Search Results (274)

Cone-beam computed tomography (CBCT) is widely used in image-guided radiotherapy because of its low radiation dose and on-board acquisition capability. However, CBCT images often suffer from scatter artifacts, increased noise, reduced soft-tissue contrast, and inaccurate Hounsfield Unit (HU) values, which limit their direct use for accurate dose calculation and quantitative analysis. To address this limitation, we propose a CBCT-to-CT synthesis framework based on 2.5D context encoding (concatenating five adjacent slices along the channel dimension) and latent-space variational diffusion. The proposed method combines a Vector Quantized Variational Autoencoder (VQ-VAE) and a U-shaped Vision Transformer (U-ViT)-based latent-space Variational Diffusion Model (VDM) to translate CBCT images into synthetic CT (sCT) images in a compressed latent space. To incorporate inter-slice anatomical context while preserving the computational efficiency of 2D processing, five adjacent CBCT slices are concatenated along the channel dimension and used as input. We evaluated the proposed method on the SynthRAD2025 paired CBCT-CT dataset covering head-and-neck, thoracic, and abdominal regions. Under the provided benchmark setting, quantitative evaluation on the validation set showed that the proposed 2.5D model improved peak signal-to-noise ratio (PSNR) from 25.39 dB to 27.44 dB (averaged across regions), structural similarity index measure (SSIM) from 0.813 to 0.846, reduced mean squared error (MSE) from 0.00313 to 0.00200, and lowered Fréchet inception distance (FID) from 1009.33 to 869.53 compared with the 2D baseline. Qualitative results also showed improved anatomical consistency and reduced artifact-related distortions. These findings suggest that neighboring-slice context can enhance HU fidelity and overall image quality in a computationally practical synthesis framework, supporting the usefulness of efficient AI-based cross-modality reconstruction for radiotherapy-related imaging workflows. Full article

Oral and Maxillofacial Surgery (OMFS) is a surgical specialty with a distinctive position at the intersection of medicine and dentistry. This unique expertise enables reliable reconstructions of complex head and neck defects, with a focus on function, esthetics, and quality of life. This review examines the historical progression, current practices, and prospective directions of head and neck reconstruction, with particular emphasis on the essential contributions of Oral and Maxillofacial Surgeons (OMSs). Beginning with early reconstructive efforts in ancient civilizations and progressing through the transformative advancements of the Renaissance, the introduction of anesthesia and antiseptics, and innovations during periods of war, the specialty has evolved in response to increasing clinical complexity. The contemporary era is characterized by the integration of microvascular reconstruction, dental rehabilitation, and advanced imaging modalities, enhancing the restoration of occlusal function, facial aesthetics, and overall quality of life. Emerging innovations such as patient-specific three-dimensional printed hardware, tissue engineering, regenerative medicine, artificial intelligence, and supermicrosurgical techniques are expected to further reshape reconstructive approaches. These technological advances aim to reduce the number of surgical steps, improve biological reconstruction, and enhance diagnostic and planning capabilities. However, they also raise ethical considerations and validation challenges that warrant careful assessment. In conclusion, Oral and Maxillofacial Surgeons continue to play a central and expanding role in head and neck reconstruction and rehabilitation. Owing to comprehensive training and technological expertise, the specialty is uniquely positioned to advance value-based, multidisciplinary care while persistently striving to improve functional, aesthetic, and quality-of-life outcomes for patients with complex craniofacial defects. Full article

Background: Reconstruction of maxillary defects in pediatric patients presents unique challenges related to craniofacial growth, functional rehabilitation, and long-term treatment planning. Although microvascular free-flap reconstruction is established in pediatric head and neck surgery, maxilla-specific data remain limited. This study aimed to describe donor-site selection patterns in pediatric maxillary microvascular reconstruction and to explore their relationship with patient age. Methods: This retrospective observational study included pediatric patients (aged 1–18 years) who underwent microvascular free-flap reconstruction of the maxilla between August 2011 and September 2025 at a single tertiary referral center. Clinical variables included age, defect characteristics, reconstruction timing, donor-site, and total flap loss. Donor-site selection patterns were analyzed in relation to patient age using nonparametric statistical methods. Results: Fifty-five patients were included. Overall flap survival was 81.82% (45/55). Donor-site selection demonstrated a significant association with patient age (p < 0.05). Younger children were more frequently reconstructed using soft-tissue flaps, whereas osseous flaps were more commonly used in older children and adolescents. No significant relationship was found between age and defect extent or reconstruction timing. Conclusions: In this single-center experience, pediatric maxillary reconstruction followed an age-adapted pattern, with soft-tissue flaps preferentially used in younger patients and osseous flaps more frequently selected in older children. These findings reflect differences in reconstructive priorities across developmental stages and support individualized planning in pediatric maxillary reconstruction. Age alone was not associated with total flap loss; however, this analysis was limited by the small number of flap loss events. Full article

The reliability of dry-type transformers depends heavily on the coil winding process, which currently lacks effective automated monitoring and relies on error-prone manual inspection. Deploying vision-based monitoring on edge devices faces challenges due to complex industrial backgrounds, target occlusions, and strict lightweight processing requirements. To address these issues, we propose LCD-YOLOv11, a lightweight object detection model built upon the YOLOv11n architecture. First, a Lightweight Ghost Coordinate Attention (LGCA) block is introduced into the backbone to reduce computational redundancy while enhancing spatial localization. Second, a CA2RAFE operator replaces standard upsampling in the neck to improve complex boundary reconstruction. Finally, a dynamic detection head (Dy-Detect) is implemented to decouple the parameter scale from the computational cost. Evaluated on a custom dataset, LCD-YOLOv11 achieves an mAP@50 of 0.841, representing a 1.8% improvement over the baseline. Crucially, it significantly reduces the parameter count by 11.58% (to 2.29 M) and the computational load by 20.63% (to 5.0 GFLOPs). LCD-YOLOv11 achieves an effective accuracy–efficiency balance, providing a highly deployable and robust solution for automated compliance verification in industrial manufacturing. Full article

Background/Objectives: Caregiver burden represents a critical yet under-integrated dimension of clinical care in head and neck cancer, where complex treatments and functional impairments impose substantial demands on informal caregivers. This study aimed to evaluate caregiver burden and to identify its clinical and psychological correlates among caregivers of patients with head and neck cancer. Methods: This prospective cross-sectional study included 132 caregivers. Caregiver burden was assessed using the Zarit Burden Interview, and psychological distress was evaluated using the Hamilton Depression (HAM-D) and Anxiety (HAM-A) Rating Scales. Clinical variables, including tracheostomy status, radiotherapy, disease stage, chemotherapy, reconstructive surgery, and disease recurrence, were analyzed. Univariate and multivariate analyses were performed to identify factors associated with caregiver burden. Statistical significance was defined as p < 0.05. Results: Caregiver burden was highly prevalent, with a substantial proportion of participants experiencing moderate to severe levels. In the univariate analyses, caregiver burden was significantly higher among caregivers of patients who underwent tracheostomy (p = 0.003), radiotherapy (p < 0.001), chemotherapy (p < 0.001), reconstructive surgery (p = 0.024), and those with advanced-stage disease (p < 0.001). Higher levels of depression and anxiety were significantly associated with increased caregiver burden (both p < 0.001) in the univariate analyses. In the adjusted analysis, anxiety and cohabitation status remained independently associated with caregiver burden, whereas disease stage, tracheostomy, radiotherapy, chemotherapy, reconstructive surgery, disease recurrence, and depression did not retain statistical significance. Educational level, professional caregiving support, and relationship to the patient were also not significantly associated with caregiver burden. Conclusions: Caregiver burden in head and neck cancer is primarily associated with caregiver psychological status and certain social characteristics, while clinical factors play a less prominent role after adjustment. These findings suggest the need for systematic identification of high-risk caregivers based on psychological vulnerability and caregiving demands. Integrating caregiver-focused assessment and targeted psychosocial interventions into multidisciplinary care could improve caregiver well-being and patient-related outcomes. Full article

Background/Objectives: Hypoglossal nerve palsy is a rare but disabling complication of general anesthesia, typically associated with tracheal intubation and head and neck surgery. This study evaluated the incidence, clinical characteristics, and potential mechanisms of postoperative tongue deviation after breast reconstruction and other surgeries performed under general anesthesia with orotracheal intubation. Methods: We retrospectively reviewed 240,646 consecutive general anesthetic procedures with orotracheal intubation performed at two tertiary hospitals between September 2011 and October 2025. Eighteen patients who developed new-onset postoperative tongue deviation were identified, and demographic features, surgical department, breast reconstruction status, anesthetic details, patient positioning, laterality of deviation, symptom duration, and recovery outcomes were analyzed. Results: Postoperative tongue deviation was documented in 18 patients, corresponding to an overall incidence of approximately 0.01%, most frequently after breast reconstruction (7/18, 38.9%), followed by vascular (27.8%), head and neck tumor (16.7%), neurosurgical (11.1%), and hepatobiliary–pancreatic surgery (5.6%). All seven breast-reconstruction cases occurred at the breast-cancer center hospital, corresponding to 0.31% of 2256 breast reconstructions. The median age was 58.0 years; 66.7% patients were female. Most patients (77.8%) achieved complete recovery, whereas 16.7% had residual deviation. Conclusions: Postoperative hypoglossal nerve palsy with tongue deviation is an exceptionally rare event after general anesthesia. In our two-center cohort, it was observed most frequently among patients undergoing breast reconstruction at one participating center; this pattern is confounded by institution-specific anesthetic and positioning practices and should not be interpreted as evidence that the procedure itself carries inherent risk. The findings are hypothesis-generating and suggest that prolonged operating time, repeated intraoperative position changes, and specific head-fixation and tube-fixation practices warrant prospective investigation. Meticulous head–neck alignment, careful tube fixation, and a structured postoperative cranial-nerve check (tongue-protrusion and voice-quality assessment in the recovery room and on postoperative day 1) may aid the early detection of this complication. Full article

General approaches of head and neck surgery involve varied procedures with developing perioperative care and a renewed effort on regional anaesthesia (RA) for intraoperative and postoperative analgesia. Due to the rich innervation and focus on enhanced recovery after surgery (ERAS), RA techniques, particularly ultrasound-guided ones, are becoming popular as part of an opioid-sparing multimodal analgesic regimen. However, the evidence base is heterogeneous and synthesised clinical guidance is needed. This narrative review, performed according to the Scale for the Assessment of Narrative Review Articles (SANRA) framework, summarises the existing literature on the role of RA in head and neck surgery, including anatomical basis, types of techniques used for RA, clinical applications, immediate outcomes and implementation. We conducted a comprehensive literature search, including studies published between January 2000 and October 2025 in English, across the PubMed/MEDLINE, Scopus, and Cochrane Library databases. Understanding of the anatomy of cervical plexus (C1–C4) and cranial nerves such as trigeminal V is basic to delineation of techniques into superficial (e.g., SCPB), deep and selective cranial nerve blocks. The evidence about decreases in postoperative pain intensity, opioid consumption (especially 24 h post-op) and decreased length of stay, largely through studies on thyroidectomy, has been consistent for SCPB as an adjunct to general anaesthesia. Ultrasound-guided regional anaesthesia (UGRA) has significantly enhanced precision and safety, reducing risks such as phrenic nerve paresis, although the concern for even higher complication rates remains with deeper or bilateral blocks. Although beneficial outcomes have been demonstrated, the literature is plagued by small and heterogeneous trials, variable block protocols, and a lack of data in complex oncologic resections or reconstructive settings. For successful implementation, there is a need for structured training programmes of anaesthesiologists and surgeons involved in the procedure performing UGRA together, institutional protocols on standardised technique, patient monitoring and outcomes auditing. RA is a useful and safe adjunct to head and neck surgery, providing analgesia in the short term and contributing to improved recovery during the perioperative period. Further studies should be conducted through large-scale, standardised trials to resolve the contributions of blocks in complex surgical cases and implement best practices for both training and clinical integration. Full article

Objectives: This study evaluates the epidemiological characteristics and survival, functional, and esthetic outcomes of pediatric patients diagnosed with head and neck sarcoma (PHNS) who underwent individualized surgical treatment for local disease control and/or for defect reconstruction. Methods: A cohort of 45 patients aged 0–18 years with histologically confirmed PHNS who underwent surgical resection and/or reconstructive procedures was analyzed. Extracted variables included demographic data, tumor histology and stage, surgical margin status, and systemic therapy modalities. Reconstructive strategies were assessed, considering technique, sequencing, and total duration of treatment. Survival analysis was performed, focusing on both overall survival (OS) and event-free survival (EFS). Results: Rhabdomyosarcoma constituted the predominant diagnosis (19/45), followed by Ewing sarcoma (7/45) and chondrosarcoma (5/45). The maxilla represented the most common primary site (18/45), whereas orbital origin was the least frequent (3/45). Complete surgical excision (R0) was achieved in 80.5% of resected cases. Margin status showed no statistically significant association with final outcome (p = 0.7786). In contrast, nodal metastasis, local recurrence, and distant dissemination were independently and collectively correlated with mortality. Survival analysis demonstrated a 3-year OS of 100% and an EFS of 79.8%, and a 5-year OS of 94.7% with an EFS of 70.7%. Conclusions: Implementation of an individualized surgical and reconstructive protocol was associated with effective local tumor control and favourable reconstructive outcomes. Oncologic prognosis was driven primarily by nodal involvement and recurrent or metastatic disease rather than margin status alone. Full article

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making. Full article

Real-time detection of apple leaf diseases in orchard environments faces ongoing challenges, particularly in preserving fine-grained disease features with limited computing resources. To address these issues, we propose a high-precision lightweight model based on YOLOv10n, called YOLO-ALD. First, we introduce Spatial and Channel Reconstruction Convolution into deeper backbone networks to replace standard downsampling layers and convolutions. This suppresses spatial and channel redundancy caused by environmental noise and optimizes feature representation. Second, we design a new C2f-Faster-SimAM module for the neck network. This module combines the inference efficiency of FasterNet with a parameter-free 3D attention mechanism to adaptively focus on early lesions, effectively distinguishing them from leaf veins without increasing model complexity. Third, in the detection head section, we use the Focaler-ShapeIoU loss function to optimize bounding box regression. It utilizes a dynamic focusing mechanism and geometric constraints to ensure the localization accuracy of irregular shapes and hard-to-detect samples. Experimental results on our self-built dataset covering four specific diseases and healthy leaves showed that, compared with YOLOv10n, the mAP@0.5 of YOLO-ALD reached 92.1%, achieving a 2.1% increase. In addition, the model has an inference speed of 105 FPS, with only 2.1 M parameters and 5.6 GFLOPs. Therefore, YOLO-ALD achieves a good balance between efficiency and robustness, showing strong theoretical potential for resource-constrained mobile agriculture diagnosis. Full article

Background and Objectives: Head and neck cancer (HNC) frequently necessitates reconstructive surgery due to defects following oncologic resection. The influence of age on reconstructive outcomes in head and neck cancer remains controversial. This study aimed to evaluate the impact of age on oncologic characteristics, reconstructive strategies, and functional outcomes following microvascular free flap reconstruction. Materials and Methods: A retrospective review was conducted on 286 patients who underwent free flap reconstruction for head and neck cancer between 2016 and 2020. Patients were stratified into three age groups: <40 years, 40–60 years, and >60 years. Demographic characteristics, tumor features, reconstructive approaches, complications, and functional outcomes—including postoperative dietary tolerance and tube feeding dependency—were analyzed. Results: The oral cavity was the most common tumor site across all age groups. Advanced-stage tumors (T4) were more frequently observed in older patients (>60 years), although the difference was not statistically significant (p = 0.0575). The overall flap survival rate was 98.6%. The mean hospital stay was 24.6 ± 15.86 days and was significantly longer in the >60-years group (p < 0.001). Postoperative dietary tolerance was comparable across age groups, with 56.8% of patients resuming a regular diet. Tube feeding dependency was slightly higher in the >60-years group but did not reach statistical significance (p = 0.1599). Conclusions: Age alone does not significantly affect reconstructive outcomes following microvascular free flap reconstruction for head and neck cancer. Despite a higher prevalence of comorbidities in and longer hospital stays for older patients, flap success rates and functional outcomes were comparable across age groups. Full article

Ossification of the vascular pedicle following fibula free flap (FFF) reconstruction is an uncommon and typically asymptomatic complication. Symptomatic cases requiring intervention are rare. We report a 29-year-old man with anterior maxillary osteosarcoma who underwent tumor resection followed by reconstruction with an osteocutaneous FFF. Calcification within the surgical site region was noted on imaging at two months after fibular reconstruction. By five months, he developed progressive trismus and pain with mastication. Computed tomography demonstrated a calcified structure extending from the mandible to the reconstructed maxilla along the flap pedicle, raising concern for tumor recurrence. Surgical excision was performed, and histopathology revealed benign woven bone without evidence of malignancy. Postoperatively, trismus improved, and flap viability was preserved. Retained periosteum during FFF harvest maintains osteogenic potential and may result in pedicle ossification. In symptomatic patients, particularly when recurrence is suspected, surgical resection is both diagnostic and therapeutic. Full article

Accurate identification of plant numbers is crucial for evaluating the effectiveness of mechanical rice seedling transplanting, which directly affects yield estimation and replanting decisions in precision agriculture. Conventional manual counting methods are time-consuming and labor-intensive, which hinders their application in modern agriculture, where efficiency and precision are paramount. Therefore, this study constructed a dataset based on images collected by consumer-grade Unmanned Aerial Vehicles (UAVs) and proposed an improved lightweight detection model named CLR-YOLO (Complex-scene Lightweight Rice-detection YOLO) based on the YOLOv11n. The model replaces the original C3k2 module with C3k2-PConv to improve computational efficiency while maintaining feature extraction capability. Additionally, it reconstructs the neck network using the Heterogeneous Selective Feature Pyramid Network (HSFPN) to optimize the handling of features from both large and small targets. Finally, the PConvHead detection head is designed to enhance feature utilization efficiency and reduce both false positives and missed detections in dense rice seedling scenarios. Experimental results demonstrated that CLR-YOLO achieved an average precision (AP@0.5) of 93.9%. While maintaining comparable accuracy, the model reduced parameters to 1.4 M, computational cost to 3.7 GFLOPs, and model size to 2.9 MB—reductions of 46.2%, 41.3%, and 44.2%, respectively, compared to the baseline model. This model provides significant support for rice seedling detection and offers valuable insights to assist agricultural producers in making subsequent decisions. Full article

Background: Dysphagia and malnutrition are common among head and neck squamous cell carcinoma (HNSCC) patients. Evidence and guidelines emphasize treatment and prevention of these conditions before surgery. In this context, multimodal prehabilitation (MP) is an essential part of a holistic treatment approach. However, the specific components and their relative importance remain debated. This study aimed to evaluate the impact of nutritional, logopedic and psychological MP. Methods: Adult HNSCC patients who completed the German version of the Functional Assessment of Cancer Therapy—Head and Neck (FACT-H&N) quality-of-life (QOL) questionnaire after undergoing curative resection and reconstructive surgery were included in this cross-sectional study. Clinical data on psychological, logopedic and nutritional MP and possible confounders was collected. To evaluate the nutritional status, bodyweight loss, the body mass index (BMI) and the Graz Malnutrition Screening (GMS) score were recorded. We determined the length of stay (LOS), the QOL, the Clavien–Dindo type III and IV complication rate (CR) as the outcome parameters for MP. Results: In total, 102 patients were included. Of those, 68 were male, while the other 34 were female. The mean age was 59.82 ± 12.27 years. The average GMS was 3.11 ± 1.45. Simultaneously, 62.75% of patients were at risk or malnourished. Malnutrition was significantly associated with adverse outcomes in the univariate, but only with decreased QOL in the multivariate model. On the other hand, MP was significantly associated with reduced LOS and improved QOL. These findings remained robust even after adjustment for possible confounders. Neither had a significant effect on the CR. Conclusions: Our findings suggest that malnutrition is a potential risk factor for adverse outcomes in curative HNSCC therapy. The GMS is a sensitive tool for identifying patients at risk of malnutrition in HNSCC surgery prehabilitation. Our multimodal protocol was associated with improved postoperative outcomes following curative surgical resection and free flap reconstruction. The observed associations may reflect potential synergistic interactions within the multimodal framework. Full article

Reconstruction in head and neck surgery requires restoration of complex functions, including speech, swallowing, and breathing, while preserving as much facial form and patient identity as possible. Over the past decade, advances in preoperative digital planning, intraoperative technologies, and robotic platforms have reshaped reconstructive strategies, giving rise to the concept of hybrid reconstruction. Hybrid approaches integrate free tissue transfer with computer-aided design and manufacturing (CAD/CAM), virtual surgical planning, intraoperative navigation, and robot-assisted microsurgery to enhance precision, reproducibility, and functional outcomes. This narrative review examines the principles and applications of hybrid reconstruction in head and neck surgery with particular emphasis on osseous reconstruction of the mandible, maxilla, and midface. The roles of intraoperative navigation and robotic assistance as enabling tools are discussed, along with their potential benefits and current limitations. Functional and morphologic outcomes, patient-reported quality of life, and challenges related to cost, access, training, and evidence heterogeneity are critically reviewed. Hybrid reconstruction represents an advancement toward outcomes-driven, patient-centered care; however, thoughtful integration of emerging technologies and continued emphasis on rigorous outcome assessment are essential to guide responsible adoption in contemporary head and neck reconstructive surgery. Full article