Background/Objectives: Oral cavity carcinomas (OCCs) represent roughly 50% of all head and neck cancers. The risk of occult neck metastases for early-stage OCCs ranges from 15 to 35%, thus the need to develop tools that can support the diagnosis detecting these neck metastases. Inflammatory biomarkers and perineural and lympho-vascular invasion are emerging as effective in this field. The aim of this study is to demonstrate the effectiveness of these parameters to detect occult neck metastases in early-stage (T1-T2/N0) OCCs. Methods: A retrospective analysis was conducted on 81 patients surgically treated for early-stage OCC. For all patients, data regarding TNM, pN status after the histopathological examination, inflammatory biomarkers, and perineural and lympho-vascular invasion have been obtained. A statistical analysis was performed using the receiver operating characteristic (ROC) curve to calculate the optimal cutoff values for SII, SIRI, PLR, and NLR. Results: Fifty-eight patients confirmed N0 status after surgery, while twenty-three resulted pN+. The best cut-off to detect occult neck metastases were PLR 249.30, NLR 13.10, MLR 0.439, SII 1043.12, and SIRI 1.85. The accuracy to detect occult neck metastases was PLR 75%, NLR 81%, MLR 74%, SII 73%, SIRI 70%, perineural invasion 70%, and lympho-vascular invasion 83%. Conclusions: Our results confirm that inflammatory biomarkers and perineural and lympho-vascular invasion are effective in detecting occult neck metastases in early-stage OCCs. The clinical relevance of this study is that these parameters could be used routinely as preoperative tools to support diagnosis and to help surgeons in the decision-making process, particularly regarding surgical indications for neck lymph nodes treatment.

Background/Objectives: Natural head position (NHP) is an important reference for orthodontic and orthognathic assessment. Although postoperative changes in head posture have been reported previously, simultaneous three-dimensional changes across yaw, pitch, and roll in different skeletal classes remain incompletely characterized. This exploratory study quantified six-month changes in three-dimensional head orientation and compared their direction and magnitude between skeletal Class II and Class III patients. Methods: Fifty-four adults (17 Class II, 37 Class III) undergoing Le Fort I osteotomy and bilateral sagittal split osteotomy were evaluated preoperatively (T0) and 6 months postoperatively (T1). Standardized 3D facial surface acquisitions were obtained using a calibrated structured-light scanner and a fixed external Cartesian laser reference. T0 and T1 datasets were registered using stable upper-facial landmarks (nasion and bilateral exocanthia), and changes in yaw, pitch, and roll were calculated within the common external reference system. Results: Statistically significant T0–T1 changes were observed across all three axes in both skeletal groups (p < 0.01). Class II patients showed mean changes of +2.28° in yaw, −1.30° in pitch, and +2.89° in roll, whereas Class III patients showed +4.61°, +1.96°, and +4.04°, respectively. Between-group differences were significant for yaw, pitch, and roll, with an opposite mean pitch direction and larger mean yaw and roll changes in Class III. Conclusions: At six months, this retrospective cohort demonstrated direction-specific changes in three-dimensional head orientation. Because repeated acquisitions, study-specific observer-reliability and measurement-error analyses, an untreated comparator, an independent validation cohort, and functional or patient-reported outcomes were not available, the findings should be interpreted as exploratory measurements rather than evidence of physiological normalization, neuromuscular adaptation, or clinical benefit. Formal prospective validation is required before the workflow can support predictive or patient management recommendations.

Parotid sialolithiasis may pose relevant surgical challenges, particularly when sialoliths are deeply located, non-palpable, and intraoperative localization is uncertain, potentially requiring extensive parenchymal dissection. This technical note describes a neuronavigation-guided targeted open approach for parotid sialolith removal applied in three selected patients with parotid sialolithiasis refractory to previous treatments. Preoperative computed tomography was used for surgical planning and intraoperative navigation, allowing precise sialolith localization and focused dissection through a limited open access, in combination with intraoperative facial nerve monitoring. After sialolith removal, intraoperative cone-beam computed tomography was performed to confirm complete extraction and exclude residual fragments. No intraoperative or postoperative complications were observed, and parotid gland function was preserved in all cases. Neuronavigation-assisted targeted open surgery, combined with intraoperative imaging verification, may represent a valuable option in selected cases of parotid sialolithiasis, improving surgical accuracy and intraoperative confidence.

Background: The aim of this study has been to investigate if inflammatory biomarkers such as the systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have any correlation with the recurrence of pleomorphic adenomas (PA) in patients afflicted by this disease. Methods: A retrospective multicentre study involving two Italian centres, the Maxillofacial Sur-gery at the Policlinico Federico II in Naples and the ENT and Maxillofacial Surgery at the IRCCS G. Pascale National Cancer Institute in Naples, has been performed. The study, involving 608 pa-tients who had received a diagnosis of PA, was conducted between January 2000 and January 2020. A Receiver Operating Characteristic (ROC) curve was used to calculate the optimal cut-off values for the SII, PLR and NLR. A linear regression model (LRM) and a non-linear logistic re-gression model (NLRM) were realized with respect to the NLR, PLR and SII. Results: The highest performance was achieved by the NLR (cut-off 2.960) with the AUC = 0.91, with an accuracy of 96.1%, sensitivity of 78.4% and specificity of 97.2%, PPV = 64.4% and NPV = 98.6%. The LRM and NLRM including all the haematological parameters did not increase the per-formance in terms of recurrence detection. Conclusion: The NLR is an excellent support tool in predicting the recurrence of PA with a cut-off of 2.960. It can be a good reference point for surgical decision-making and follow-up in clinical practice.

Background: Smile aesthetics arise from the interaction between objective dentofacial characteristics and subjective patient perception, and discrepancies between the two may influence treatment planning and postoperative satisfaction. This exploratory study aimed to describe how adults perceive variations in maxillary incisor exposure, sagittal incisor projection, and dental midline deviation, and to identify the self-reported levels of perceptual tolerance at which these variations become consciously noticeable. Methods: Eighty-three adult volunteers (20–65 years; 59.6% female) underwent standardised photographic analysis, three-dimensional facial scanning, and completion of a purpose-built self-perception questionnaire. Objective morphometric measurements were compared with subjective self-estimates, and the difference (delta) was computed for each parameter. Analyses were descriptive; the association between the magnitude of objective–subjective discrepancy and aesthetic dissatisfaction was assessed with Spearman’s rank correlation. No inferential threshold-modelling was performed. Results: Self-reported perceptual tolerance levels were 3.2 mm for incisor exposure at rest, 9.4 mm during smiling, 3.6 mm for midline deviation, and 4.7 mm (protrusion)/3.9 mm (retrusion) for sagittal projection. The proportion of participants whose objective measurement exceeded their own tolerance level was 23.1% (smiling), 17.3% (rest), 15.4% (sagittal), and 3.8% (midline). Objective and subjective assessments were concordant in 60% of cases (27% underestimation, 13% overestimation). A moderate, statistically significant correlation was observed between the magnitude of objective–subjective discrepancy and aesthetic dissatisfaction (Spearman’s ρ = 0.67, p < 0.01). Sagittal discrepancies beyond approximately ±4 mm relative to the Barcelona line were most consistently associated with negative self-perception. Conclusions: Objectively measurable dentofacial discrepancies are not uniformly perceived as unattractive and may remain within individual perceptual tolerance. These descriptive findings are hypothesis-generating and should be interpreted in light of the single-centre design and the non-validated questionnaire; they nonetheless suggest that integrating digital facial analysis with patient-reported perception may support communication and expectation management in aesthetic planning.

Purpose: Paranasal sinus osteomas are benign but potentially symptomatic lesions whose management remains heterogeneous despite recent advances. Choosing between a purely endoscopic or a combined approach can be challenging, particularly for larger lesions. This study aims to present our institutional experience in the surgical management of paranasal sinus osteomas and to propose a flowchart that integrates clinical and radiological findings and modern technologies, including intraoperative navigation and patient-specific cutting guides, to assist clinicians in selecting the optimal surgical approach. Methods: A retrospective review was conducted on patients who underwent surgical resection of frontal and ethmoidal sinus osteomas at the Maxillofacial Surgery Unit of the University of Naples “Federico II” between January 2020 and April 2024. Patients were classified according to anatomical grading and surgical approaches were categorized as endoscopic or combined. Demographic data, radiological features, surgical details, and postoperative outcomes were analyzed. Based on these findings, our flowchart was developed. Results: 22 patients (13 males, 9 females; mean age = 51.5 years) were included. 9 (41%) were Type I, 7 (32%) Type II, and 6 (27%) Type III osteomas. Endoscopic surgery was performed in 16 cases (73%), while combined approaches were required in 6 cases (27%), exclusively for Type III lesions. No major postoperative complications or recurrences were observed during a mean follow-up of 40.3 months (20–68 months). Conclusions: Endoscopic treatment is effective for most fronto-ethmoidal osteomas, while combined approaches remain indicated for large or extended lesions. This flowchart offers a guide for selecting endoscopic or combined approaches, enhancing safety and outcomes.