The Role of Large Language Models (LLMs) in Providing Triage for Maxillofacial Trauma Cases: A Preliminary Study.

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.

AurkA/TPX2 co-overexpression in nontransformed cells promotes genome instability through induction of chromosome mis-segregation and attenuation of the p53 signalling pathway.

The Aurora-A kinase (AurkA) and its major regulator TPX2 (Targeting Protein for Xklp2) are key mitotic players frequently co-overexpressed in human cancers, and the link between deregulation of the AurkA/TPX2 complex and tumourigenesis is actively investigated. Chromosomal instability, one of the hallmarks of cancer related to the development of intra-tumour heterogeneity, metastasis and chemo-resistance, has been frequently associated with TPX2-overexpressing tumours. In this study we aimed to investigate the actual contribution to chromosomal instability of deregulating the AurkA/TPX2 complex, by overexpressing it in nontransformed hTERT RPE-1 cells. Our results show that overexpression of both AurkA and TPX2 results in increased AurkA activation and severe mitotic defects, compared to AurkA overexpression alone. We also show that AurkA/TPX2 co-overexpression yields increased aneuploidy in daughter cells and the generation of micronucleated cells. Interestingly, the p53/p21 axis response is impaired in AurkA/TPX2 overexpressing cells subjected to different stimuli; consistently, cells acquire increased ability to proliferate after independent induction of mitotic errors, i.e. following nocodazole treatment. Based on our observation that increased levels of the AurkA/TPX2 complex affect chromosome segregation fidelity and interfere with the activation of a pivotal surveillance mechanism in response to altered cell division, we propose that co-overexpression of AurkA and TPX2 per se represents a condition promoting the generation of a genetically unstable context in nontransformed human cells.

Coronavirus disease 2019 pandemic related chondrodermatitis nodularis helicis: the role of masks.

BACKGROUND: Chondrodermatitis nodularis helicis is a benign, but painful inflammatory condition of the ear, characterised by a tender nodule located on the helix or antihelix. This study aimed to investigate the occurrence of chondrodermatitis nodularis helicis associated with the use of coronavirus disease 2019 masks during the pandemic. METHOD: A retrospective single-centre study was performed from February 2020 to February 2022 in the Maxillo-Facial Unit at the University Hospital of Siena, Italy. RESULTS: During the indexed period, 11 patients were affected by chondrodermatitis nodularis helicis. All patients wore a mask for more than 8 hours a day, every day for several months. CONCLUSION: Although there is no certain proof of the correlation between masks and chondrodermatitis nodularis helicis, an increase in the incidence of this condition was highlighted in our single-centre experience in the pandemic period. The prolonged use of coronavirus disease 2019 masks may explain this correlation.

Tetris Genioplasty: A New Paradigm for Chin Asymmetries Correction.

The chin plays a crucial role as a fundamental structural component that contributes to the overall aesthetics and harmony of the face. Recognizing its central position, medical science has seen the evolution of numerous surgical techniques over the years, all aimed at correcting the range of structural irregularities that can affect the chin. In this contribution, the authors introduce an innovative osteotomy technique, aimed at cases of chin asymmetry in which the skeletal median diverges from the dental median. This technique, called "Tetris genioplasty", involves performing the classic rectangular osteotomy, but includes an additional vertical osteotomy in order to obtain two distinct segments. Finally, these segments are translocated and repositioned to obtain a realignment between the skeletal median and the dental median. The results were entirely satisfactory for the patients, aligning perfectly with the expected appearance after the operation. Furthermore, no complications were reported, proving the success and safety of the procedure. The Tetris genioplasty aligns itself with this progressive trend by offering a minimally invasive method that nevertheless is able to achieve excellent results with a high impact on the patient's quality of life, presenting a promising path in the pursuit of optimal aesthetic results with minimized patient morbidity and greater overall safety.

Tongue Reconstruction with Buccinator Myomucosal Island Flaps: Technical Considerations, Oncologic Safety, Functional Outcomes and QoL Assessment-A Retrospective Observational Study.

The objective of this study was to investigate the effectiveness of buccinator myomucosal island flaps for tongue reconstruction following malignant tumor resections. A retrospective study was performed on 52 patients who underwent tongue reconstructions with buccinator myomucosal island flaps between 2012 and 2020. We reviewed the flap type and size, harvesting time, recipient- and donor-site complications, postoperative oncologic outcomes, functional recovery and QoL assessment. All of the flaps were transposed successfully without any total flap loss. Neither in the primary site nor in the neck were cancer relapses observed. An evaluation of the sensitivity revealed that 96.1% of patients experienced a recovery of touch, two-point and pain sensations. There were significant differences between the flap and the native mucosa in terms of the tactile (p < 0.001), pain (p < 0.001) and two-point (p < 0.001) thresholds. The average swallowing score recorded was 6.1 out of 7, with only minor complaints. The quality of life assessments demonstrated high scores across physical (24.5 out of 28), social (25.8 out of 28), emotional (20.3 out of 24) and functional (25 out of 28) aspects. The present study showed how buccinator myomucosal island flaps represent an effective and functional tongue reconstructive option, requiring a short operative time with a low rate of donor site morbidity, and with evidence of long-term oncologic safety and high quality of life.

A Single-Center Retrospective Analysis of 14 Head and Neck AVMs Cases Treated with a Single-Day Combined Endovascular and Surgical Approach.

Arteriovenous malformations (AVMs) are rare congenital defects of vascular development whose treatment remains challenging. The paper presents a retrospective single-center study of 14 patients with AVMs of the head and neck region undergoing combined endovascular and surgical treatment in a single day. AVM architecture and therapeutic strategies were determined on the basis of angiographic studies, while the psychological involvement of each patient was assessed by means of a questionnaire. Most of the 14 patients achieved satisfactory clinical results with no recurrences, good aesthetic and functional results, and most patients reported improved quality of life. The combined endovascular and surgical approach is an effective treatment for AVMs of the head and neck and performing it on the same day is a possible option often accepted by patients which guarantees operative advantages for the surgeon.

Sarcoidosis of the lacrimal gland: the prominence of the differential diagnosis.

Sarcoidosis is a multisystem disease that can involve any organ; lungs, lymph nodes and skin are the most involved. Compatible clinical and imaging features, the identification of non-caseous granulomas on biopsy and the exclusion of other causes of granulomatous disorders help formulate the diagnosis of sarcoidosis. A bilateral symmetrical hilar lymphadenopathy together with the typical perilymphatic distribution of nodules is typically visible on high-resolution CT.The average age is 48 years. Ocular sarcoidosis is not rare, it is reported in 25% of cases. Half of the sarcoidosis patients resolve spontaneously; treatment is only indicated in cases with severe symptoms or signs of organ damage. Classical treatments are based on the use of corticosteroids and immunosuppressive therapies, sometimes combined.

Multidisciplinary evaluation of orbital floor fractures: dynamic MRI outcomes.

PURPOSE: Orbital floor fractures can cause functional disorders such as limitation of ocular motility. The dysfunction of the extrinsic muscles was studied with the Hess-Lancaster test; although we expected a large percentage of inferior rectus muscle dysfunction, the results showed 52% superior rectus muscle dysfunction. METHODS: In light of these results, we began testing five patients with functional deficits evidenced by the Hess-Lancaster test with magnetic resonance imaging to assess the change in thickness of the affected muscle compared to the contralateral healthy muscle during standardized eye movements. RESULTS: This investigation showed an increase in the size of the inferior rectus muscle on the affected side during the fraction of time when the patient was asked to look up, probably due to post-traumatic fibrosis. According to our hypothesis, muscle thickness would condition the correct release of the inferior rectus muscle to such an extent that it would also influence the contraction of the superior rectus muscle, which would then be deficient. CONCLUSIONS: Based on our experience, a multidisciplinary approach and longer follow-up with thorough investigations should be considered for patients with orbital floor fractures. Furthermore, our results suggest the need for early surgical treatment, in contrast to current guidelines that aim to delay restorative surgery.

Masseteric giant capillary haemangioma: a bulky mass treated with scarless and minimally invasive surgery.

In this article, the authors report their management with minimally invasive surgery and embolisation of a bulky intramuscular capillary haemangioma. Masseteric capillary haemangioma is a rare tumour in adults: in cases of large-sized tumours we suggest a multidisciplinary approach in choosing the best treatment and minimally invasive, scarless surgery.