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Innovation in Head and Neck Reconstructive Surgery—Series 2
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Innovation in Head and Neck Reconstructive Surgery—Series 2

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (25 April 2024) | Viewed by 7921

Special Issue Editors

Dr. Achille Tarsitano

E-Mail Website
Guest Editor
1. Maxillo-Facial Surgery, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
2. Head of Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
Interests: maxillofacial surgery; head and neck surgery; head and neck oncology; new technologies in medicine; computer-assisted surgery; virtual surgery; CAD/CAM reconstructive surgery; 3D printing in medicine
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Florian M. Thieringer

E-Mail Website
Guest Editor
Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
Interests: CAD/CAM; additive manufacturing; virtual surgical planning; cranio-maxillofacial surgery; innovation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We would be honored to have robust contributions from eminent experts on head and neck reconstructive surgery in order to update the scientific literature on this fascinating topic. This Special Issue, “Innovation in Head and Neck Reconstructive Surgery—Series 2”, is a new volume; 16 papers were published in the first volume. For more details, please visit:

https://0-www-mdpi-com.brum.beds.ac.uk/journal/jcm/special_issues/Head_Neck_Reconstructive_Surgery.

The field of head and neck reconstruction is exceptionally complex. Many of the anatomical structures requiring reconstruction have a crucial role in facial morphology and for functions such as speech, swallowing, and mastication. All these aspects strongly influence the patient’s daily quality of life. The lack of effective reconstruction techniques in the distant past left surgeons and patients with poor outcomes.

Over the past few years, the development of new technologies such as virtual surgical planning and 3D printing have been shown to result in better outcomes in terms of reconstructive accuracy, with good improvement in results as compared to traditional reconstruction techniques. The field of head and neck reconstruction is on the move. In fact, computer-assisted surgery with customized implants is becoming increasingly common for head and neck reconstruction, also associated with revascularized tissue transfer. These techniques allow surgeons to provide increasingly personalized reconstruction, improving the average results and reducing surgical time.

The present Special Issue aims to explore these new frontiers of reconstructive surgery as supported by 3D technology.

Dr. Achille Tarsitano
Prof. Dr. Florian M. Thieringer
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • reconstructive surgery
  • head and neck surgery
  • 3D printing
  • new technologies
  • virtual surgical planning
  • computer-assisted surgery
  • personalized reconstructive surgery
  • augmented reality
  • microvascular reconstruction

Related Special Issue

Published Papers (6 papers)

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Research

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8 pages, 3857 KiB  
Article
The Central Facial Defect Reconstruction Using a Radial Forearm Free Flap after Malignant Cutaneous Tumor Ablation
by Kyusang Cho, Jinsol Park and Seokchan Eun
J. Clin. Med. 2023, 12(22), 7148; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12227148 - 17 Nov 2023
Viewed by 706
Abstract
Purpose: Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to [...] Read more.
Purpose: Acquired defects of the central face pose significant challenges in achieving acceptable cosmetic and functional outcomes. The site, size, and depth of tissue loss often render local tissues inadequate for the repair of major nasal defects. In this article, we aim to demonstrate the efficacy of radial forearm-free flaps as an ideal choice for various central facial unit reconstructions. Methods: This study encompassed patients treated between 2020 and 2022 who underwent facial reconstruction using radial forearm flaps. These flaps were employed in eleven patients with defects involving the lower lid, nose, upper lip, and lower lip. Additionally, we used osteocutaneous flaps in one patient to reconstruct a right nasal bone defect. In three patients requiring medial and lateral canthal tendon reconstruction in one case and oral sphincter reconstruction in two cases, the palmaris longus tendon was included with the flap. Results: In the majority of cases, we achieved good to excellent aesthetic and functional results. Notably, there were no instances of flap failure or partial necrosis in this series. All patients experienced uneventful healing at the donor site. Conclusions: The radial forearm-free flap stands as an ideal and reliable method for reconstructing various facial defects. It offers efficient and thin-conforming skin coverage. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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11 pages, 6860 KiB  
Article
Comparison of Antero-Lateral Thigh Flap and Vastus Lateralis Muscle Flap for the Treatment of Extensive Scalp Defects—A Retrospective Cohort Study
by Julius Moratin, Philip Dao Trong, Karl Semmelmayer, Jan Mrosek, Sven Zittel, Moritz Bleymehl, Oliver Ristow, Christian Freudlsperger, Jürgen Hoffmann and Michael Engel
J. Clin. Med. 2023, 12(19), 6208; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12196208 - 26 Sep 2023
Cited by 1 | Viewed by 659
Abstract
Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap [...] Read more.
Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm2. There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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10 pages, 1652 KiB  
Article
Preclinical Application of Augmented Reality in Pediatric Craniofacial Surgery: An Accuracy Study
by Federica Ruggiero, Laura Cercenelli, Nicolas Emiliani, Giovanni Badiali, Mirko Bevini, Mino Zucchelli, Emanuela Marcelli and Achille Tarsitano
J. Clin. Med. 2023, 12(7), 2693; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12072693 - 04 Apr 2023
Cited by 6 | Viewed by 1300
Abstract
Background: Augmented reality (AR) allows the overlapping and integration of virtual information with the real environment. The camera of the AR device reads the object and integrates the virtual data. It has been widely applied to medical and surgical sciences in recent years [...] Read more.
Background: Augmented reality (AR) allows the overlapping and integration of virtual information with the real environment. The camera of the AR device reads the object and integrates the virtual data. It has been widely applied to medical and surgical sciences in recent years and has the potential to enhance intraoperative navigation. Materials and methods: In this study, the authors aim to assess the accuracy of AR guidance when using the commercial HoloLens 2 head-mounted display (HMD) in pediatric craniofacial surgery. The Authors selected fronto-orbital remodeling (FOR) as the procedure to test (specifically, frontal osteotomy and nasal osteotomy were considered). Six people (three surgeons and three engineers) were recruited to perform the osteotomies on a 3D printed stereolithographic model under the guidance of AR. By means of calibrated CAD/CAM cutting guides with different grooves, the authors measured the accuracy of the osteotomies that were performed. We tested accuracy levels of ±1.5 mm, ±1 mm, and ±0.5 mm. Results: With the HoloLens 2, the majority of the individuals involved were able to successfully trace the trajectories of the frontal and nasal osteotomies with an accuracy level of ±1.5 mm. Additionally, 80% were able to achieve an accuracy level of ±1 mm when performing a nasal osteotomy, and 52% were able to achieve an accuracy level of ±1 mm when performing a frontal osteotomy, while 61% were able to achieve an accuracy level of ±0.5 mm when performing a nasal osteotomy, and 33% were able to achieve an accuracy level of ±0.5 mm when performing a frontal osteotomy. Conclusions: despite this being an in vitro study, the authors reported encouraging results for the prospective use of AR on actual patients. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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11 pages, 4680 KiB  
Article
Can Steam Sterilization Affect the Accuracy of Point-of-Care 3D Printed Polyetheretherketone (PEEK) Customized Cranial Implants? An Investigative Analysis
by Neha Sharma, Jokin Zubizarreta-Oteiza, Céline Tourbier and Florian M. Thieringer
J. Clin. Med. 2023, 12(7), 2495; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12072495 - 25 Mar 2023
Cited by 3 | Viewed by 1621
Abstract
Polyetheretherketone (PEEK) has become the biomaterial of choice for repairing craniofacial defects over time. Prospects for the point-of-care (POC) fabrication of PEEK customized implants have surfaced thanks to the developments in three-dimensional (3D) printing systems. Consequently, it has become essential to investigate the [...] Read more.
Polyetheretherketone (PEEK) has become the biomaterial of choice for repairing craniofacial defects over time. Prospects for the point-of-care (POC) fabrication of PEEK customized implants have surfaced thanks to the developments in three-dimensional (3D) printing systems. Consequently, it has become essential to investigate the characteristics of these in-house fabricated implants so that they meet the necessary standards and eventually provide the intended clinical benefits. This study aimed to investigate the effects of the steam sterilization method on the dimensional accuracy of POC 3D-printed PEEK customized cranial implants. The objective was to assess the influence of standard sterilization procedures on material extrusion-based 3D-printed PEEK customized implants with non-destructive material testing. Fifteen PEEK customized cranial implants were fabricated using an in-house material extrusion-based 3D printer. After fabrication, the cranial implants were digitalized with a professional-grade optical scanner before and after sterilization. The dimensional changes for the 3D-printed PEEK cranial implants were analyzed using medically certified 3D image-based engineering software. The material extrusion 3D-printed PEEK customized cranial implants displayed no statistically significant dimensional difference with steam sterilization (p > 0.05). Evaluation of the cranial implants’ accuracy revealed that the dimensions were within the clinically acceptable accuracy level with deviations under 1.00 mm. Steam sterilization does not significantly alter the dimensional accuracy of the in-house 3D-printed PEEK customized cranial implants. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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13 pages, 4104 KiB  
Article
Accuracy Evaluation of an Alternative Approach for a CAD-AM Mandibular Reconstruction with a Fibular Free Flap via a Novel Hybrid Roto-Translational and Surface Comparison Analysis
by Mirko Bevini, Francesco Vitali, Francesco Ceccariglia, Giovanni Badiali and Achille Tarsitano
J. Clin. Med. 2023, 12(5), 1938; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12051938 - 01 Mar 2023
Viewed by 1464
Abstract
Although the fibula free flap represents the gold standard for mandibular reconstructions, when implanted as a single barrel, this flap does not have the cross-sectional requisites to restore the native mandibular height, which is in turn required for the implant-supported dental rehabilitation of [...] Read more.
Although the fibula free flap represents the gold standard for mandibular reconstructions, when implanted as a single barrel, this flap does not have the cross-sectional requisites to restore the native mandibular height, which is in turn required for the implant-supported dental rehabilitation of the patient. Our team has developed a design workflow that already considers the predicted dental rehabilitation, positioning the fibular free flap in the correct craniocaudal position to restore the native alveolar crest. The remaining height gap along the inferior mandibular margin is then filled by a patient-specific implant. The aim of this study is to evaluate the accuracy in transferring the planned mandibular anatomy resulting from said workflow on 10 patients by means of a new rigid body analysis method, derived from the evaluation of orthognathic surgery procedures. The analysis method has proved to be reliable and reproducible, and the results obtained show that the procedure already has satisfactory accuracy (4.6° mean total angular discrepancy, 2.7 mm total translational discrepancy, 1.04 mm mean neo-alveolar crest surface deviation), while also pointing out possible improvements to the virtual planning workflow. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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Review

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15 pages, 1475 KiB  
Review
Is the Pre-Shaping of an Orbital Implant on a Patient-Specific 3D-Printed Model Advantageous Compared to Conventional Free-Hand Shaping? A Systematic Review and Meta-Analysis
by Ashutosh Kumar Singh, Nikita Khanal, Rajib Chaulagain, Neha Sharma and Florian M. Thieringer
J. Clin. Med. 2023, 12(10), 3426; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12103426 - 12 May 2023
Cited by 2 | Viewed by 1528
Abstract
This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in [...] Read more.
This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42021261594). A search was conducted in MEDLINE (PubMed), Embase, Cochrane Library, Clinicaltrials.gov, Google Scholar, and the grey literature. Ten articles were included, and six outcomes were analyzed. In total, 281 patients were in the 3DP group and 283 were in the MFS group. The studies had an overall high risk of bias. 3DP models resulted in a better accuracy of fit, anatomical angle reproduction, and defect area coverage. The correction of orbital volume was also superior with statistical significance. There was a higher percentage of the correction of enophthalmos and diplopia in the 3DP group. Intraoperative bleeding and hospital stay were reduced in the 3DP group. The meta-analysis of operative time showed a reduction in the average operative time by 23.58 min (95% CI: −43.98 to −3.19), which was statistically significant (t(6) = −2.8299, p = 0.0300). The 3DP models appear advantageous for an accurate orbital wall reconstruction, with fewer complications than those for conventional free-hand-shaped implants. Full article
(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery—Series 2)
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