Recent advances and controversies in head and neck reconstructive surgery

Advances in head and neck reconstruction has made significant improvement in the quality of life and resectability of head and neck cancer. Refinements in microsurgical free tissue transfer leave made restoration of form and complex functions of head and region a reality. Standardized reconstructive algorithms for common head and neck defects have been developed with predictable results. Some of the major advances in the field include- sensate free tissue transfer, osseo integrated implant and dental rehabilitation, motorized tissue transfer and vascularized growth center transfer for pediatric mandible reconstruction. However there exist several controversies in head and neck reconstructive surgery. Some are old; resolved partially in the light of recent clinical evidences and others are new, developed as a result of newly introduced reconstructive techniques. These include, primary versus secondary reconstruction, pedicled versus free flaps, primary closure versus free tissue transfer for partial glossectomy defects, reconstruction of posterior mandible and reconstruction of orbital exenteration defects. Rapid advances in the field of tissue engineering and stem cell research is expected to make radical change in the field of reconstructive surgery. This manuscript review progress in head and neck reconstructive surgery during the last decade, current controversies and outline a road map for the future