Limited data exist regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction. A systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis. A meta-analysis of 14 two-arm studies comparing the impact of adjuvant radiotherapy versus no adjuvant radiotherapy was performed. The main analysis revealed that 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to nonirradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in nonirradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for nonirradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume. Compared to nonirradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should take this into account when planning the surgical reconstruction of head and neck defects. Conducting large-scale prospective studies with standardized protocols and well-defined follow-up measurements could contribute to defining the ideal, personalized free flap volume for optimal function and patient-reported outcomes.

Neurolymphatic dysfunction has been linked to cognitive decline and implicated in the pathogenesis of neurodegenerative disorders such as Alzheimer’s Disease (AD) and Parkinson’s Disease (PD). Despite its growing recognition, the potential role of pharmacological or surgical neurolymphatic modulation remains poorly understood. This review summarizes current evidence on the neurolymphatic system’s anatomy, physiology and its involvement in neurodegenerative diseases. It also examines emerging pharmacological and lymphatic reconstructive techniques. A comprehensive literature search was conducted in PubMed, yielding 187 studies related to the neurolymphatic system. Studies were screened for the following topics: (1) Anatomy and physiology of the neurolymphatic system, (2) The association between neurolymphatic dysfunction and neurodegenerative diseases, (3) Pharmacological and (4) Microsurgical neurolymphatic modulation. Current evidence suggests that the neurolymphatic system facilitates drainage of interstitial and cerebrospinal fluid to the deep cervical lymph nodes. Preclinical models suggest that enhancing their clearance may promote the clearance of neurotoxic proteins and potentially improve cognitive function. Scientific evidence on neurolymphatic modulation in neurodegenerative diseases is scarce. Both pharmacological and microsurgical modulatory techniques remain experimental approaches for neurodegenerative diseases, with a significant potential to improve patients’ quality of life. However, further research is warranted to establish their safety, feasibility, and efficacy. The current knowledge gaps underscore the need for a detailed mapping of the neurolymphatic pathways, preclinical evaluation, and translational interdisciplinary trials.

The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes. The authors aim to provide an up-to-date review of innovations in head and neck reconstruction for oncologic defects.

Background: Artificial intelligence (AI) is rapidly advancing and increasingly applied in facial palsy research. However, there is no comprehensive review to guide surgeons on AI-based facial assessment tools. Although photographic standards exist, videographic standards for emotions have not been proposed. Implementing these standards is essential for improving information exchange and data comparison with the new AI tools. Methods: The authors conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, by analyzing databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. The authors’ focus was on the use of AI-based facial assessment tools in patients with facial palsy who subsequently received intervention or surgery for their facial palsy. Data were evaluated descriptively, and recommendations, including videographic standards, were developed in collaboration with experts from multiple centers. Results: The authors identified 3222 articles, 35 of which met the inclusion criteria. Five AI applications analyzed static, dynamic, and chemodenervation procedures in unilateral or bilateral facial palsy. These focused on specific facial landmarks or emotion recognition from photographs and videos, but varied in the expressions and emotions analyzed. Five studies provided validation data with either healthy subjects or other outcome measurements. The authors recommend a minimum videographic assessment including the validated emotions neutral and happy. Conclusions: AI-related publications on facial palsy have significantly increased, but no consensus exists on the optimal AI-assessment software. The proposed flowchart from the authors’ systematic review can guide clinicians in decision-making. The authors recommend using the proposed videographic emotions to improve study consistency and comparability, and also encouraging further validation studies.