Paolo Gennaro

Background: Facial skin reconstruction is challenging, requiring tissue quality, color match, and optimal aesthetic outcomes. Local flaps, such as submental flaps, offer advantages over free flaps but can be limited by bulk or complex perforator dissection. We described the Submandibular‐Facial Artery Perforator Flap (S‐FAPF), a novel upper neck flap, including its anatomical basis, surgical technique, and clinical application. Methods: A 61‐year‐old male with a 3 × 6 cm basal cell carcinoma of the cheek underwent radical excision. A S‐FAPF, pedicled on two robust indirect facial perforators from the submental artery, was harvested and tunneled to cover the defect. Intraoperative fluoroscopy confirmed flap perfusion. An ancillary defatting procedure was performed to optimize aesthetics. Results: Flap survival was 100%, with excellent color, texture, and contour match. Donor‐site morbidity was minimal; 12‐month follow‐up demonstrated high patient satisfaction and inconspicuous scarring. Conclusion: S‐FAPF is a reliable, versatile, and technically straightforward option for lower facial reconstruction, particularly in bearded regions.

Introduction Large language models (LLMs) offer remarkable potential in assisting healthcare professionals with diagnostic and therapeutic decision-making processes. However, the integration of LLMs into healthcare decision-making processes also introduces several doubts in the field of usefulness, reliability and ethical implications. Materials and Methods To assess the potential of LLMs in managing intricate surgical situations, a cross-sectional study with 30 real-world cases of maxillofacial traumatology was designed. The cases were presented to ChatGPT-4, Google Bard, and maxillofacial surgery residents in a standardized manner, and the results of the subjects were evaluated by an expert surgeon panel of reviewers using the AIPI and QAMAI tools. Results ChatGPT-4 and Bard showed comparable performances in patient feature consideration but differed significantly in their ability to suggest differential diagnoses. ChatGPT-4 outperformed Bard in proposing additional examinations and treatment plans. Compared to LLMs, human surgery residents consistently scored higher across all parameters of the QAMAI tool, indicating superior accuracy, clarity, relevance, completeness, quality of references, and overall usefulness. Discussion Both LLMs demonstrated their potential to support clinical decision-making in facial traumatology, but they require further development to be sufficiently reliable for real-world clinical use. Conclusions AIPI and QAMAI proved their utility as evaluation tools but highlighted the need for standardization in LLM-generated responses assessment.

Temporomandibular disorders (TMDs) have been historically linked to symptoms such as tinnitus, hearing loss, and vertigo. The aim of this systematic review is to investigate the association between TMDs and audiological symptoms. Adhering to the PRISMA guidelines, a comprehensive literature search in three databases was performed searching for studies utilizing imaging and audiometric assessments to diagnose TMDs and audiological symptoms. Of the 1153 studies retrived, a total number of 6 studies were included. Although tinnitus was commonly reported among patients with TMDs, objective audiological deficits were not consistently confirmed. The majority of existing studies lack standardized diagnostic methods and the heterogeneity of methodologies and limited sample sizes restricted the feasibility of a meta-analysis. The lack of appropriate instrumental diagnostic tests makes it difficult to draw conclusions about the causal relationship between TMDs and audiological symptoms. Future trials are needed to clarify this clinical association.

Purpose ChatGPT has gained popularity as a web application since its release in 2022. While artificial intelligence (AI) systems’ potential in scientific writing is widely discussed, their reliability in reviewing literature and providing accurate references remains unexplored. This study examines the reliability of references generated by ChatGPT language models in the Head and Neck field. Methods Twenty clinical questions were generated across different Head and Neck disciplines, to prompt ChatGPT versions 3.5 and 4.0 to produce texts on the assigned topics. The generated references were categorized as “true,” “erroneous,” or “inexistent” based on congruence with existing records in scientific databases. Results ChatGPT 4.0 outperformed version 3.5 in terms of reference reliability. However, both versions displayed a tendency to provide erroneous/non-existent references. Conclusions It is crucial to address this challenge to maintain the reliability of scientific literature. Journals and institutions should establish strategies and good-practice principles in the evolving landscape of AI-assisted scientific writing.

Secondary lymphedema of the extremities affects millions of people in the world as a common side effect of oncological treatments with heavy impact on every day life of patients and on the health care system. One of the surgical techniques for lymphedema treatment is the creation of a local connection between lymphatic vessels and veins, facilitating drainage of lymphatic fluid into the circulatory system. Successful results, however, rely on using a functional vessel for the anastomosis, and vessel function, in turn, depends on its structure. The structure of lymphatic collecting vessels changes with the progression of lymphedema. They appear initially dilated by excess interstitial fluid entered at capillary level. The number of lymphatic smooth muscle cells in their media then increases in the attempt to overcome the impaired drainage. When lymphatic muscle cells hyperplasia occurs at the expenses of the lumen, vessel patency decreases hampering lymph flow. Finally, collagen fiber accumulation leads to complete occlusion of the lumen rendering the vessel unfit to conduct lymph. Different types of vessels may coexist in the same patient but usually the distal part of the limb contains less affected vessels that are more likely to perform efficient lymphatic–venular anastomosis. Here we review the structure of the lymphatic collecting vessels in health and in lymphedema, focusing on the histopathological changes of the lymphatic vessel wall based on the observations on segments of the vessels used for lymphatic–venular anastomoses.

Background: Lymphedema is characterized by an accumulation of interstitial fluids due to inefficient lymphatic drainage. Primary lymphedema is a rare condition, including congenital and idiopathic forms. Secondary lymphedema is a common complication of lymph node ablation in cancer treatment. Previous studies on secondary lymphedema lymphatic vessels have shown that after an initial phase of ectasia, worsening of the disease is associated with wall thickening accompanied by a progressive loss of the endothelial marker podoplanin. Methods and Results: We enrolled 17 patients with primary and 29 patients with secondary lymphedema who underwent lymphaticovenous anastomoses surgery. Histological sections were stained with Masson's trichrome, and immunohistochemistry was performed with antibodies to podoplanin, smooth muscle α-actin (α-SMA), and myosin heavy chain 11 (MyH11). In secondary lymphedema, we found ectasis, contraction, and sclerosis vessel types. In primary lymphedema, the majority of vessels were of the sclerosis type, with no contraction vessels. In both primary and secondary lymphedema, not all α-SMA-positive cells were also positive for MyH11, suggesting transformation into myofibroblasts. The endothelial marker podoplanin had a variable expression unrelatedly with the morphological vessel type. Conclusions: Secondary lymphedema collecting vessels included all the three types described in literature, that is, ectasis, contraction, and sclerosis, whereas in primary lymphedema, we found the ectasis and the sclerosis but not the contraction type. Some cells in the media stained positively for α-SMA but not for MyH11. These cells, possibly myofibroblasts, may contribute to collagen deposition.

Lymphedema is an important medical issue around the world, caused by an anomalous collection of fluid in soft tissue due to congenital malformations or stenosis or obstruction of lymphatic vessels. Magnetic resonance lymphangiography (MRL) is an emerging technique focused on noninvasive or minimally invasive imaging of lymphatics with the goal to diagnose and treat lymphedema. This review will briefly discuss lymphatic imaging starting with lymphography and radionuclide lymphoscintigraphy up to the newest methods, focusing on MRL, a rising technique, and highlighting the technical aspects fundamental for achieving high-resolution MRL.

Schwannoma is a rare benign tumor, originating from Schwann cells of the peripheral nerve sheath. We describe a case of intraconal orbital schwannoma, causing compression to the optic nerve and progressive visual impairment treated with surgical resection. The diagnosis of benign orbital schwannoma was provided by histopathological examination (large spindle cell tumor with AntoniB-type cell pattern) and also with immunohistochemistry (positivity for S-100 protein). The 6 months’ follow-up was performed. The patient was asymptomatic during the 6-month follow-up.