Structured reconstructive planning for head and neck surgery
Sugan Shegar & Keval Shah
A rule-based decision-support tool ranking free flap, regional, and local reconstructive options against defect, patient, and donor-site parameters — with explicit reasoning behind every recommendation.
Select a site to begin. MRPI will show only questions that can influence this case; optional refinements can be added before or after the first recommendation.
Case basics
For maxillary alveolar defects requiring structural maxillary/infrastructure reconstruction, select Maxilla as the primary defect site.
ℹ Hard palate — treated as Brown Class I (palatal only; infrastructure intact). For more extensive maxillary resection select Maxilla.
Use ‘No’ only when free tissue transfer is not considered clinically feasible. Use ‘Uncertain’ when feasibility depends on comorbidity, recipient vessels or operative risk.
Independent of prior radiotherapy — both can apply in salvage reconstruction.
Clinical staging
Established pre-treatment cTNM, if available
Enter the established pre-treatment cTNM, if available. MRPI does not derive staging from the tumour dimensions below.
Geometry
Tumour dimensions for defect estimation
Tumour dimensions (from CT / imaging)— used to estimate the post-resection defect
Tick when the planned resection breaches the full thickness of the cheek. This defines reconstructive extent; confirm the clinical T classification separately from the established staging assessment above.
Does resection include mandible?
Mandible — Planned bony resection
Drives continuity vs replacement pathway
Describe the planned continuity defect rather than the tumour epicentre.
Relevant when implant rehabilitation or occlusal plane restoration is planned.
Maxilla / Palate — Defect class
Brown classification — determines separation, support, and implant strategy
For palate-only defects select Hard/soft palate as site — Class II–IV apply to maxillectomy.
Auto-confirmed for Class III/IV. Tick manually for Class II if floor is resected.
Indicates composite defect with external skin loss — dual-surface reconstruction will be required.
Class III: orbital contents preserved. Selecting exenteration promotes the defect to Class IV.
Modifiers & priorities
Select a site to infer priority
Clinical judgement required — both thin and bulk are viable for this defect.
Levels planned
Levels planned
Use “Equivocal” for an abnormal or uncertain screening result that still requires objective vascular assessment. Use “No” only when collateral circulation is confirmed inadequate for radial-artery sacrifice.
