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Introduction Head and neck cancer (HNC) significantly affects patients worldwide, often resulting in physical disfigurement, functional impairment, and diminished quality of life (QoL). Advanced HNC may necessitate reconstructive surgeries using free tissue transfer, which, despite improving survival, can exacerbate emotional and social challenges such as anxiety, depression, and social isolation. This study aims to evaluate the well-being of patients undergoing free flap surgery for advanced HNC using validated tools. Methods We conducted a prospective longitudinal study of 30 patients with advanced HNC (≥T3, stage ΙΙΙ-IV) who underwent free flap reconstructive surgery at the General Oncological Anticancer Hospital of Athens 'Agios Savvas' between January 2018 and January 2024. Patient-reported outcomes were assessed using three validated questionnaires in Greek: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression Scale (HADS), and the Brief Pain Inventory (BPI). Statistical analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY), with statistical significance set at p < 0.05. Results Among the 30 patients (10 women and 20 men; mean age = 56.6 years), post-surgical assessments indicated significant worsening of symptoms, including increased pain (p < 0.001), swallowing difficulties (p < 0.001), and speech impairments (p < 0.001). Nearly all patients reported increased analgesic use post surgery (p = 0.003), and a significant correlation was found between pain severity and diminished daily functioning, particularly life enjoyment (correlation coefficient = 0.788, p < 0.001). Additionally, 63% of patients (n = 19) were diagnosed with depression and 67% with anxiety (n = 20), with men showing a higher prevalence of depression (p = 0.001). No significant differences in anxiety rates were found between the sexes. Overall, pain severity had a broad impact on both physical and psychological status, contributing to social withdrawal and isolation. Conclusions Patients with HNC who undergo free flap reconstructive surgery face significant challenges in emotional, social, and physical well-being. Depression and anxiety are common but often undetected, especially in men. Pain remains a significant factor affecting QoL and social engagement. Comprehensive care models, including standardized pre- and post-treatment assessments, early mental health screenings, and personalized rehabilitation strategies, are essential to improve outcomes and enhance QoL for HNC patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Audit Department of Anticancer Institute of Athens issued approval 7739/F.448/3032021. The study was conducted following the Helsinki Declaration and approved by the institutional ethics committee (Institutional Board Approval No.: 7739/F.448/3032021). All participants provided informed consent before their involvement. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Neamonitou et al.)

Background Facial palsy detrimentally impacts an individual's quality of life due to its effects on function and appearance. There are several reconstructive surgical techniques available that aim to restore facial symmetry. Techniques such as direct neurorrhaphy, nerve grafts, dual reanimation, and reinnervation have the potential to enable varying motor functions, including the re-establishment of a dynamic smile. This study aimed to assess the outcomes of facial palsy reconstructive surgeries undertaken at a tertiary care centre for facial nerve reconstruction in Athens. Methods This study consisted of a comprehensive case series showcasing the outcomes of facial palsy reconstructive surgeries on 29 patients at our Tertiary General Oncological Anti-Cancer Hospital of Athens 'Agios Savvas'. The surgical procedures from October 2004 to December 2023 included reinnervation, nerve grafting, free muscle transfer, and myoplasties following our recommended algorithm. We categorized the patients into two groups: Group A and Group B based on the timing of the reconstruction: delayed or immediate. The House-Brackmann grading scale evaluated the degree and improvement of facial paralysis. Results In Group A, two of the seven patients exhibited activation of the mimetic musculature immediately postsurgery, while the remaining five experienced enhanced facial nerve function in the subsequent months. Adverse outcomes were temporalis dysfunction in one case and tongue atrophy in another. Conversely, in Group B, 21 of 22 patients demonstrated facial activation immediately postsurgery. Only one patient from this group did not show any facial nerve function postoperatively. Two of the 22 patients in Group B encountered complications: one with trismus and another with temporalis dysfunction. All patients were observed for a minimum of 12 months postsurgery. Conclusion With the exception of one patient, all participants showed improved postoperative results, which were satisfactory when weighed against the observed morbidity rate. While our case analysis did not reveal any clear indication of one particular technique being superior, the selection of methods should be based on several factors, and this algorithm could serve as a useful aid in that regard. A comprehensive and standardized clinical assessment of facial palsy, both before and after surgery, is crucial to establish a consensus and plan individualized therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Neamonitou et al.)