Masako Dunn

Background: Reconstructive with free flap procedures are often required following ablative removal of pathologies from the head and neck. The Clavien–Dindo Classification (CDC) system is widely used to grade complication severity; however, there are limited studies examining the relationship between complications and length of stay (LOS) in this cohort. Purpose: To evaluate the association between complication severity and both hospital and intensive care unit (ICU) LOS in patients undergoing head and neck free flap reconstruction. Methods: This retrospective cohort study included 994 patients treated between 2016 and 2024. Complications were graded using the CDC system. LOS was analysed using generalised linear models with a Gamma distribution and log‐link. Kruskal–Wallis tests were used for supplementary analysis. Results: Complications occurred in 54.5% of patients. Higher CDC grades were significantly associated with longer ICU ( p < 0.001) and hospital LOS ( p < 0.001). CDC Grades II, IIIb and IVa were independently associated with prolonged ICU LOS. All CDC grades were associated with increased hospital LOS. Conclusion: This study provides outcome data linking complication severity to ICU and hospital LOS. The CDC, while advantageous, fails to separate significant negative outcomes, such as free flap failure from a more simple return to theatre. Modifications may further improve distinction in complications and effect on overall hospital stay.

Background: Trismus is a common and disabling complication following head and neck cancer (HNC) treatment, particularly after multimodal therapy. Survivors in regional areas face barriers to accessing specialist rehabilitation. This study explored whether a patient's geographical location of residence influenced their response to trismus therapy. Methods: Secondary analysis of pooled data from three Restorabite trials (2021–2024) was performed. Adults with HNC‐related trismus (maximal interincisal opening [MIO] ≤ 35 mm) completed a 10‐week individualized rehabilitation program incorporating manual therapy, daily jaw exercises, and weekly speech pathology review delivered in person or via telehealth. Most participants (96.6%) received all or part of their intervention via telehealth. Outcomes included MIO and Gothenburg Trismus Questionnaire (GTQ) scores. Longitudinal change was modeled using generalized estimating equations. Results: A total of 175 participants with a broad range of HNC subsites, tumor stage, and treatment modalities were included. MIO improved by an average of 1.2 mm/week and GTQ scores by −2.7 points/week after 10 weeks of trismus rehabilitation (both p < 0.001). While multimodal treatment had a negative effect on both MIO and GTQ, geographical residence was not associated with change in MIO or GTQ in adjusted models ( p = 0.5 and p = 0.1, respectively). Conclusions: For geographically dispersed patients, geographical residence was not associated with poorer trismus outcomes within a predominantly telehealth‐supported model of care, supporting the use of telehealth to facilitate access to specialist trismus rehabilitation.

Background: Data on health‐related quality‐of‐life (HRQoL) is indispensable in understanding patient outcomes following jaw reconstruction. This study aims to evaluate long‐term HRQoL using validated patient‐reported outcome measures (PROMs) following jaw reconstruction using buried skin grafts to facilitate implant‐retained dental prosthetic rehabilitation. Methods: A cohort study of all patients that underwent prelamination as described by Rohner or the Sydney Modified–Alberta Reconstruction Technique (SM‐ART) from October 2012 to June 2023 at Chris O'Brien Lifehouse, Sydney, Australia with HRQoL data was conducted. HRQoL was assessed using the FACE‐Q Head and Neck Cancer Module, MD Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) at one‐year intervals from baseline to 5 years post‐operatively. Results: Twenty‐eight cases (Rohner technique; n = 19 or SM‐ART; n = 9) were included (median age, 52 years). Six dental implant losses were recorded across five patients (median time to implant loss, 21.5 months). Three patients required denture removal; however, all had an implant‐retained prosthesis at end of follow‐up. While cross‐sectional HRQoL scores were lower across most subscales at 12 months post‐operatively as compared with baseline, mean scores among available respondents showed favourable trends towards baseline by 60 months. Appearance distress notably improved beyond baseline (mean difference [MD] +19.9, 95% confidence interval [CI] −4.1 to 43.9), while oral competence (MD −16.6, 95% CI −53.4 to 20.2) and eating distress (MD −8.5, 95% CI −50.3 to 33.3) suggested a more persistent deficit. Conclusions: Favourable trends in long‐term HRQoL were observed following these reconstructive techniques to optimise dental rehabilitation, although long‐term estimates should be interpreted cautiously. These data may help inform patient counselling regarding the anticipated trajectory of recovery.

Purpose Malnutrition is prevalent in patients undergoing reconstruction surgery for head and neck cancer (HNC), impacting negatively on outcomes. Despite the availability of evidence-based guidelines (EBGs), evidence-practice gaps persist. This study examined the feasibility of implementing a pre-operative, nutrition evidence-based care pathway (EBCP). Methods This mixed-methods, pre-post study included a retrospective audit (Jan–Dec 2023) and prospective pilot implementation of a pre-operative, supportive care-led clinic (Oct 2024–Jan 2025). Nutrition care processes (referrals, malnutrition screening, and nutrition assessment with validated tools) were benchmarked against Clinical Oncology Society of Australia (COSA) EBGs. Secondary analysis examined associations with clinical outcomes (complications, length of stay (LOS), and readmissions). Multidisciplinary team (MDT) engagement informed the EBCP, guided by the Action, Actor, Context, Target, Time (AACTT) Implementation Framework. Results Pre- (n = 115, 56% male, mean (SD) age 62 (15) years) and post-implementation (n = 41, 64% male, 62 (14) years) cohorts were included. Pre-operative nutrition care processes all improved following EBCP implementation, including referrals (64% vs. 95%, p < 0.001) and malnutrition screening (91% vs. 98%, p = 0.14). False negative screening reduced (22% vs. 10%, p = 0.13) and median time from screening to surgery increased (0 vs. 5 days, < 0.001). Nutrition assessment with a validated tool increased (13% vs. 80%, p < 0.001). Survey responses pre- (n = 11) and post- (n = 8) implementation indicated improved perception of the service and fewer barriers to screening and assessment following ECBP implementation. Conclusion Implementation of a pre-operative nutrition EBCP is feasible, improves adherence to evidence-based nutrition care for patients with HNC, and has the potential to improve patient outcomes. This model may be transferrable to other areas of cancer care.