Background: In the evolving field of maxillofacial surgery, integrating advanced technologies like Large Language Models (LLMs) into medical practices, especially for trauma triage, presents a promising yet largely unexplored potential. This study aimed to evaluate the feasibility of using LLMs for triaging complex maxillofacial trauma cases by comparing their performance against the expertise of a tertiary referral center. Methods: Utilizing a comprehensive review of patient records in a tertiary referral center over a year-long period, standardized prompts detailing patient demographics, injury characteristics, and medical histories were created. These prompts were used to assess the triage suggestions of ChatGPT 4.0 and Google GEMINI against the center’s recommendations, supplemented by evaluating the AI’s performance using the QAMAI and AIPI questionnaires. Results: The results in 10 cases of major maxillofacial trauma indicated moderate agreement rates between LLM recommendations and the referral center, with some variances in the suggestion of appropriate examinations (70% ChatGPT and 50% GEMINI) and treatment plans (60% ChatGPT and 45% GEMINI). Notably, the study found no statistically significant differences in several areas of the questionnaires, except in the diagnosis accuracy (GEMINI: 3.30, ChatGPT: 2.30; p = 0.032) and relevance of the recommendations (GEMINI: 2.90, ChatGPT: 3.50; p = 0.021). A Spearman correlation analysis highlighted significant correlations within the two questionnaires, specifically between the QAMAI total score and AIPI treatment scores (rho = 0.767, p = 0.010). Conclusions: This exploratory investigation underscores the potential of LLMs in enhancing clinical decision making for maxillofacial trauma cases, indicating a need for further research to refine their application in healthcare settings.

Purpose: This pilot study aims to evaluate the feasibility and effectiveness of computer-assisted surgery protocol with 3D-preformed orbital titanium mesh (3D-POTM), using presurgical virtual planning and intraoperative navigation in primary inferomedial orbital fracture reconstruction. Methods: Between March 2021 and March 2023, perioperative data of patients undergoing surgery for unilateral inferomedial orbital fracture treated with 3D-POTM were analyzed. Presurgical virtual planning with a Standard Triangle Language file of preformed mesh was conducted using the mirrored unaffected contralateral side as a reference, and intraoperative navigation was used. The reconstruction accuracy was determined by: correspondence between postoperative reconstruction mesh position with presurgical virtual planning and difference among the reconstructed and the unaffected orbital volume. Pre- and postoperative diplopia and enophthalmos were assessed. Results: Twenty-six patients were included. Isolated orbital floor fracture was reported in 14 (53.8%) patients, meanwhile medial wall and floor one in 12 (46.1%) cases. The mean difference between final plate position and ideal digital plan was 0.692 mm (95% CI: 0.601–0.783). The mean volume difference between reconstructed and unaffected orbit was 1.02 mL (95% CI: 0.451–1.589). Preoperative diplopia was settled out in all cases and enophthalmos in 19 (76.2%) of 21 patients. Conclusion: The proposed protocol is an adaptable and reliable workflow for the early treatment of inferomedial orbital fractures. It enables precise preoperative planning and intraoperative procedures, mitigating pitfalls and complications, and delivering excellent reconstruction, all while maintaining reasonable costs and commitment times.

Background: Facial nerve injury is one of the most concerning complications of parotid gland surgery, with temporary and permanent dysfunction rates varying widely in the literature. This study aimed to identify factors associated with facial nerve injury during surgery for benign parotid tumors and assess the protective efficacy of intraoperative nerve monitoring (NIM) in preventing nerve injury. Methods: This retrospective study analyzed 329 patients who underwent parotid gland surgery between 2010 and 2023. Data collected included patient demographics, tumor characteristics (size, location, histology), surgical parameters (operation time, NIM usage), and postoperative nerve function evaluated using a modified House–Brackmann scale. Descriptive and inferential statistical analyses, including Chi-square tests and logistic regression, were employed to identify predictors of facial nerve outcomes. Results: Facial nerve injury occurred in 5.2% of patients, comprising 4.6% temporary and 0.6% permanent damage. Tumors located in the deep and inferior lobes significantly increased the risk of facial paralysis/palsy (p = 0.035), while tumor size and histology showed no significant associations. Using NIM significantly reduced the risk of facial nerve injury (p < 0.05; OR: 0.35, 95% CI: 0.25–0.50). Age was also identified as a significant predictor of nerve dysfunction (p < 0.05). Conclusions: The findings emphasize the importance of NIM in mitigating facial nerve injury, especially in anatomically complex tumor locations. Tailored surgical approaches based on tumor location and patient-specific factors, combined with the routine use of NIM, are recommended to optimize nerve preservation and improve postoperative outcomes.

Airway management in maxillofacial trauma is a critical and complex challenge, requiring both secure ventilation and optimal surgical access while minimizing risks to vital structures. This study evaluated the efficacy of submental intubation (SMI) as a minimally invasive alternative to tracheostomy in patients with complex maxillofacial fractures. A retrospective analysis of 52 patients treated between 2015 and 2023 was conducted by comparing clinical outcomes between those who underwent SMI (n = 26) and those who underwent tracheostomy (n = 26). The duration of hospitalization, infection rates, and perioperative complications were assessed using t-tests, chi-square tests, and multivariate regression. Results indicated that SMI was associated with significantly shorter hospital stays (11.15 ± 3.29 vs. 23.96 ± 6.47 days, p < 0.001) and lower infection rates (3.8% vs. 30.8%, p = 0.028). Additionally, the SMI group demonstrated fewer intraoperative (p = 0.049) and postoperative complications (p = 0.037). Multivariate analysis identified tracheostomy as an independent predictor of prolonged hospitalization and increased complications. These findings support SMI as a safe and effective alternative to tracheostomy for short-term airway management in maxillofacial trauma, providing a shorter recovery period and fewer complications. Therefore, prospective studies with larger cohorts are warranted to confirm these results and establish comprehensive guidelines.

The present study investigates the impact of the COVID-19 pandemic on the management of Non-Melanoma Skin Cancer (NMSC) in the head and neck region. Conducted at the University Hospital “Le Scotte” in Siena, Italy, the research includes 111 patients treated from 2018 to 2021. The study aims to understand how pandemic-related healthcare changes affected NMSC treatment, focusing on differences in diagnosis and management before and during the pandemic. Methods involved retrospective analysis of patient demographics, clinical characteristics, lesion details, and treatment modalities, using Jamovi software (version 1.6) for statistical analysis. Results revealed the scalp as the most common NMSC site, with Squamous Cell Carcinoma (SCC) being the predominant histotype. A significant rise in Basal Cell Carcinoma (BCC) cases and a reduction in surgery duration were noted during the pandemic. The shift to local anesthesia was more pronounced, reflecting the necessity to adapt to healthcare limitations. Despite the disruptions caused by the pandemic, there was no significant drop in NMSC cases, which is attributed to the noticeable nature of head and neck lesions. In conclusion, this study highlights that the COVID-19 pandemic significantly influenced surgical practices in NMSC management, emphasizing the need for effective healthcare strategies that balance quality patient care with public health safety measures.