Reconstruction—The Final Dimension in Head and Neck Surgery: The 2017 Hayes Martin Lecture
The Hayes Martin lecture is dedicated to a giant who was essential to developing the surgical management of patients with head and neck cancer. Since that time, advents in anesthesia, intensive care, and improved diagnostic abilities have improved our ability to surgically manage and treat head and neck cancer. The original paradigm of resection, reconstruction, and rehabilitation was formulated as we endeavored to develop paradigms of treatment for our patients. We have maximized our resective and reconstructive abilities. Recognition that replacement of composition tissue defects allows one to best rehabilitate patients is persuasive throughout the field. The adoption of free tissue transfer has allowed us to reconstruct composition defects succinctly. The paradigm of a reconstructive ladder has been replaced with that of a reconstructive armamentarium. For most defects, compensate tissue is the preferred option. Rehabilitation of the maxillo/mandibular area requires providing patients with the ability to eat, drink, and articulate. Improvements in 3-dimensional modeling and surgical planning have allowed for exact reconstruction of the dental/alveolar/maxillary/mandibular structures. Thus, dental rehabilitation has markedly improved. Whereas it is still difficult to obtain this rehabilitation in many parts of the country, others are advancing the field to the concept of “teeth in a day.” Patients will be able to undergo surgical resection and reconstruction and go home with functional dental implants. Finally, the ability to manipulate the milieu of the surgical and to promote cellular differentiation remains elusive but has tremendous potential to decrease the quantity of invasive surgery required to functionally rehabilitate our patients.