Jonas Wüster

Background: Head and neck squamous cell carcinoma (HNSCC) is a common malignancy with increasing incidence. Histopathological assessment remains the diagnostic gold standard, but is labor‐intensive and affected by a growing shortage of specialized pathologists. Limited availability of annotated data poses a major challenge for AI‐based support tools in digital pathology. Methods: We evaluated the transfer performance of a domain‐specific foundation model, Tissue Concepts, compared to standard ImageNet pretraining for HNSCC detection in histopathological whole slide images. A multicentric, retrospective dataset comprising digitized H&E‐stained slides from The Cancer Imaging Archive was used (390 slides, 268 HNSCC cases, 112 patients). Tumor regions were annotated by expert pathologists. Model representations were assessed without task‐specific fine‐tuning using a standardized classifier probe. Sample efficiency was investigated on patch‐based and patient‐based levels to estimate the number of annotated cases required for robust performance. Results: The foundation model consistently outperformed ImageNet pretraining across all experiments. On a patch‐based level, Tissue Concepts achieved substantially higher discrimination performance with minimal training data (AUROC = 0.70 vs. = 0.50 using only 1 patch). On a patient‐based level, the foundation model reached robust performance with a limited number of annotated cases (AUROC = 0.90 with 10 cases), whereas ImageNet‐based representations showed slightly inferior performance despite substantially larger training sets (AUROC = 0.87 with 50 cases). Performance improvements plateaued beyond 10 cases, indicating diminishing returns with additional annotations. Conclusion: Domain‐specific foundation models enable competitive HNSCC detection under annotation‐scarce conditions. However, performance depends on the representativeness of annotated cases and tumor heterogeneity across anatomical sites and institutions. Further multicenter and prospective studies are required to assess generalizability and integration into routine histopathological workflows.

Purpose: Facial expressions and aesthetics are vital for communication, self-expression, and social interaction. Therefore, this study aimed to evaluate the impact of localization and size of facial cutaneous squamous cell carcinoma (cSCC) on changes in perceived pre- and postoperative health-related quality of life (HR-QoL). Methods: This retrospective study included patients who had undergone surgery for facial cSCC. Size, localization and stage were assessed. Pre- and postoperative HR-QoL were evaluated using the Skindex-29. Statistical analyses, including descriptive statistics, the X2 Test, Wilcoxon Test, and repeated-measures ANOVA, were performed to analyze demographic data, tumor characteristics, and changes in HR-QoL. Results: Forty patients (mean age of 78.5 years) were included. Postoperatively, significant improvements were observed in the overall, emotional, and symptomatic HR-QoL. Tumor dimensions had an impact on presurgical emotional distress. For tumor sizes from 6 to 15 mm, significant release in symptom burden and improvement in general HR-QoL were observed. While women experienced notable improvement only in emotional distress, men also exhibited improvement in symptoms, and overall HR-QoL. All age groups showed improvements in emotional distress, symptoms and overall HR-QoL. No significant differences were found in terms of age or localization. Conclusions: This study suggests that sex, tumor localization, and tumor size may interact in influencing postoperative HR-QoL outcomes in patients with cSCC. While surgical treatment by experienced specialists was associated with an overall improvement in HR-QoL following successful tumor eradication, these findings should be interpreted with caution given the limited sample size. The results indicate that surgery remains an important first-line treatment option, particularly for medium-sized tumors. In this cohort, TNM classification was not associated with postoperative HR-QoL changes; however, interpretation is limited by the predominance of early-stage tumors. Further studies with larger patient populations are required to confirm these observations and to better elucidate the relationship between clinical staging and HR-QoL outcomes.

The DaVinci Single-Port (SP) transoral robotic surgery (TORS) platform was developed to overcome spatial constraints and instrument collisions encountered with multiport systems in head and neck surgery. We systematically reviewed and meta-analyzed perioperative performance, safety, functional recovery, and oncologic outcomes of SP TORS. Following PRISMA 2020, we searched PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and the first 25 pages of Google Scholar through January 1, 2026. Peer-reviewed English-language clinical and cadaveric studies evaluating SP TORS were included. Three reviewers screened studies and extracted data. Random-effects meta-analyses were performed where appropriate. Fourteen studies (2019–2025) including 479 patients met inclusion criteria. Patient-level evidence was concentrated in oncologic cohorts, with additional smaller clinical applications in obstructive sleep apnoea-related tongue-base surgery (37 patients), hypopharyngeal foreign body removal (1 patient), parapharyngeal space surgery (2 patients), and SP-assisted reconstruction (3 patients), as well as preclinical feasibility studies. No study reported intraoperative conversion to multiport or open surgery. Pooled estimates were console time 60.04 min (95% CI 29.56–90.51; I² = 99.1%), docking time 10.13 min (0.47–19.79; I² = 97.9%), operative time 57.72 min (37.23–78.21; I² = 0.0%), length of stay 10.63 days (2.43–18.82; I² = 99.8%), and blood loss 24.16 mL (− 6.95 to 55.27; I² = 86.8%). Bleeding was the most consistently reported surgical complication, with major bleeding requiring operative management reported in larger cohorts but remaining uncommon. Functional recovery suggested early oral intake, although timing was inconsistently reported. Margin status was predominantly R0 in several oncologic cohorts, although one matched cohort reported a lower R0 rate. SP TORS appears feasible across indications, but current evidence is limited by nonrandomized designs, inconsistent long-term reporting, and between-study heterogeneity.

Purpose: For the first time, this study explores the transfer precision of computer aided design and computer aided manufacturing (CAD/CAM) in mandibular reconstruction with scapula free flaps (SFF). Methods: Patients undergoing mandibular reconstruction with SFF and patient-specific 3D-printed titanium plates were retrospectively analyzed. To assess planning accuracy, pre- and postoperative datasets were overlaid using 3D Slicer software. Specific measurements included the fit at the mandibular resection site, intersegmental gap width between scapula and mandible, scapular segment positioning, and condylar alignment. Osseous union was evaluated via postoperative computed tomography (CT) or cone beam CT, and plate-related complications were recorded clinically. Results: In total 15 patients (mean age 65.7 ± 10.0 years) were included. Postoperative scapular segment positioning showed deviations in the posterior region (basal: 6.78 ± 3.34 mm; crestal: 7.61 ± 3.40 mm) and anterior region (basal: 3.54 ± 1.52 mm; crestal: 4.49 ± 2.51 mm). Mean deviation in segmental gap width at the anterior and posterior sites ranged from 0.55 to 1.72 mm and was statistically significant at all four measurements. Mean contralateral condyle position differed significantly from the initial position (8.56 ± 4.31 mm). Intraoral plate exposure occurred in three patients without adjuvant radiotherapy; no extraoral exposure, fractures, or loosening were observed. Non-union between the mandible and SFF was found in three patients. Conclusion: As with other CAD/CAM-assisted mandibular reconstructions, SFF exhibit discrepancies between virtual planning and the postoperative outcome. The surrounding soft tissue bulk of the scapula can hinder the precise fit of cutting guides, potentially compromising reconstruction accuracy and contributing to increased deviations. Despite these challenges, CAD/CAM-assisted SFF demonstrates acceptable surgical predictability.

Background: Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions. Methods: A narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability. Results: Flap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions—such as thin fasciocutaneous or muscle flaps on well‐perfused beds—were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap “training,” showed potential to promote vascular remodeling, but clinical evidence remains limited. Conclusion: Flap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.

Objectives: This study aimed to investigate the long-term survival of dental implants in patients after ablative resection of the maxilla or mandible and consecutive reconstruction with microvascular free fibula flaps (FFF). Materials and methods: Patients treated with a FFF reconstruction of the mandible/maxilla and dental implant insertion were included. Implant survival and the influence of age, gender, radiotherapy, and localization were evaluated. Moreover, mesial and distal bone resorption was recorded. Implant survival was assessed using Kaplan–Meier methods and Cox regression, while bone loss was analyzed with linear mixed models. Multiple testing was adjusted by Scheffé’s method; significance was set at p < 0.05. Results: In total, 53 patients with 257 implants were evaluated. The mean observation period was 64 months. The cumulative survival rate was 98.4% at 1 year, 95.7% after 3 years, and 91.8% at 5 years. After five years, adjuvant radiotherapy was associated with reduced implant survival (73.8%) and significantly increased distal bone loss ( p = 0.009). Moreover, native bone (mesial: 3.2 ± 0.6; distal 3.2 ± 0.8) demonstrated significantly greater bone loss compared with fibula bone (mesial: 2.6 ± 1.6; distal 2.8 ± 1.7). Conclusion: Adjuvant radiotherapy results in a markedly reduced implant survival and a significantly greater marginal bone (distal) loss after five years. Clinical relevance: Dental implants reveal higher survival in fibula bone after mandibular/maxillary reconstruction with microvascular FFF when irradiation was performed prior to reconstruction with a FFF and in patients without irradiation.

Objectives: Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) – techniques are increasingly considered the gold standard for orofacial osseous reconstruction. By facilitating the harvesting and transfer of microvascular bone flaps, CAD/CAM offers potential advantages over conventional methods. Therefore, this study aimed to compare both methods in a large cohort. Materials and methods: Patients who underwent conventional or CAD/CAM-planned osseous reconstruction with microvascular free flaps between 2000 and 2019 were included. Primary outcomes included osseous union, plate fracture, duration of intensive care (ICU) treatment, ischemic time, surgical time, oncological clearance and red blood cell transfusion requirements (RBT). Confounding factors influencing primary results were also analyzed. Statistical analyses were performed with a multivariate regression model; the level of significance was set to p = 0.050. Results: A total of 112 patients were included, with 56 cases undergoing conventional reconstruction and 56 receiving CAD/CAM-assisted surgery. Patients in the CAD/CAM-group had significantly shorter ischemic times ( p = 0.007), with no disadvantages regarding resection margins ( p = 0.509). Nevertheless, reconstruction with scapula osteocutaneous free flaps (SOFF) and reconstruction with deep circumflex iliac artery grafts (DCIA) flaps showed a significant association ( p = 0.015 and p = 0.036 respectively) for red blood cell transfusion requirements when performed with CAD/CAM. Conclusions: CAD/CAM-techniques reduce ischemic time in osseous reconstruction and show no disadvantages regarding clear margin resection. When performing complex reconstructions with chimeric SOFF using CAD/CAM-technique, longer ICU stay and prolonged surgical time was noticed. Furthermore, CAD/CAM-technique is associated with higher requirements for RBT when performing reconstructions with SOFF and DCIA flaps. Nevertheless, these results must be interpreted with caution, as the conventional group included younger patients (mean: 58.66 ± 9.15 years) than the CAD/CAM group (mean: 64.98 ± 10.41 years). Clinical relevance: CAD/CAM-techniques reveal advantages, such as reduced ischemic time when compared to the conventional technique and enables extensive reconstructive surgery even for older patients. Nevertheless, due to the retrospective character with heterogeneous study groups, further research is highly recommended to evaluate long-term outcomes and further define the role of CAD/CAM in oncologic head and neck reconstruction.

Purpose: Panoramic X-rays (PX) are extensively utilized in dental and maxillofacial diagnostics, offering comprehensive imaging of teeth and surrounding structures. This study investigates the automatic determination of Kennedy’s classification in partially edentulous jaws. Methods: A retrospective study involving 209 PX images from 206 patients was conducted. The established Mask R-CNN, a deep learning-based instance segmentation model, was trained for the automatic detection, position labeling (according to the international dental federation’s scheme), and segmentation of teeth in PX. Subsequent post-processing steps filter duplicate outputs by position label and by geometric overlap. Finally, a rule-based determination of Kennedy’s class of partially edentulous jaws was performed. Results: In a fivefold cross-validation, Kennedy’s classification was correctly determined in 83.0% of cases, with the most common errors arising from the mislabeling of morphologically similar teeth. The underlying algorithm demonstrated high sensitivity (97.1%) and precision (98.1%) in tooth detection, with an F1 score of 97.6%. FDI position label accuracy was 94.7%. Ablation studies indicated that post-processing steps, such as duplicate filtering, significantly improved algorithm performance. Conclusion: Our findings show that automatic dentition analysis in PX images can be extended to include clinically relevant jaw classification, reducing the workload associated with manual labeling and classification.

Background/Objectives: Acetylsalicylic acid (ASA) medication has been suggested to have a beneficial effect on cancer risk and survival. Therefore, this retrospective case–control study investigated the correlation between ASA and HNC in over 11,000,000 patients to investigate the impact of ASA intake on the risk of developing HNC, five-year survival rates, and the likelihood of secondary malignant neoplasms and malignant lymph node involvement. Methods: Retrospective clinical data was retrieved from a federated EHR network. Patients prescribed ASA were assigned to Cohort I, while those who were not prescribed ASA were assigned to Cohort II. Moreover, patients diagnosed with HNC, and prescribed ASA were assigned to Cohort III, while those with HNC but no history of ASA use were assigned to Cohort IV. Results: After matching, Cohorts I and II included 5,716,056 patients each. HNC incidence was significantly lower (OR 0.88; 95% CI 0.86–0.90) in Cohort I (+ASA) compared to Cohort II (−ASA). Furthermore, five-year survival was higher for patients taking ASA medication (survival probability 67.93%) compared to patients who did not (65.54%). These findings coincide with a lower risk of death of 22.8% (+ASA) compared to 23.6% (−ASA), which was statistically significant (p = 0.006). Patients with ASA intake also showed a lower risk of malignant neoplasms of lymph nodes (17.4% vs. 18.5%). Conclusions: Our analyses revealed a lower risk of HNC, a higher five-year survival rate, and a lower risk of malignant neoplasms of lymph nodes in patients with ASA medication. However, the retrospective design and the lack of evaluation of confounders limit the significance of our data, and, therefore, further analyses should be considered.