Complex Head and Neck Reconstruction | Featuring Australia | Global Partners Webinar Series-Complex Head and Neck Reconstruction

Video Transcription

Video Summary

This webinar featured three Australian presentations on head and neck reconstruction.<br /><br />Dr. Sydney Chung discussed how neoadjuvant and adjuvant immunotherapies are changing skin cancer management, especially melanoma and cutaneous squamous cell carcinoma. She reviewed evidence showing improved recurrence-free survival with agents like pembrolizumab and promising complete or major pathological responses with neoadjuvant checkpoint inhibitors such as submethpimab. She emphasized that these therapies may reduce the need for postoperative radiotherapy, which often harms reconstruction through fibrosis, necrosis, and graft resorption. While current evidence does not suggest increased wound complications from immunotherapy, it may change the timing and type of reconstructive surgery. She highlighted streamlined nasal reconstruction, especially her use of ascending helical free flaps, and noted that future cases may involve different defect patterns after excellent medical responses.<br /><br />Dr. Anand Ramakrishnan focused on virtual surgical planning (VSP) for bony head and neck reconstruction, particularly fibula free flaps for mandibular defects. He explained that VSP improves precision, implant positioning, and occlusion, but requires careful preoperative planning because changes in resection can disrupt the plan. He discussed selecting cases for VSP, balancing contour versus dental rehabilitation, and technical points such as perforator mapping, guide design, plate fixation, and soft tissue planning. He stressed that soft tissue reconstruction is often what determines the quality of the final result.<br /><br />Dr. Damian Grinsell presented the DCIA flap as an underused but highly effective option for maxillary and midface reconstruction. He argued it offers superior bony contour, useful muscle for palatal and orbital lining, and good support for dental implants. He described techniques for total and extended maxillectomy, including use of internal oblique for orbital defects and titanium mesh for orbital floor reconstruction.

Keywords

head and neck reconstructive surgery

neoadjuvant therapies

adjuvant therapies

immune checkpoint inhibitors

virtual surgical planning

fibula flap

DCIA flap

immediate dental implants

prosthodontic-driven reconstruction

Keynote 716 trial

head and neck reconstruction

immunotherapy

melanoma

cutaneous squamous cell carcinoma

fibula free flap

mandibular reconstruction

maxillary reconstruction

nasal reconstruction