Virtual Planning Improves Outcomes

By Denise Bray Hensley

Laura Minhui Kim, MD, MSc

Nadia Mohyuddin, MD, FACS

Houston Methodist’s Head and Neck Surgery Team is experiencing better outcomes and success stories for patients with the use of virtual surgical planning to reduce times in the operating room. “As is always the case, efficiency in surgery is very important and directly related to the post operative course of the patients. Surgeries with virtual planning have improved outcomes, and recovery times are shorter,” said Laura Minhui Kim, MD, MSc, who joined Houston Methodist in October 2022. She and Nadia Mohyuddin, MD, FACS, stay busy with perhaps three or more joint cases a week. Dr. Mohyuddin joined Houston Methodist Hospital in 2018 after coming to Houston in 2009. She initially was an Assistant Professor in the Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery at Baylor College of Medicine. “You can say Dr. Kim and I work hand in hand to care for our patients. I love coming to work and building relationships with my patients,” Dr. Mohyuddin said. "I really love reconstructive surgery and want to see how busy we get as the need grows," said Dr. Kim who also is Assistant Professor of Otolaryngology – Head and Neck Surgery, Houston Methodist Academic Institute; and Assistant Member, Research Institute.

Surgeries with virtual planning have improved outcomes, and recovery times are shorter.

Laura Minhui Kim, MD, MSc

Dr. Kim is a head and neck surgical oncologist and microvascular reconstructive surgeon. She typically takes care of the reconstruction after Dr. Mohyuddin removes the cancer. This may involve refitting the bone to the contour of the patient’s face or neck if there is involvement of the upper or lower jaw from tumor. Dr. Mohyuddin is Associate Professor of Clinical Otolaryngology, a clinical member of the Research Institute and Residency Program Director for Otolaryngology – Head and Neck Surgery. “When we take out bony components of the face – like the mandible or the cheekbone area – we reconstruct it using bones from other parts of the body – just like we do with soft tissue,” Dr. Kim said. Most of the time, the fibula or scapula are used in reconstruction, she added.

Young patient with right lower jaw tumor needing mandibulectomy and fibula bone reconstruction.

This is when virtual surgical planning comes in. Patient-specific CT scans are sent to the engineers and surgeons who are on the resecting team and reconstructive team. “When we go into the operating room with all the soft tissue still attached to the bone, we’re able to use a patient-specific cutting guide to make the exact cuts at the exact angles and dimensions,” Dr. Kim said. “Sometimes I will need to take a piece of the fibula bone and divide it into segments in order to contour so that we get it as close as possible to the native shape of the jaw. We’re able to do that on the computer system before we go into surgery so we can shorten the operative time and make the fit exact and specific to the patient,” Dr. Kim said. Dr. Mohyuddin added that the use of virtual surgical planning has become the “standard of care” for top hospitals like Houston Methodist where patients come when they will experience the need for reconstruction after head and neck surgery.

You can say Dr. Kim and I work hand in hand to care for our patients. I love coming to work and building relationships with my patients.

Nadia Mohyuddin, MD, FACS

The two clinicians work with the medical company Synthes that has a team of engineers who upload all the patient-centric scans in their system. Then everyone from the company and from Methodist gets online together. “We come up with a plan together virtually. Synthes then takes that planning system and creates cutting guides for the surgery,” Dr. Kim adds. Most of the surgeries performed by the team at Houston Methodist involve squamous cell carcinoma of the head and neck region. The most complex cases are patients who have had this surgery or similar surgeries before and undergone treatment with radiation and chemotherapy so that soft tissue is not as new and good for healing. Dr. Mohyuddin grew up in the Midwest near St. Louis, Missouri, with a physician father and other family members in healthcare. She received her bachelor’s and medical degrees in a joint program from the University of Missouri-Kansas City. She went for Otolaryngology – Head and Neck Surgery residency training at the University of Illinois-Chicago. She then completed a Microvascular and Head and Neck Surgical Oncology fellowship at the Medical University of South Carolina in Charleston, SC. Dr. Kim spent her childhood in Seoul, Korea, before moving to Canada where she completed medical school at the University of Toronto. She did her residency in Otolaryngology — Head and Neck Surgery at Western University. Then, she studied Head and Neck Surgical Oncology and Microvascular Reconstruction during a two-year fellowship at MD Anderson Cancer Center. In Canada, she learned reconstructive procedures, sometimes the old-fashioned way – with rulers and free hand. Fortunately, she had a creative side. "I love the creative aspect of art, and I think this is why I enjoy reconstructive surgery because it requires a lot of creativity sometimes," Dr. Kim said.