To review current intraoperative imaging techniques utilized in head and neck reconstruction, with a focus on applications in vascular perfusion assessment, bony reconstruction, and improved intraoperative visualization and education. To assess for real-time flap perfusion, indocyanine green fluorescence angiography (ICG) has become increasingly adopted, allowing for early identification of vascular compromise and improved flap viability. In bony reconstruction, intraoperative CT and navigation systems have enhanced the precision of osteotomies and hardware placement. Emerging technologies such as the exoscope system have also contributed to improved intraoperative visualization, surgical planning, and education for trainees and multidisciplinary teams.
Summary: Intraoperative imaging continues to advance the safety and precision of head and neck reconstruction. Techniques such as ICG, intraoperative navigation, and augmented visualization tools support better decision-making, reduced complication rates, and enhanced surgical education. Ongoing investigation is needed to standardize protocols, integrate quantitative thresholds for perfusion and bony alignment, and more widely implement technologies.
