Intraoral Microvascular Anastomosis in Immediate Free Flap Reconstruction for Midfacial Tumor Defects: A Retrospective Multicenter Study.

(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free flaps in midfacial reconstruction have been executed using cervical vessels. However, this approach necessitates neck access, resulting in extraoral scars and a substantial pedicle length. In light of these considerations, using intraoral anastomoses via the facial vessels emerges as a promising alternative. This retrospective multicentric study aims to provide a comprehensive account of immediate midface reconstruction through intraoral anastomoses. (2) Methods: Between 2020 and 2023, patients were included who underwent intraoral resection of midface/orbit segments (Brown Classes I-VI) as a result of malignant diseases. In all cases, immediate reconstruction was accomplished by utilizing the facial vessels through an intraoral approach. Outcome criteria were identification of vessels, parotid duct or facial nerve damage, success of vascular anastomoses, and flap survival. (3) Results: A total of 117 patients with 132 flaps (91 osseous and 41 cutaneous) were included. The intraoral preparation of facial vessels was successfully completed in less than 1 h, and no complications related to the dissection or anastomoses were observed. In two cases, the vessel diameter was insufficient to facilitate anastomoses, necessitating adopting an extraoral approach. During a follow-up period of 48 months, two osseous flaps were lost, accounting for a 1.5% loss rate out of 132 flaps used. Additionally, 3 flaps experienced partial loss, including a skin island of a scapula, the border zone of a femur, and a rectus flap, resulting in a 2.3% partial loss rate out of 130 flaps utilized. (4) Conclusions: This case series underscores the feasibility of employing intraoral anastomoses for immediate complex midface reconstruction following oncological resection. This approach is particularly advantageous for flaps with shorter pedicles, as it helps mitigate external scarring and minimizes the risk of facial nerve injury.

Current Knowledge and Awareness of Healthcare Professionals of Oral Cancer: a Study at a UK District General Hospital.

The aim of this study was to assess the levels of awareness of oral cancer in healthcare staff at a district general hospital in the UK. This excluded those staff involved in head and neck cancer management. The study identified the areas where there was a deficiency in knowledge and quantified any differences across the professions. Following a literature review utilising the National Institute for Health and Care Excellence (NICE) Healthcare Databases Advanced Research (HDAS) tool, a questionnaire was designed, which was piloted amongst healthcare professionals on one ward. The feedback from the respondents was used to test the suitability of the survey format and modified before implementation across the hospital. One hundred fifty-five completed surveys were collected. The respondents were divided into doctors, nursing staff, and healthcare assistants (HCAs). There were generally low to middle levels of subjective individual confidence in identifying oral cancer. There was confusion on the clinical signs of oral cancer, with 29% of respondents believing that toothache was a sign. Almost half of all the respondents believed that dental decay was a risk factor for oral cancer. Although the significance of an early diagnosis was recognised as being important, a number of respondents were not aware of the likely differences in morbidity and mortality based on the stage of disease on diagnosis. This study has demonstrated that the healthcare workforce has gaps in knowledge both in of the presentation of oral cancer and the morbidity and mortality associated with a delay in diagnosis. Further learning opportunities for all healthcare staff will help to reduce future disease burden.

Odontogenic myxomas: what is the ideal treatment?

There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.