Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: This review seeks to describe the current state of virtual surgical planning (VSP) for head and neck free flap reconstruction, highlighting recent advancements, future directions, and outstanding limitations.

Recent findings: Three-dimensional (3D)-printed plates have been shown to confer increased accuracy and lower fracture rate compared to hand-bent plates. Efforts are underway to optimize plate design for load bearing and dental rehabilitation. Preclinical work is investigating bioresorbable plate materials and 3D-bioprinting of composite materials using stem cell and tissue engineering technology. Advances in imaging and artificial intelligence may improve reconstructive planning. Use of robots and augmented reality may increase precision and intraoperative flexibility in the future. Cost of VSP remains a concern, but has shown to be offset by decreased operative time and in-house VSP, and will likely continue to fall as use of VSP increases. While numerous advantages have been shown for VSP, few studies have investigated correlation of VSP to patient-reported outcomes, which is an increasingly important metric.

Summary: In addition to increasing accuracy, decreasing operative time, and facilitating complex reconstructions, VSP has the potential to harness advancements in reconstructive materials, imaging, and artificial intelligence to advance free flap reconstruction and improve patient outcomes.

Purpose of review: The purpose of this manuscript is to review the current literature regarding nonoperative strategies for management of upper airway obstruction (UAO) among infants with Robin sequence (RS). We evaluate and discuss recent advances, benefits, and challenges of preepiglottic baton plate (PEBP) use as an alternative to more invasive surgical interventions for RS in infancy.

Recent findings: Over the last two decades, the use of an orthodontic appliance has become an increasingly popular nonoperative intervention for the treatment of RS in newborns. Among infants with isolated RS, PEBP placement has been proven effective in diminishing signs of upper airway obstruction, avoiding tracheostomy, and facilitating oral feeding. When compared side-by-side to proven surgical interventions, such as mandibular distraction osteogenesis (MDO), at least one study suggests that PEBP may be equally effective in treating infants with moderate UAO. In addition, PEBP utilization may result in improved feeding and growth outcomes compared to those reported among infants who undergo MDO.

Summary: This article summarizes the current landscape of an evolving, nonoperative treatment option for neonatal tongue base obstruction, which, in the appropriate patient population, represents an exciting alternative to surgical management.

Purpose of review: The purpose of this review is to summarize the current management of radiation-induced trismus. It will provide an overview of radiation-induced trismus' pathophysiology, assessment, diagnosis, and treatment, along with directions for future research.

Recent findings: Despite advances in radiation technology, the proximity of head and neck tumours to the masticatory muscles prevents shielding of these critical structures, increasing the risk of trismus. Trismus has been treated using various techniques including stretching and strengthening exercises in the rehabilitation setting that have resulted in improvements in mouth opening, however, the exercise approach in both research and clinical practice rarely accommodates an individual's goals and priorities. The effect of prophylactic trismus exercises during radiation can be challenging to measure, likely due to exercise adherence with the onset of treatment related toxicities. There is limited support from the literature as to its preventive efficacy. Recent papers provide direction for trismus exercises and devices which may offer greater capacity to individualize treatment and optimize both functional and quality of life outcomes.

Summary: The incidence of radiation induced trismus is anticipated to rise along with that of head and neck cancers globally. Trismus carries significant functional and quality of life implications with known limitations and opportunities for optimizing its management.

Purpose of review: Trismus (decreased mouth opening) is frequently associated with oral premalignant/malignant lesions, and also occurs in upto 40% of head neck cancer patients post radiation therapy. Trismus is associated with adverse functional and oncologic outcomes through impact on quality of life and posttreatment disease surveillance. Relevant literature is mostly retrospective and single author/institution- a review of the same would aid management of this complex multifactorial disorder.

Recent findings: Newer innovations aim at obviation of trismus during treatment planning for head neck cancer, including radiological and serologic prediction, surgical/reconstructive modifications, and tailored radiation therapy with emphasis on sparing excessive treatment to masticatory apparatus.Rehabilitation of manifest treatment-associated trismus, on the other hand, begins with accurate assessment of etiology and extent. Treatments range from exercises and device-based interventions, novel reconstructive methods aimed at ensuring maximal interincisal opening while minimizing donor site morbidity, and ensuring compliance through monitored adherence and self-reporting.

Summary: Trismus prevention and rehabilitation in oral cancer is a multistep sustained process necessitating inputs from several specialties. Personalized treatment and rehabilitation regimens should be incorporated at the outset and continued till at least one year post treatment completion, to ensure optimized outcomes.

Purpose of review: Auricular avulsion injuries present complex reconstructive challenges due to the intricate three-dimensional (3D) structure and vascular supply of the ear. This review examines traditional and emerging techniques in auricular trauma repair, including microsurgical advancements, digital planning, tissue engineering, and 3D bioprinting, highlighting their impact on reconstructive outcomes.

Recent findings: Traditional techniques, such as multilayer closure and microsurgical reattachment, remain foundational in auricular reconstruction. However, recent studies suggest that subtotal amputations with small vascular pedicles may survive without microvascular anastomosis. Microsurgical refinements, including digital planning and customized surgical guides, enhance precision in reconstruction. Tissue engineering innovations, such as 3D bioprinting with biomimetic scaffolds and magnetoresponsive hydrogels, show promise for auricular cartilage regeneration. Additionally, postoperative adjuncts like antipressure alarm systems and bioactive hydrogels seeded with stem cells improve healing and long-term outcomes.

Summary: Auricular trauma repair is evolving through a combination of established and innovative techniques. Digital planning, microsurgical advancements, and tissue engineering are shaping a new era of patient-specific reconstruction. Future research should focus on refining these technologies, evaluating long-term efficacy, and addressing economic feasibility to optimize patient outcomes.

Purpose of review: Maxillomandibular fixation (MMF) is essential for many surgeries on the bony middle and lower face. MMF techniques have multiplied in recent years, each with unique benefits and drawbacks. This review catalogs MMF trends and evidence for and against the most prevalent MMF methods.

Recent findings: Traditional Erich arch bars remain the most robust technique in establishing MMF, particularly for comminuted/complicated fractures. Drawbacks are increased operative time required, wire stick injuries, poor oral hygiene, and gingival trauma. Screw-based techniques save considerable time but cannot stabilize comminuted fractures as adequately and risk tooth root and nerve damage. Embrasure wires offer time and cost savings but are solely for intraoperative use and uncomplicated fractures. Similarly, dental occlusion ties provide the benefits of reduced time and wire sticks, with the added capability of postoperative use, but require adequate dentition and minimally displaced fractures. Recent studies show decreased use of wire-based techniques, with increased adoption of hybrid systems and dental occlusion ties.

Summary: MMF techniques each have unique advantages and weaknesses. Selection should depend on surgical goals, including the severity of fractures, the need to maintain occlusion postoperatively, application/removal time, safety, and patient comfort.

Purpose of review: This review describes recent innovations in craniofacial imaging, focusing on emerging techniques such as 3D photogrammetry, smartphone-based scanning, and artificial intelligence applied to cephalometric assessments in facial plastic and reconstructive surgery.

Recent findings: Traditional methods like occipitofrontal circumference and cephalic index remain widely used, but newer, more precise technologies have recently emerged. 3D photogrammetry is a reproducible, safe, and noninvasive alternative, offering detailed cranial modeling using external landmarks. The integration of smartphone technologies has further democratized craniofacial imaging by enabling accurate 3D scans with minimal cost and radiation exposure. Despite variability in certain facial regions, these technologies have shown promising accuracy for clinical use. Furthermore, AI-driven approaches enhance diagnostic precision by generating synthetic data and improving landmark detection in complex cranial morphologies.

Summary: Recent technological advances are reshaping craniofacial imaging and optimizing preoperative and postoperative care in facial plastic and reconstructive surgery. 3D imaging and AI applications offer significant improvements over traditional methods and allow for more precise and reliable methods for operative planning and longitudinal assessments. As these tools develop, they are bound to become the new standards for clinical evaluation of craniofacial anomalies.

Purpose of review: Wounds within the face, head, and neck region can have devastating aesthetic, functional, and potentially fatal outcomes for patients and often require multimodality treatment. Here we discuss the role of hyperbaric oxygen for a variety of wounds within the head and neck region and the clinically associated outcomes.

Recent findings: Hyperbaric oxygen (HBO) treatment can be useful in the management of wounds and infections within the head and neck region. While there are few randomized controlled clinical trials evaluating the effectiveness of HBO therapy, there is a large amount of retrospective literature supporting its adjunctive role in the treatment of radiation associated head and neck wounds, compromised grafts and flaps, and necrotizing soft tissue infections. The most common treatment protocols are typically initiated at 2-2.4 atmosphere absolute (ATA) at 100% oxygen for 90 min for 30 daily sessions, though this varies significantly in the available literature. In the setting of osteoradionecrosis (ORN) and medication-induced osteonecrosis of the jaw (MRONJ), however, emerging treatments such as the Potentiation by Clodronate (PENTOCLO) protocol may provide more effective treatment that HBO therapy.

Summary: Hyperbaric oxygen therapy should be considered as an adjuvant therapy for head and neck wounds involving radiated soft tissue, compromised local and free flaps, filler-induced soft tissue necrosis or blindness, and for necrotizing soft tissue infection; however, more randomized controlled trials are needed to better evaluate both their clinical impact as well as better establish treatment protocols, particularly in the setting of ORN and MRONJ.

Purpose of review: Mandibular plate fracture (MPF) is a serious complication of mandibular reconstruction, leading to postoperative morbidity and potential revision surgeries. Recently, there has been an increased utilization of virtual surgical planning (VSP) with patient-specific reconstruction plates to decrease operative time and improve postoperative outcomes. It is critical for surgeons performing mandibular reconstruction to have a comprehensive understanding of the contributing factors and strategies for minimizing the likelihood of MPF.

Recent findings: This review examines the patient-related and surgical factors contributing to MPF. The literature highlights that patient-related factors include younger age and degree of occlusion, while surgical factors include lateral mandibular defects, the absence of coronoidectomy, and the use of bridging plates without bony reconstruction. Notably, recent studies suggest a reduction in MPFs with the implementation of VSP and patient-specific reconstruction plates.

Summary: This review aims to inform surgeons about patients who are at increased risk of MPF following mandibular reconstruction, emphasizing the need for close monitoring. Furthermore, it underscores the additional benefits of VSP and patient-specific reconstruction plates in improving postoperative outcomes. However, further research is required to assess the long-term efficacy of these reconstruction plates.