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Objective The aim of the study was to evaluate the impact of the COVID-19 pandemic on new diagnoses of head and neck cancer (HNC) in South Tyrol, northern Italy in terms of the number of new diagnoses and worsening disease stage due to diagnostic delay. Methods Patients were divided into two groups: the control group with a first diagnosis of HNC in 10 months before the national lockdown (March 9th, 2020) and the study group with a first diagnosis of HNC in 10 months after lockdown. Results A total of 124 patients were included in the study. Before the spread of COVID-19, 79 new diagnoses of HNCs were registered, while in the period after the lockdown, 45 new cancers cases were diagnosed and the difference was statistically significant (p = 0.01278). Early clinical T-stage results showed 52 cases in the control group and 21 in the study group, again with a significant difference (p = 0.03711). Advanced T-stage results showed 27 cases in the control group and 24 in the study group. Conclusions This study highlights the impact of the COVID-19 pandemic on HNCs, showing a statistically significant difference in the number of diagnoses before and after the lockdown which was related to the spread of the SARS-CoV-2 virus, and with a relevant decrease in early cT-staged HNCs.

Simple Summary Head and neck bone reconstruction with revascularized free periosteal flaps and scaffold is an overlooked option in the literature. Aim of the present paper was to systematically analyse the results of maxillary and mandibular reconstruction with this technique. We found a total of 7 studies with 55 patients fitting with our inclusion criteria. The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Our paper therefore highlighted that maxillary and mandibular reconstruction with revascularized free periosteal flaps and scaffold is a possible alternative in patient unable to bone free flap complex reconstruction, with a success rate higher to that of other secondary options. Abstract Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.

Tecnica alternativa per il prelievo del lembo di platisma miocutaneo nell’era dei lembi liberi: esperienza clinica in 61 pazienti.La ricostruzione della cavità orale e dei difetti orofaringei a seguito di un intervento chirurgico radicale per carcinoma a cellule squamose (SCC) può essere ottenuta con varie opzioni. In alcuni casi selezionati il lembo miocutaneo di platisma (MPF) potrebbe essere una valida alternativa ai lembi liberi. Tuttavia, sono sorte negli anni numerose controversie anatomiche e oncologiche sull’uso di questo lembo. È stato condotto uno studio retrospettivo su 61 pazienti trattati tra gennaio 2005 e dicembre 2017 in due centri di riferimento, in cui è stata utilizzato il MPF per la ricostruzione dei difetti risultanti dalla resezione chirurgica di carcinomi squamosi della cavità orale e dell’orofaringe. Viene descritta la tecnica chirurgica di prelievo del lembo con particolare attenzione ai dettagli anatomici: in tutti i casi trattati l’arteria submentale veniva sacrificata preservando l’arteria facciale ed il peduncolo vascolare è stato basato su rami collaterali dell’arteria stessa. Le neoplasie coinvolgevano la cavità orale nel 95,1% dei casi e l’orofaringe nel 4,9%. La stadiazione patologica (TNM 7a edizione) dei tumori era: pT1 (42,6%), pT2 (39,3%), pT3 (4,9%) e pT4a (13,1%). Il tasso di successo del lembo è stato del 93,4%. Quattro (6,5%) pazienti hanno sviluppato una necrosi parziale della padella cutanea senza coinvolgimento del piano muscolare del platisma; in nessun caso si è resa necessaria una revisione chirurgica del lembo. Il follow-up medio è stato di 69 mesi (5-153 mesi). Tredici pazienti (21,3%) hanno sviluppato una recidiva locale, in 1 paziente questa era associata alla presenza di una metastasi del collo controlaterale. L’MPF può essere un’alternativa nella ricostruzione di difetti di piccole o medie dimensioni della testa e del collo in casi selezionati. Il peduncolo vascolare può essere fornito da rami dell’arteria facciale, raggiungendo così sia una corretta radicalità oncologica, sia un’ottimale vascolarizzazione del lembo.Reconstruction of oral cavity and oropharyngeal defects following radical surgery for squamous cell carcinoma (SCC) can be achieved by a variety of options. In selected cases myocutaneous platysma flap (MPF) may be a valid choice. However, several anatomical and oncological controversies on the use of this flap are debated. A retrospective study on 61 patients treated between January 2005 and December 2017 in two referral centres in which MPF was used for the reconstruction of defects following surgical resection of SCC of the oral cavity and oropharynx was conducted. The technique of flap harvesting with anatomic details is described. In all cases the submental artery was sacrificed preserving the facial artery. All clinical data were collected. Tumours involved the oral cavity in 95.1% of cases, and the oropharynx in 4.9%. Pathological staging (TNM 7