Objective To compare pain control (opioid consumption and postsurgical pain scores) in head and neck (H&N) free flap reconstruction patients who undergo traditional means of postoperative analgesia including use of opioids versus a novel protocol that includes ketamine and gabapentin. Methods Single‐institution retrospective cohort study. Results Eighty‐six patients who underwent H&N free flap reconstruction from 2015 to 2018 were included. Forty‐three patients were in the control cohort treated with opioids only, and 43 patients were in the treatment group. There was a statistically significant decrease in opioid consumption in each of the first 5 postoperative days ranging from 80% to 83% in the treatment group. The daily pain scores were significantly lower in the treatment group in the first 2 postoperative days. At the 1‐month postoperative visit, there was no significant difference in pain scores between the groups; however, by the 2‐month visit, the treatment group reported significantly lower pain scores than the control group (P = 0.001). No adverse outcomes of ketamine or gabapentin were experienced. Conclusion Ketamine and gabapentin are safe and effective analgesics in H&N free flap surgery that significantly decrease opioid use in the acute postoperative setting and may improve pain control. Level of Evidence 3a Laryngoscope, 130:1686–1691, 2020

The evaluation and management of a patient with panfacial fractures are multifaceted. Herein, we describe basic facial skeletal anatomy, considerations for airway securing, and common concurrent injuries. Finally, we discuss primary and secondary reconstructions of facial trauma including sequencing of repair, available landmarks, and the utility of intraoperative computed tomography imaging and virtual surgical planning with custom implants.