoint inhibitors in recurrent and metastatic head and neck squamous cell carcinoma.

OBJECTIVES: Immune checkpoint inhibitors (ICI) have introduced a new era in the treatment of recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). Optimal duration for ICI therapy is still unclear and the long-term outcomes and toxicity in patients responding to these therapies warrant further exploration. This study attempts to identify the clinical and biological determinants of a durable response and evaluate outcomes following ICI treatment discontinuation. MATERIALS AND METHODS: A retrospective review of 181 patients treated with ICI for R/M HNSCC was conducted. Long-term responders were defined as patients who sustained disease control at least two years after initiating ICI therapy. We compared clinical and biological characteristics associated with these long-term responders against the broader treatment population. RESULTS: 10 % of R/M HNSCC patients treated with ICIs demonstrated a durable long-term response. Only three relapses (16 %) occurred after discontinuing ICI treatment in this subset, with a median follow-up of 52 months. Upon retreatment with ICI, two attained a documented response. Extended ICI response was observed even with < 2 years of treatment. 74 % of long-term responders experienced immune-related adverse events (irAEs), 37 % of which severe irAEs. Hypothyroidism was the most frequently reported irAEs. The predictive potential of systemic inflammation indices for clinical response appears to be limited. CONCLUSIONS: ICI present an optimistic avenue for HNSCC patients, offering substantial long-term responses. The study suggests that a two-year treatment could be optimal and irAEs, although common, are typically mild.

Accuracy of surgical navigation for patient-specific reconstructions of orbital fractures: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques. MATERIALS AND METHODS: A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles. RESULTS: After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm3 ± 0.47 cm3) when surgical navigation was used compared with conventional surgery (2.17 cm3 ± 1.35 cm3). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used. CONCLUSION: Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.

A 16-year retrospective study of vascular anomalies in the head and neck region.

Depending on the diagnostic modality, the classification of vascular anomalies varies and so does the nomenclature. The 'International Society for the Study of Vascular Anomalies' (ISSVA) is the most widely accepted classification in the literature and is mainly based on the radiologic and clinical presentation. The aim of this article is to review the clinical practice of diagnosis and treatment of vascular anomalies in the head and neck region in a university hospital, with special focus on the nomenclature. All patients with a vascular anomaly presenting to the department of oral and maxillofacial surgery were reviewed in a retrospective manner. Nomenclature, diagnostic process, lesion characteristics, treatment and outcome were examined. The lesions were (re)classified according to the ISSVA classification. A total of 185 patients were identified, of which 12.4% (n = 23) had a congenital anomaly. After reclassification, the most common lesions were venous malformations (n = 47, 25.4%), followed by lobular capillary hemangiomas (n = 17, 9.2%). A group of 39 anomalies could not be further specified. One hundred and one patients (54,6%) received treatment, of which 93 were treated surgically (92,1% of treated patients). Endovascular treatment was considered in 41 patients but applied in only eight. This strict selection led to a low a complication rate. We provide an overview of the clinical practice in the management of vascular anomalies in a university hospital. The histology report is a source of miscommunication because clinicians use the ISSVA classification, while pathologists use the WHO classification. Every professional involved should be aware of the differences in classification and nomenclature.

Maxillomandibular Reconstruction Using Insourced Virtual Surgical Planning and Homemade CAD/CAM: A Single-Center Evolution in 75 Patients.

BACKGROUND: Virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD/CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftsmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD/CAM technology is expensive and may not be an option for many institutions worldwide. METHODS: The authors present here a consecutive series of 75 maxillofacial reconstructions from 2015 to 2020. We established an insourced "in-house" protocol for VSP and "home-made" CAD/CAM for the reconstruction of maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were analyzed retrospectively, and relevant parameters influencing the reconstructive outcome were determined. RESULTS: The authors went from a fibula-based protocol toward the selection of optimal vascularized bone for immediate placement of osteointegrated implants. Bone flap survival was 94.7% after 4 months. The 3-year patient survival is 77.6%. The authors show the multiple steps required for the routine use of in-house CAD/CAM and report the related financial balance. CONCLUSIONS: Insourced VSP and CAD/CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality-of-life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The predictive and prognostic value of weight loss and body composition prior to and during immune checkpoint inhibition in recurrent or metastatic head and neck cancer patients.

BACKGROUND: Response rates of immune checkpoint inhibitor (ICI) therapy for recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC) are low. PATIENTS AND METHODS: This retrospective multicentre cohort study evaluates the predictive and prognostic value of weight loss and changes in body composition prior and during therapy. Patient, tumor, and treatment characteristics of 98 patients were retrieved, including neutrophil and platelet-lymphocyte-ratio (NLR and PLR). Programmed death-ligand 1 (PD-L1) expression was determined on residual material. Cachexia was defined according to Fearon et al. (2011). Skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were evaluated on computed tomography scans at the third lumbar vertebrae level. Univariable and multivariable regression analyses were performed for 6 months progression free survival (PFS6m) and overall survival (OS). RESULTS: Significant early weight loss (>2%) during the first 6 weeks of therapy was shown in 34 patients (35%). This patient subgroup had a significantly higher NLR and PLR at baseline. NLR and PLR were inversely correlated with SM and VAT index. Independent predictors of PFS6m were lower World Health Organization performance status (HR 0.16 [0.04-0.54] p = 0.003), higher baseline SAT index (HR 1.045 [1.02-1.08] p = 0.003), and weight loss <2% (HR 0.85 [0.74-0.98] p = 0.03). Baseline cachexia in combination with >2% early weight loss remained a predictor of OS, independent of PD-L1 expression (HR 2.09 [1.11-3.92] p = 0.02, HR 2.18 [1.13-4.21] p = 0.02). CONCLUSION: We conclude that the combination of cachexia at baseline and weight loss during ICI therapy is associated with worse OS in R/M HNSCC patients, independent of PD-L1 expression.

Do Gender and Age Influence Nasal Soft Tissue Widening After Bone-Borne Transpalatal Distraction?

PURPOSE: Widening of the nasal soft tissue after transpalatal distraction (TPD) is a well-known consequence of this treatment method used to correct transverse maxillary deficiency. However, because literature is scarce about the influence of gender and age, the purpose of this study is to estimate changes in the nasal soft tissue after TPD and to measure the association of gender and age with these observed changes. METHODS: In this retrospective cohort study, patients with transverse maxillary deficiency underwent combined orthodontic-surgical treatment. Maxillary and nasal anatomical landmarks were compared using superimposed cone beam computed tomography images preoperatively and approximately 1 year postoperatively. Measurements included nasal soft tissue, nasal skeletal, and maxillary parameters. Significant differences in nasal soft tissue changes were correlated with patient gender, age, maxillary, and nasal skeletal changes using regression models. RESULTS: Ninety one patients were included of which 33 were men (36%) and 58 women (64%). Independent of the maxillary widening, the mean nasal soft tissue widening was limited to 2 mm. Nasal soft tissue expansion was 60% to 80% of the nasal skeletal width and 25% to 31% of the skeletal maxillary width. The alar nasal base increased approximately 57% more than the alar nasal width. CONCLUSIONS: Significant gender-related differences in nasal soft tissue widening were observed. Age-related differences were identified only as a trend. Small age-related and gender-related differences may not be relevant clinically since there are no established threshold values to assess a layperson's perception of nasal width variations. Technical and/or aesthetic concerns regarding TPD surgery can be addressed without patient's gender and/or age consideration.

Long-term survival of implant-based oral rehabilitation following maxillofacial reconstruction with vascularized bone flap.

AIM: The aim of the study was to assess the 5-year cumulative survival rate of implant-based dental rehabilitation following maxillofacial reconstruction with a vascularized bone flap and to investigate the potential risk factors which might influence the survival rate. MATERIALS AND METHODS: A retrospective cohort study was designed. Inclusion criteria involved 18 years old or above patients with the availability of clinical and radiological data and a minimum follow-up 1 year following implant placement. The cumulative survival rate was analyzed by Kaplan-Meier curves and the influential risk factors were assessed using univariate log-rank tests and multivariable Cox-regression analysis. RESULTS: 151 implants were assessed in 40 patients with a mean age of 56.43 ± 15.28 years at the time of implantation. The mean number of implants placed per patient was 3.8 ± 1.3 with a follow-up period of 50.0 ± 32.0 months. The cumulative survival at 1-, 2- and 5-years was 96%, 87%, and 81%. Patients with systemic diseases (HR = 3.75, 95% CI 1.65-8.52; p = 0.002), irradiated flap (HR = 2.27, 95% CI 1.00-5.17; p = 0.05) and poor oral hygiene (HR = 11.67; 95% CI 4.56-29.88; p < 0.0001) were at a significantly higher risk of implant failure. CONCLUSION: The cumulative implant survival rate was highest at 1st year followed by 2nd and 5th year, indicating that the risk of implant failure increased over time. Risk indicators that seem to be detrimental to long-term survival include poor oral hygiene, irradiated flap and systemic diseases.

Value of six comorbidity scales for predicting survival of patients with primary surgery for oral squamous cell carcinoma.

BACKGROUND: Comorbidities influence treatment outcome of oral squamous cell carcinoma (OSCC). This study compared the predictive performance of six comorbidity scales for overall survival after surgery for OSCC. METHODS: We retrospectively analyzed OSCC patients, surgically treated at an academic center in Belgium between January 01, 2000 and January 01, 2020. Validity of the scales was evaluated using the area under the curve (AUC) of receiver operating characteristic curves. RESULTS: Three hundred and twenty three patients were included. Elixhauser Comorbidity Index (AUC = 0.74, 95% CI: 0.55-0.92; AUC = 0.73, 95% CI: 0.55-0.80), modified Elixhauser Comorbidity Index (AUC = 0.72, 95% CI: 0.54-0.91; AUC = 0.69, 95% CI: 0.51-0.77), and Combined Comorbidity Index (AUC = 0.76, 95% CI: 0.58-0.84; AUC = 0.76, 95% CI: 0.59-0.84) were meaningful predictors for 2 and 5-year survival, respectively. CONCLUSION: Selected comorbidity scales were capable of predicting overall survival for OSCC patients 2 and 5 years after primary surgery.

A Retrospective Analysis of a Cohort of Patients Treated With Immune Checkpoint Blockade in Recurrent/Metastatic Head and Neck Cancer.

OBJECTIVE: The treatment approach of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) has long been similar for all patients. Any difference in treatment strategy was only based on existing comorbidities and on preferences of the patient and the treating oncologist. The recent advance obtained with immune therapy and more specifically immune checkpoint blockade (ICB) has been a true game changer. Today, patients and physicians have a choice to omit chemotherapy. In a small subset of patients, ICB induces a very durable disease control. The subgroup of patients in which ICB without chemotherapy would be the preferential approach is still ill-defined. Yet, this evolution marks a major step towards a more personalized medicine in R/M HNSCC. MATERIALS AND METHODS: In this paper, we present a retrospective cohort study of a patient population that was treated with ICB in a single center and we analyze potential factors that are associated with outcome and may help to select patients for treatment with ICB. RESULTS: 137 consecutively treated patients were identified. Male gender and metastatic disease appeared to be associated with improved overall survival (OS). There was no correlation observed with age, number of previous treatment lines or immune target. CONCLUSION: Along with PD-L1 status defined by Combined Positive Score (CPS), clinical parameters such as site of recurrence and gender may help to define the optimal treatment strategy in R/M HNSCC.

Survival analysis of segmental mandibulectomy with immediate vascularized fibula flap reconstruction in stage IV oral squamous cell carcinoma patients.

PURPOSE: This study aims to assess the survival rate of oral squamous cell carcinoma (OSCC) patients following immediate mandibular reconstruction with vascularized fibula flap (VFF) and to identify risk factors influencing the overall survival rate and postoperative outcomes. PATIENTS AND METHODS: Patients suitable for the inclusion criterion diagnosed and treated between January 1996 till June 2019 for OSCC were retrospectively reviewed (n = 74). Potential risk factors and postoperative outcomes were recorded and analyzed. RESULTS: The overall cumulative survival rate of patients was 0.52 at the end of 5th year. Overall, advanced pN stage (p = 0.0422), poor tumor differentiation (p < 0.0001), positive/close surgical margins (p = 0.0209), vascular invasion (p = 0.0395), perineural invasion (p = 0.0022) and tumor recurrence (p = 0.0232) were significantly related to a decreased cumulative survival. Tumor recurrence was significantly correlated with involvement of positive/close surgical margins, moderate (p = 0.0488), poor-differentiated tumors (p = 0.202), extracapsular spread (p = 0.0465), computer-assisted surgery (p = 0.0014) and early complications (p = 0.0224). Pain was significantly associated with the extracapsular spread (p = 0.0353) and early complications (p = 0.0127). CONCLUSION: The five-year survival rate of advanced OSCC patients after segmental mandibulectomy with fibula free-flap reconstruction was 52.4%. Clinical/pathological risk factors such as the pN stage, tumor differentiation, surgical margins, vascular invasion, perineural invasion, tumor recurrence significantly influenced the overall cumulative survival rate.

Preclinical study of additive manufactured plates with shortened lengths for complete mandible reconstruction: Design, biomechanics simulation, and fixation stability assessment.

BACKGROUND: A combination of short titanium plates fabricated using additive manufacturing (AM) provides multiple advantages for complete mandible reconstruction, such as the minimisation of inherent implant deformation formed during AM and the resulting clinical impact, as well as greater flexibility for surgical operation. However, the biomechanical feasibility of this strategy is still unclear, and therefore needs to be explored. METHOD: Three different combinations of short mandible reconstruction plates (MRPs) were customised considering implant deformation during the AM process. The resulting biomechanical performance was analysed by finite element analysis (FEA) and compared to a conventional single long MRP. RESULTS: The combination of a long plate and a short plate (Design 3 [LL61 mm/RL166 mm]) shows superior biomechanical properties to the conventional single long plate (Design 1 [TL246 mm]) and reveals the most reliable fixation stability among the three designs with short plates. Compared to conventional Design 1, Design 3 provides higher plate safety (maximum tensile stress on plates reduced by 6.3%), lower system fixation instability (relative total displacement reduced by 41.4%), and good bone segment stability (bone segment dislocation below 42.1 µm) under masticatory activities. CONCLUSIONS: Preclinical evidence supports the biomechanical feasibility of using short MRPs for complete mandible reconstruction. Furthermore, the results could also provide valuable information when treating other large-sized bone defects using short customised implants, expanding the potential of AM for use in implant applications.

Application of Three-Dimensional Printed Customized Surgical Plates for Mandibular Reconstruction: Report of Consecutive Cases and Long-Term Postoperative Evaluation.

ABSTRACT: This study aims to evaluate the use of customized surgical plates in patients with mandibular defects concerning postoperative aesthetics and functional outcomes during the 2-year follow-up. Preoperative virtual surgical plans and patient-specific three-dimensional printed plates were tailored for consecutive patients. Preoperative preparation, surgical produces, postoperative aesthetics, and functional outcomes were described in detail. The average follow-up period was over 2 years. In the presented clinical cases, aesthetic and functional outcomes were reported to be satisfactory.

Cardiac metastasis in a patient with oral squamous cell carcinoma.

A 55-year-old man initially presented with an undifferentiated, HPV-p16-negative squamous cell carcinoma (SCC) in the left tonsillar region (cT4a N0 M0), which was treated with a combination of radiotherapy and chemotherapy. Several months later, the patient developed osteoradionecrosis on the left side of the mandible as well as a second primary lesion at the left base of the tongue. Surgical resection and mandibular reconstruction with a free vascularised fibula flap was performed. Regional clinical and radiologic follow-up showed no signs of tumour recurrence. However, routine positron emission tomography (PET)-CT showed a hypermetabolic mass intracardially. MRI confirmed the presence of a mass intramurally in the left ventricle, highly indicative of metastasis. Cardiac metastasis following oral cancer is rare and usually asymptomatic. Therefore, it can be missed easily and is mostly described as a finding postmortem. Reporting these cases is important for contributing to the insight into the uncommon development of metastasis.

Adherence to Computer-Assisted Surgical Planning in 136 Maxillofacial Reconstructions.

OBJECTIVE: To investigate the adherence to initially planned maxillofacial reconstructions using computer-assisted surgery (CAS) and to identify the influential factors affecting its compliance for maxillofacial reconstruction. PATIENTS AND METHODS: A retrospective analysis of 136 computer-assisted maxillofacial reconstructive surgeries was conducted from January 2014 to June 2020. The categorical parameters involved age, gender, disease etiology, disease site, defect size, bone flap segments, and flap type. Apart from descriptive data reporting, categorical data were related by applying the Fisher-exact test, and a p-value below 5% was considered statistically significant (P < 0.05). RESULTS: The main reasons for partial or non-adherence included unfitness, patient health condition, and other subjective reasons. Out of the total patient population, 118 patients who underwent mandibular reconstruction showed higher CAS compliance (83.9%) compared to the 18 midface reconstruction (72.2%) without any statistically significant difference (p = 0.361). Based on the size of the defect, a significantly higher CAS compliance (p = 0.031) was observed with a minor defect (80.6%) compared to the large-sized ones (74.1%). The bone flaps with two or more segments were significantly (p = 0.003) prone to observe a partial (15.4%) or complete (12.8%) discard of the planned CAS compared to the bone flaps with less than two segments. The malignant tumors showed the lowest CAS compliance when compared to other disorders without any significant difference (p = 0.1). CONCLUSION: The maxillofacial reconstructive surgical procedures offered optimal compliance to the initially planned CAS. However, large-sized defects and multiple bone flap segments demonstrated a higher risk of partial or complete abandonment of the CAS.

The Effect of Smoking on the Postoperative Course After Head and Neck Reconstruction With a Vascularized Free Flap: A Retrospective Study.

OBJECTIVES: The objective of the present study is to determine the impact of smoking on hospital and intensive care unit stay, need for surgical reintervention, Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity, and surgical complications after head and neck reconstructions. METHODS: All 153 patients who underwent head and neck reconstructions with free tissue transfer at the department of oral and maxillofacial surgery at the University Hospitals of Leuven between January 1, 2015 and December 31, 2018 were enrolled in this retrospective cohort study. Data from medical charts were extracted. Univariate and multiple regression analyses were performed. A level of significance of P < 0.05 (α = 0.05) was used. RESULTS: Smoking was not associated with Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity, hospital or ICU stay, the incidence of postoperative complications in both flap and donor site, or surgical reintervention. CONCLUSIONS: Regarding the outcomes included in this study, smoking status should not be considered as a critical factor in patient selection for head and neck reconstructions with a vascularized free flap.

Computer-assisted versus traditional freehand technique for mandibular reconstruction with free vascularized fibular flap: A matched-pair study.

OBJECTIVES: This study aimed to perform a surgery-related and patient-related outcome analysis of a case-matched series of patients treated with computer-assisted surgery (CAS) and traditional freehand surgery. METHODS: A total of 153 patients who underwent mandibular reconstruction by VFF were included from Jan 1999 to Dec 2019. The mandibular resection and reconstruction were performed by four experienced oral and maxillofacial surgeons. Reasons for reconstruction were oncologic, osteoradionecrosis, trauma, and osteoporosis. All the patients were followed up postoperatively for at least 1 year. Eighteen pairs were formed with the matched cohort consisting of a total of 36 patients who underwent primary mandibular reconstruction without additional combined flaps. The surgery-related and patient-related continuous and categorical parameters were assessed in both groups. RESULTS: The average operation time and bleeding volume in the CAS group were less than those in the non-CAS group. Additionally, both hospitalization and ICU days were lower in the CAS group without any significant difference. The only significant finding related to surgical parameters was observed for the ischemia time, which was lower in the CAS group. CONCLUSIONS: Computer-assisted surgery indicated improved efficiency considering reduced ischemia time, operation time, and length of hospital stay with lower early complications than that of conventional surgical procedures. It can thus be considered as an optimized alternative to the freehand approach.

Donor- and recipient-site morbidity of vascularized fibular and iliac flaps for mandibular reconstruction: A systematic review and meta-analysis.

The aim of this article is to evaluate the early and late morbidities of the donor- and recipient-site in patients undergoing mandibular reconstruction using either vascularized fibular flap (VFF) or vascularized iliac flap (VIF). Electronic databases, including PubMed, Web of Science, Cochrane Central and Embase, were explored for literature published until October 2020. A total of twenty-four articles reporting complications following mandibular reconstruction surgery with follow-up periods ranging from six to 63 months were selected based on the exclusion criteria. For each research, the JBI Critical Assessment Tool and the ROBINS-I Tool were used to analyze the methodological quality and the risk of bias. A single-arm meta-analysis was performed to have a synthesized analysis of the donor- and recipient-site early and late morbidities. Results showed that the early morbidities in VFF group ranged from 3% to 12%, and the late morbidities in VFF group ranged from 5% to 67%. In VIF group, the early morbidities ranged from 3% to 16%, and the donor-site late morbidities ranged from 6% to 43%. Complications with the top three morbidities in the VFF group were: chronic sensory disturbances at the donor-site (67%), malocclusion (22%) and chronic lower limb weakness (20%); and in the VIF group were: chronic sensory disturbances at the donor-site (43%), chronic pain at the donor-site (26%), chronic gait disturbance (20%). Further controlled clinical trials are needed to assess the long-term outcome of VFF or VIF grafting.