Reconstructive
Facial
Surgery

Learning objective

Given three fictional histories, classify the cause and chronology of each facial defect, state one function potentially at risk, and list two missing facts before planning reconstruction.

In this lesson

• Start with an established loss, not a named operation: Define the presenting problem as missing or altered tissue, impaired function, or both, and distinguish an observed defect from a proposed repair. The ASPS reconstructive overview places functional and appearance effects within reconstructive care, while the AO patient examination guide begins with the nature and time course of the problem.
• Separate cause from current anatomy: A similar-looking facial gap can follow trauma, tumor removal, a congenital condition, or earlier treatment, and those histories create different unresolved questions. In a post-cancer case, the ASPS skin-cancer overview keeps disease treatment and appearance in the same discussion; cause alone does not select a reconstructive method.
• Build the chronology before assigning urgency: Record when the defect arose, whether it is evolving or stable, what care has occurred, and whether an intervention is already planned by another team. The AO examination guide explicitly asks about the timing and details of primary surgery and associated treatments in secondary reconstruction.
• Keep acute injury priorities distinct from later repair: An acute facial injury can coexist with more urgent general or head-and-neck problems; route immediate concerns through qualified local trauma pathways before discussing elective appearance goals. The AO midface trauma reference describes associated injuries and the patient's overall condition as central to prioritization, but its fracture-specific timing is not a rule for every defect.

Learning objective

Construct a baseline map for a fictional facial defect that distinguishes at least three tissue components, three functional domains, observed findings from reports, and two limits of the available images.

In this lesson

• Inventory what is missing and what remains: Describe visible skin and soft-tissue loss separately from suspected structural, lining, or deeper involvement, and mark an unexamined layer as unknown. The AO patient examination guide calls for assessment of defect extent, overlying tissues, the eye, dentition, and cranial nerve function rather than a label based only on the surface.
• Pair anatomy with functional baseline: Record the patient's report of breathing, eye comfort or closure, eating, speech, sensation, or facial movement only where the affected region makes them relevant. The AO facial-nerve evaluation illustrates how eye and mouth function are assessed separately; this domain-specific example cannot stand in for a complete examination of every defect.
• Use photographs as dated observations: Document the view, expression, date, and purpose of an image before comparing it with a later image; a photograph cannot prove the depth or cause of a defect by itself. AO nasal reconstruction planning uses clinical photographs within a broader examination, and GMC visual-recording principles require appropriate authority, privacy, and secure handling for patient images.
• Mark baseline uncertainty explicitly: Separate a direct examination finding, a patient's account, a prior record, and a clinical hypothesis into different fields. The AO examination guide ties assessment to medical and prior-treatment history, so absent operative notes or uncertain tissue quality should remain open questions rather than inferred facts.

Learning objective

Write a patient-led goal statement and a role-and-handoff matrix for a fictional case, preserving two patient priorities, identifying three relevant disciplines, and naming the owner of each unresolved decision.

In this lesson

• Elicit the person's own definition of success: Ask what function, appearance, comfort, and daily activity the person most wants to regain, and what tradeoff they would find unacceptable. The GMC consent principles require professionals to find out what matters to the patient before explaining benefits, harms, and reasonable alternatives.
• Distinguish desired improvement from a promised result: Translate a broad request such as 'look normal again' into specific functions and appearance concerns without promising symmetry, concealment of scars, or a particular social response. The ASPS reconstructive overview emphasizes discussion of benefits and complications, while the GMC consent guidance keeps decisions individualized.
• Assign disciplines by the problem, not by a fixed roster: Depending on the cause and region, assessment may involve reconstructive, trauma, cancer, dental, eye, speech-and-swallow, or craniofacial services; state each service's question and handoff owner. The ACPA care parameters demonstrate interdisciplinary longitudinal care for congenital cleft and craniofacial differences, whereas NICE NG36 is specific to upper aerodigestive tract cancer.
• Record psychosocial concerns without replacing clinical goals: Invite the person to describe work, relationships, distress, and practical barriers in their own terms, then offer relevant support without treating a visible defect as a measure of distress. The ACPA parameters include psychosocial and family needs within congenital craniofacial care; GMC consent principles support listening and time for understanding in any shared decision.

Learning objective

Assemble a case-specific assessment and handoff sheet that separates confirmed findings from unknowns, requests three relevant prior records, and names an owner for each open question.

In this lesson

• Reassess the present defect, not the referral label: Record the current defect's location, extent, adjacent structures, functional effects, and the quality of remaining tissue before any pathway comparison. The AO examination guide treats these as clinical findings alongside general health and previous treatment, not conclusions that can be imported from a brief referral title.
• Request records that change the decision: Seek the available operative account, pathology or cancer-plan communication where applicable, prior radiotherapy information, and the latest relevant functional assessment. The AO examination guide highlights previous surgery and treatment in secondary reconstruction; a missing result should be assigned an owner rather than silently treated as reassuring.
• Make tests conditional on a clinical question: State what a proposed image or specialist examination must clarify and who will interpret it; avoid a standard scan order for every facial defect. The AO examination guide discusses imaging and donor-site work-up in specific anatomical and transfer contexts, so its examples require case-specific specialist judgment.
• Close the loop on clinical and visual information: A handoff should identify the sending and receiving teams, the question, records supplied, gaps, urgency, and the person responsible for confirming receipt. If clinical photographs travel with the referral, the GMC visual-recording principles require an appropriate care purpose, authority, privacy, and secure handling under local rules.

Learning objective

Triage three fictional presentations into immediate local assessment, prompt specialty review, or planned review, and document health or treatment factors that could change readiness without giving a universal timing rule.

In this lesson

• Recognize needs that outrank elective reconstruction: Acute airway, bleeding, serious associated trauma, or threatened eye function calls for immediate assessment through the appropriate local pathway rather than a routine reconstructive appointment. The AO midface trauma reference prioritizes systemic and associated injuries, and the AO facial-nerve reference makes corneal protection an early concern when eye closure is impaired; neither supplies a universal triage diagnosis at a distance.
• Review patient and wound readiness together: Check general health, healing concerns, current wound condition, prior procedures, and the patient's ability to engage with the proposed care pathway. The AO examination guide identifies wound-healing conditions, overall status, and anesthesia fitness as assessment domains; readiness remains a qualified team's case-specific decision.
• Coordinate disease-treatment priorities: When a defect follows cancer treatment, identify who holds the disease plan, whether relevant results and further treatment decisions are pending, and how reconstruction affects coordinated care. The ASPS skin-cancer overview addresses both health and appearance, while NICE NG36 describes multidisciplinary care for its defined upper aerodigestive cancer population; neither justifies assuming clearance from an empty chart.
• Use team checks as a safety conversation: Record the responsible team, unresolved safety questions, and the point at which a local safety check must be completed before an intervention proceeds. The WHO surgical safety checklist manual emphasizes multidisciplinary involvement, staff engagement, and local adaptation, not a substitute for clinical assessment or a guarantee against harm.

Learning objective

Compare four broad pathway families for a fictional defect by stating the information each requires, one likely benefit, one potential limitation, and one reason to defer selection to an appropriately trained team.

In this lesson

• Treat deferral or staging as assessed options: A team may consider an assessed decision to defer reconstruction or a staged plan only after reviewing the defect, functional exposure, disease context, and patient priorities. The GMC consent principles include the option to take no action among reasonable alternatives, while AO nasal planning illustrates case-specific stages rather than a generic recommendation to wait.
• Understand direct closure and grafting as distinct families: Direct closure and skin grafting address different tissue and coverage questions; a surface-covering option does not by itself restore every deeper structure or function. The ASPS microsurgery overview lists primary closure and grafting among alternatives to complex transfer, and ASPS skin-cancer safety guidance notes that a graft can fail to take in its specific context.
• Recognize local and regional tissue transfer conceptually: Nearby-tissue options can be considered alongside the amount and quality of missing tissue, regional function, scarring, and previous treatment. The ASPS microsurgery overview names local and regional flap transfer as reconstructive alternatives; this lesson compares pathways without teaching flap markings, incisions, or movement.
• Reserve complex transfer for specialist comparison: Free tissue transfer may be relevant to a complex defect when simpler families are inadequate, but it adds donor-site and specialist coordination questions. The ASPS microsurgery overview describes highly individualized use, and the AO examination guide makes donor-site assessment conditional on that plan; no technique is automatically highest or best.

Learning objective

Prepare a patient-specific tradeoff matrix with at least two functional aims, two appearance concerns, two donor-site or treatment burdens, and an uncertainty statement for each broad option family.

In this lesson

• Place function beside, not beneath, appearance: For an affected facial region, separately record the functions to protect and the appearance changes the patient values; the two need not carry equal weight for every person. The AO nasal planning reference discusses anatomy, appearance, form, and function together, while the AO facial-nerve evaluation shows the importance of eye and mouth goals in a different clinical domain.
• Include burdens beyond the facial site: A pathway that uses tissue from elsewhere raises questions about the donor area, prior procedures, circulation, recovery burden, and which specialist evaluates those matters. The AO examination guide explicitly makes donor-site work-up plan-specific; the course does not turn its named tests into routine screening.
• State complications and uncertainty in context: Discuss the plausible kinds of healing, sensation, deeper-structure, graft, and revision concerns relevant to the case, while acknowledging that their likelihood cannot be inferred from a generic page. The ASPS skin-cancer safety page gives examples for post-skin-cancer care, and the GMC consent principles require harms to be explained in light of what matters to this patient.
• Use a transparent comparison rather than an appearance ranking: Place each feasible family beside patient priorities, unresolved clinical questions, expected follow-up needs, and an option to take no immediate action when clinically appropriate. The GMC consent principles support reasonable alternatives, including no action, while the ASPS microsurgery overview describes complex transfer as individualized rather than a default endpoint.

Learning objective

Produce a fictional shared-decision record that states the patient's goals, proposed stage boundaries, reasonable alternatives, individualized material risks and uncertainties, a voluntariness check, and who will confirm the decision under local consent rules.

In this lesson

• Describe the aim and boundary of each possible stage: A staged plan should explain what the first decision seeks to achieve, what remains contingent, and what findings could change later steps. AO nasal reconstruction planning illustrates written analysis of anatomy, function, materials, and stages in one region; a staged outline is a discussion aid, not an irrevocable schedule.
• Discuss reasonable alternatives and material risks: Explain likely benefits and burdens of feasible options, including an assessed decision to defer or take no action, and connect risks to the patient's stated priorities. The GMC seven consent principles require reasonable alternatives and patient-relevant harms; ASPS skin-cancer safety guidance provides examples whose applicability must be checked for the individual case.
• Check understanding, choice, and freedom from pressure: Invite questions, allow time and support to understand, and ask whether anyone or any deadline is pressuring the person to decide. The GMC consent guidance starts from adult decision-making capacity while requiring a decision-specific legal assessment when capacity is in doubt; local law governs the actual consent process.
• Record the dialogue and outstanding safety duties: Document what was explained, the person's questions and preferences, the agreed decision or decision to wait, who will complete outstanding assessments, and how the plan will be revisited. The GMC recording-decisions standard says a form is not a substitute for meaningful dialogue, while the WHO checklist manual places later procedural safety checks with the responsible team.

Learning objective

Given a fictional facial-trauma handoff, separate three immediate whole-patient or regional safety questions from later reconstructive goals, and write a staged responsibility map with at least three named specialty roles and two review triggers.

In this lesson

• Place facial injury within the whole trauma assessment: A facial defect after injury may coexist with threats to breathing, bleeding control, vision, head or cervical-spine safety, and other injuries. The emergency team must use its local trauma pathway before an elective reconstructive plan is considered; the AO midface reference emphasizes whole-patient priorities, but its fracture-specific triage details do not set rules for every facial wound. AO midface trauma considerations.
• Describe the present defect without assuming its final form: Record mechanism, chronology, tissue and structural loss, contamination concerns reported by the treating team, and the status of adjacent eye, nose, mouth, nerves, and dentition where relevant. Distinguish findings already assessed from unknowns, because associated injuries and evolving tissue findings can change the eventual reconstructive question. The AO examination framework supports cause, time course, defect extent, prior care, and regional function as separate fields. AO patient examination; AO midface trauma considerations.
• Sequence decisions through named teams rather than a fixed clock: Make a map of which service owns acute stabilization, injury characterization, functional assessment, reconstructive consultation, and communication with the patient. A later reconstructive choice may depend on overall health and associated injuries; no single timing threshold from midface-fracture guidance should be exported to soft-tissue loss or other trauma patterns. Record what information must be handed over before the plan can be reviewed. AO midface trauma considerations; AO patient examination.
• Revisit goals and consent when the situation changes: Once the patient can participate, identify immediate function and appearance concerns in their own words and distinguish provisional discussion from consent to a specific intervention. A change in the defect, overall condition, available options, or patient preference is a trigger to reopen the decision; local law and emergency protocols govern care when ordinary consent is not possible. The GMC describes decision-making as ongoing and calls for review when circumstances or the proposed care change. GMC consent principles; GMC reviewing decisions.

Learning objective

For two fictional post-tumor defects, create separate cancer-team and reconstruction-team handoffs that identify disease-status uncertainty, at least three functional or appearance goals, proposed treatment interactions, and a patient-facing follow-up owner without applying one cancer guideline to both cases.

In this lesson

• Keep disease management and reconstruction connected but distinct: A reconstruction plan after tumor removal must be based on what the treating cancer team has established about the disease, the defect, and any further treatment still under consideration. A facial skin-cancer defect and an upper aerodigestive tract cancer defect may have very different oncologic pathways; a reconstructed surface is not evidence that cancer assessment or follow-up is complete. ASPS discusses health and appearance after skin-cancer removal, while NICE NG36 is specifically scoped to upper aerodigestive tract cancers in people aged 16 or older. ASPS skin cancer removal; NICE NG36 recommendations.
• Request the facts that change a reconstructive discussion: Ask the cancer service to specify the treated site, the current defect, whether further disease-related decisions are pending, and the named clinician who communicates them; document unknowns rather than inferring clearance from a referral note. The reconstructive assessor separately records tissue components, eye or oral involvement, nerve function, general health, and prior treatment. The AO examination reference supports this history, but its investigation examples are conditional and are not a universal scan order. AO patient examination; NICE NG36 recommendations.
• Plan around cancer-care effects and patient-defined function: For an eligible upper aerodigestive tract cancer case, include swallowing, voice, nutrition, and anticipated rehabilitation in discussion with the relevant team, alongside facial appearance and wound goals. For a skin-cancer case, ask about scar, sensation, deeper-structure and healing risks without assuming the same swallowing pathway applies. NICE and ASPS each address their own populations; neither selects an individual reconstructive method. NICE NG36 rehabilitation recommendations; ASPS skin cancer risks.
• Close the oncology, reconstruction, and follow-up communication loop: Document who will explain disease decisions, who will explain reconstructive options and material tradeoffs, and who the patient should contact about new symptoms or a changed plan. Make room for reasonable alternatives and for a revised decision when new cancer-care information arrives. NICE supports locally agreed risk-adapted follow-up for its defined cancer population, while the GMC requires patient-specific discussion of benefits, harms, uncertainty, and alternatives. NICE NG36 follow-up recommendations; GMC consent dialogue.

Learning objective

Create a region-by-function assessment grid for a fictional multi-region facial defect with separate eye, nasal, and oral questions, at least one timely referral in each affected domain, and a statement of why a satisfactory appearance photograph cannot settle function.

In this lesson

• Treat an exposed or poorly protected eye as a safety question: Ask whether the person can close the eye, protect the cornea, and obtain prompt qualified assessment for concerning ocular symptoms; do not infer eye safety from a symmetric portrait. AO facial-nerve guidance identifies corneal protection as the immediate priority in facial paralysis, and the broader AO examination includes eye involvement in midface and skull-base defects. These pages concern specific mechanisms, so referral and management follow the actual local eye pathway. AO facial-nerve evaluation; AO patient examination.
• Separate nasal lining, support, airflow, and appearance questions: A nasal defect record should state which components appear missing, the patient's breathing concern, and which findings still need qualified examination. AO nasal planning links anatomical loss, form, and function and permits staged planning, but this nose-specific reference does not dictate the method or number of stages for other facial regions. A photographic outline alone cannot show whether airflow is satisfactory. AO nasal planning.
• Give the mouth its own competence, speech, and swallowing goals: Record reported difficulty maintaining oral closure, eating, speaking, or swallowing, and route each concern to the relevant examiner or rehabilitation professional. AO facial-nerve assessment considers oral competence and speech, while NICE NG36 addresses swallowing, voice, and nutrition in its defined cancer population. The latter should not be applied wholesale to non-cancer facial defects. AO facial-nerve evaluation; NICE NG36 rehabilitation recommendations.
• Integrate regions through explicit specialist handoffs: Where one defect crosses facial regions, make a single shared record of patient priorities, what each specialist has assessed, what remains uncertain, and who reconciles competing goals. Eye protection, nasal breathing, and oral function can matter independently of contour, so an appearance-first plan needs challenge before consent. The AO examination and GMC decision-making guidance support region-specific assessment and discussion of personally material tradeoffs. AO patient examination; GMC consent principles.

Learning objective

From a fictional secondary-reconstruction record, identify at least five prior-treatment or healing facts to retrieve, separate verified findings from unknowns, and draft a focused multidisciplinary referral with a named reply owner and a plan-review trigger.

In this lesson

• Reconstruct the treatment history before proposing another pathway: Record when the defect arose and obtain the previous operation and treatment history, including earlier reconstruction, radiation, systemic treatment, and relevant dental or neck care when applicable. Scarred or previously treated anatomy may alter the feasible options, but the label 'difficult case' says little without the original record and current examination. AO's reconstruction examination asks explicitly for prior procedures, associated treatment, healing risks, defect extent, and adjacent functions. AO patient examination.
• Separate healing concern from an assumed indication: Document wound status, general health, factors that may compromise healing, and whether a donor region has been treated before, leaving case-specific testing to the qualified team. A previous scar or radiotherapy history should prompt a more careful assessment rather than an automatic choice of graft, flap, or delayed treatment. AO's examples are oriented to complex head-and-neck reconstruction and must not be converted into a universal test bundle. AO patient examination.
• Ask cancer specialists about ongoing and late effects when relevant: For a patient within the upper aerodigestive tract cancer scope, identify ongoing cancer surveillance, anticipated further treatment, and symptoms or late effects that could change function and follow-up. NICE calls for tailored information about recurrence and late effects and locally agreed, risk-adapted follow-up; it does not specify a universal revision interval or apply to every irradiated facial defect. AO facial-nerve guidance also recognizes prior radiation and scar as variables in facial movement assessment. NICE NG36 follow-up recommendations; AO facial-nerve evaluation.
• Make a complex referral answerable and close the loop: Send the receiving specialist a specific question about the unresolved function, tissue, treatment interaction, or risk, plus the known defect history and patient priorities; ask who will communicate the response. If new information changes the available options, revisit benefits, harms, alternatives, and the person's choice rather than relying on an earlier consent conversation. The GMC guidance treats decision-making as iterative and patient-specific; local pathways determine referral urgency. GMC consent dialogue; GMC reviewing decisions.

Learning objective

Draft a fictional discharge-to-follow-up handoff that names the responsible clinician and contact route, records individualized care instructions, separates routine review from symptom escalation, and identifies at least three findings that need prompt qualified assessment.

In this lesson

• Assign a reachable owner for each part of recovery: Record who owns wound review, function review, pending results, and any cancer-specific surveillance; list how the patient and other clinicians can reach the appropriate team. The patient should leave with individualized instructions and a clear contact route rather than a generic recovery calendar. CDC surgical site infection basics stresses knowing whom to contact before discharge; ASPS recovery guidance asks for a surgeon-specific follow-up plan in its skin-cancer context.
• Translate the plan into individualized care information: A handoff should say which team gives wound-care, activity, and dressing advice, what instructions have actually been provided, and which questions remain unanswered. Do not turn the ASPS skin-cancer recovery examples into universal instructions for trauma, congenital, or head-and-neck cancer reconstructions; the operating team must tailor care to the defect and treatment. ASPS recovery guidance explicitly directs patients to follow their own surgeon's instructions.
• Route possible complications instead of diagnosing them remotely: New or worsening wound redness or pain, cloudy drainage, and fever are possible infection signs requiring immediate contact with a health professional in CDC advice. Bleeding, threatened tissue healing, or new functional loss also warrant qualified assessment through the local postoperative or emergency pathway according to severity; a course case cannot assign a diagnosis from a message or photograph. Eye closure is a special concern when facial nerve function is affected. CDC surgical site infection basics; ASPS skin-cancer surgery risks; AO facial-nerve evaluation.
• Close the loop after an unscheduled contact: Document the patient's report, the route used, the qualified person who reviewed it, the action communicated, and the subsequent recheck. For a head-and-neck cancer case, keep oncologic follow-up and late-effect surveillance assigned separately from reconstructive wound review; NICE recommends tailored information and locally agreed, risk-adapted follow-up in its defined cancer population. This source does not impose one schedule on other facial defects. NICE NG36 recommendations.

Learning objective

Build a fictional follow-up matrix that pairs at least three baseline patient-defined goals with current patient reports, observed function, a relevant rehabilitation referral or review owner, and a stated limit on each outcome measure.

In this lesson

• Match rehabilitation to the affected function and clinical context: Revisit the patient's documented goals and current deficits, then ask the responsible team whether swallowing, speech, mouth opening, facial movement, nutrition, or psychosocial support needs a relevant specialist assessment. NICE describes selected speech and language, swallowing, mouth-opening, and shoulder interventions for people with upper aerodigestive tract cancer; those recommendations are not a universal facial-reconstruction exercise plan. NICE NG36 recommendations; AO facial-nerve evaluation.
• Ask the patient about function, appearance, and participation separately: Compare current daily function and appearance experience with the patient's original priorities rather than using wound closure or a clinician-rated photograph as the sole outcome. The ACPA parameters include satisfaction, psychosocial well-being, growth, function, and appearance in longitudinal craniofacial review; their cleft and often pediatric scope limits transfer to acquired adult defects. ACPA care parameters.
• Choose a patient-reported measure with population limits visible: Original FACE-Q studies offer distinct scales for head-and-neck cancer, facial skin-cancer surgery, and early outcomes after traumatic fracture repair. The trauma study assessed scale reliability in a selected early postoperative fracture cohort; it does not validate every scale for all reconstructions. Identify which population and domain a proposed scale was studied in before using it, and check current instrument-use permissions; do not copy its questionnaire into course materials or treat a score as an individual success threshold. FACE-Q Head and Neck Cancer Module development; FACE-Q Skin Cancer Module validation; FACE-Q facial-trauma study.
• Reconcile reports with examination and changed priorities: A patient may report improved wound coverage yet persistent eating difficulty or appearance-related distress; record these as separate observations and questions for qualified review. Repeat assessment should make clear whether the same functional task, patient-reported domain, and clinical context are being compared over time. NICE includes quality of life and psychosocial issues in cancer follow-up, while ACPA emphasizes longitudinal outcome documentation for craniofacial conditions; neither source defines one measure for every facial reconstruction. NICE NG36 recommendations; ACPA care parameters.

Learning objective

Write a renewed decision record for a fictional residual-defect concern that separates observed change from attribution, compares continued review with revision assessment, preserves disease-specific follow-up, and documents at least four fresh consent or safety questions.

In this lesson

• Describe the remaining concern against the original plan: Record the patient's present functional and appearance concerns, the initial defect and goals, and what can actually be compared from the available baseline. A visible scar, color difference, or altered contour can remain after skin-cancer reconstruction, and a later procedure may sometimes be discussed; neither fact makes revision inevitable or defines a universal failure. ASPS skin-cancer results; ASPS recovery guidance.
• Separate persistence, new change, and disease questions: Ask whether the feature was documented before treatment, persisted after it, or is newly changing; record missing examination, pathology, or comparable images without assigning a cause. For a cancer-related defect, a new lesion or symptom belongs in the appropriate cancer pathway before an appearance-led revision discussion; NICE NG36 defines structured, risk-adapted follow-up for its upper aerodigestive cancer population. This does not establish a surveillance schedule for facial skin cancer or non-cancer defects. NICE NG36 recommendations; ASPS skin-cancer surgery risks.
• Treat revision as a new shared decision: Compare continued observation and support, further assessment or second opinion, and any proposed intervention in terms of current goals, likely tradeoffs, material risks, and uncertainty. Earlier consent and an earlier plan cannot substitute for a fresh conversation when circumstances or goals have changed; the record should include the option to take no action and who agreed each next step. GMC decision making and consent; GMC recording decisions.
• Keep longer-term outcomes and responsibility visible: At later reviews, place patient-reported function, appearance experience, psychosocial effects, and observed clinical findings beside the initial goals; mark incomplete or non-comparable data. ACPA calls for longitudinal documentation in congenital craniofacial care, and the FACE-Q Head and Neck Cancer Module was developed in a specified cancer cohort; neither supports one universal outcome threshold. Assign the review owner and any rehabilitation or disease-surveillance handoff instead of closing the case because a photograph appears satisfactory. ACPA care parameters; FACE-Q Head and Neck Cancer Module development.