There is growing concern regarding the fiscal sustainability of health care systems with an increasing need to better understand heath care economics. Efforts to limit health care spending and provide efficient use of health care dollars has become paramount. This panel is designed to allow experts in the field to debate controversial fiscal topics in head and neck reconstruction. These include use of the 3D modeling for reconstruction, free flap monitoring methods and free flap reconstruction following palliative surgical ablation. Are these practice patterns cost-effective and justifiable or are they going to be increasingly difficult to defend?