Head and neck malignancies are aggressive, have complex anatomical placements, and require extensive surgical intervention for functional and cosmetic reasons. Recent advances in stem cell biology have expanded our understanding of their activities beyond oncogenic pathways to encompass tissue repair and regeneration. Mesenchymal and pluripotent stem cells have been studied for their immunomodulatory, microenvironmental, and bone and soft-tissue regeneration abilities following oncologic resection. Stem cells can connect oncologic treatment with reconstructive surgery, as shown in this narrative assessment of recent translational and regenerative advances in head and neck oncology. Autologous and allogeneic stem cell-based approaches, often combined with bioengineered scaffolds, have been shown to improve vascularization and functional restoration in complex craniofacial structures. Despite these promising advances, worries about tumor recurrence, stem cell plasticity, and the carcinogenic dangers of introducing stem cell-derived or growth-factor-enriched materials into previously treated or irradiated areas persist. In addition, regulatory, ethical, and scientific barriers prevent the widespread use of stem cell-based therapies in clinical oncology. Stem cell-centered research can transform head and neck cancer treatment from survival-focused to holistic oncological and functional rehabilitation that improves lifespan and quality of life by integrating regenerative science with precision surgery.

Background and Objectives: Patients admitted to plastic surgery units increasingly present with multimorbidity, advanced age, diabetes, cardiovascular disease, chronic wounds, and complex metabolic requirements. In several surgical specialties, internal medicine specialist (IMS) co-management has been associated with improved clinical outcomes, yet its potential role in plastic surgery remains unexplored. Materials and Methods: A narrative scoping review conducted using systematic search principles was conducted using MEDLINE, Web of Science, Scopus, and Google Scholar from inception to 1 December 2025. Search terms combined “internal medicine,” “co-management,” and “surgery.” Studies assessing outcomes of IMS involvement in surgical inpatient care were included. Data on population, intervention characteristics, and outcomes were extracted and summarized. PRISMA recommendations were used to report the study selection process. The review focuses on adult and elderly surgical inpatients, as the available evidence is not applicable for pediatric populations. Results: Twenty-two articles met the inclusion criteria. IMS co-management demonstrated consistent benefits across multiple surgical specialties, including reduced length of stay, lower complication rates, improved metabolic and cardiovascular stabilization, enhanced perioperative optimization, and decreased costs. Despite the growing complexity of plastic surgery inpatients, no studies specifically evaluated IMS co-management in this field. Conclusions: Evidence from other surgical specialties suggests that structured IMS co-management may offer substantial benefits for plastic surgery patients, particularly those with multimorbidity, diabetes, severe burns, chronic wounds, or undergoing microsurgical reconstruction. Prospective studies are needed to determine its impact on patient outcomes, resource utilization, and clinical workflows within plastic surgery.

Surgery for advanced stage or recurrent parotid tumors often involves VII nerve sacrifice. Facial reanimation techniques aim to restore corneal protection and both static and dynamic facial symmetry, without compromising resection.Surgical strategies were based on tumor histology and intraoperative frozen section analysis. Masseteric to facial nerve branch (for the ZMM) neurorrhaphy was done in patients without perineural invasion, while temporalis muscle tendon lengthening was used when that nerve was resected. Facial symmetry and function were objectively assessed using the eFACE system preoperatively and in follow-up.Postoperative eFACE analysis demonstrated good results in both static and dynamic facial symmetry. Masseteric to facial neurorrhaphy achieved satisfactory smile excursion (81 ± 14), while static symmetry parameters, including nasolabial fold orientation (90 ± 4), were high across both surgical groups. Gentle and full eye closure scored lower (79 ± 3 and 85 ± 4), reflecting the limited impact of reanimation techniques on voluntary eyelid closure.The multimodal facial reanimation protocol adopted effectively addressed recovery of facial symmetry and function. Masseteric to ZMM branch neurorrhaphy combined with cross face nerve graft offers excellent dynamic results with minimal morbidity, while additional static techniques ensure immediate ocular protection and aesthetic outcomes.

Virtual surgical planning (VSP) is essential step in mandible reconstruction, involving multiple tasks, such as structure segmentation, cutting-plane definition, and implant planning. While many studies have shown promising results on subtasks using specialized ML models, these models are typically developed in isolation. This fragmentation prevents their seamless integration into a unified, automated clinical pipeline. We present a fully automated VSP assistant integrated into 3D Slicer combining segmentation, reconstruction, and planning modules into a single clinical framework. The proposed pipeline was validated on real clinical datasets, including unhealthy mandible dataset containing mandible abnormalities, healthy mandible dataset with normal mandible, and fibula dataset of normal fibula. Quantitative evaluation using the dice similarity coefficient (DSC) yielded scores of 0.911 for mandible segmentation, 0.854 for defect segmentation, 0.908 for fibula segmentation, and 0.816 for mandible reconstruction. The planning module reduced the average operation time by 57% while maintaining accuracy comparable to manual planning. End-to-end evaluation on real clinical cases demonstrated a dramatic reduction in the total time engineer spent completing tasks from average of 5 hours 21 minutes using the manual workflow to 29 minutes 38 seconds. Our results demonstrate that automated VSP offers a practical, clinically precise solution that reduces the time-intensive nature of VSP, bridging the gap between isolated ML research and real-world surgical practice.

Background: Head and neck carcinomas represent a heterogeneous group of aggressive malignancies with often poor prognosis and high recurrence rates. In recent years, the identification and characterization of cancer stem cells (CSCs) within these tumors have profoundly reshaped our understanding of tumorigenesis, resistance mechanisms, and metastatic potential in this anatomical district. Cancer stem cells (CSCs) play a central role in therapeutic resistance, recurrence, and metastatic progression in head and neck squamous cell carcinoma (HNSCC), particularly within the anatomically complex maxillofacial region. This review has synthesized recent advances in CSC biology, including marker heterogeneity, stemness-associated pathways, and interactions with the tumor microenvironment. Methods: A narrative review of the available literature was conducted, focusing on studies dealing with cancer stem cells in head and neck carcinoma and their implications for maxillofacial surgery. Results: We have critically examined emerging systemic and locoregional CSC-targeted therapies, highlighting inhibitors of Notch, Wnt/β-catenin, Hedgehog, and Hippo/YAP pathways, ALDH and ABC transporter inhibitors, autophagy modulators, nanoparticle-based delivery systems, and CSC-directed immunotherapies. The implications of these approaches for surgical planning, resection margins, and postoperative disease control in maxillofacial oncology have been discussed. To enhance clarity and analytical value, we have incorporated two comprehensive tables summarizing CSC markers and therapeutic strategies. Collectively, the evidence indicates that integrating CSC-oriented diagnostics and therapeutics into multimodal management may improve long-term outcomes for patients with maxillofacial HNSCC. Conclusions: This review highlights the critical need for integrating CSC-focused research into clinical practice to develop more effective, personalized, and durable treatment strategies. Such an approach could enhance oncologic control, reduce recurrence, and improve functional outcomes for patients undergoing complex oncologic procedures in the maxillofacial region.

Transformer-based large language models (LLMs), such as ChatGPT-4, are increasingly used to streamline clinical practice, of which radiology reporting is a prominent aspect. However, their performance in interpreting complex anatomical regions from MRI data remains largely unexplored. This study investigates the capability of ChatGPT-4 to produce clinically reliable reports based on orbital MR images, applying a multimetric, quantitative evaluation framework in 25 patients with orbital lesions. Due to inherent limitations of current version of GPT-4, the model was not fed with MR volumetric data, but key 2D images only. For each case, ChatGPT-4 generated a free-text report, which was then compared to the corresponding ground-truth report authored by a board-certified radiologist. Evaluation included established NLP metrics (BLEU-4, ROUGE-L, BERTScore), clinical content recognition scores (RadGraph F1, CheXbert), and expert human judgment. Among the automated metrics, BERTScore demonstrated the highest language similarity, while RadGraph F1 best captured clinical entity recognition. Clinician assessment revealed moderate agreement with the LLM outputs, with performance decreasing in complex or infiltrative cases. The study highlights both the promise and current limitations of LLMs in radiology, particularly regarding their inability to process volumetric data and maintain spatial consistency. These findings suggest that while LLMs may assist in structured reporting, effective integration into diagnostic imaging workflows will require coupling with advanced vision models capable of full 3D interpretation.

The entry of artificial intelligence, in particular deep learning models, into the study of medical–clinical processes is revolutionizing the way of conceiving and seeing the future of medicine, offering new and promising perspectives in patient management. These models are proving to be excellent tools for the clinician through their great potential and capacity for processing clinical data, in particular radiological images. The processing and analysis of imaging data, such as CT scans or histological images, by these algorithms offers aid to clinicians for image segmentation and classification and to surgeons in the surgical planning of a delicate and complex operation. This study aims to analyze what the most frequently used models in the segmentation and classification of medical images are, to evaluate what the applications of these algorithms in maxillo-facial surgery are, and to explore what the future perspectives of the use of artificial intelligence in the processing of radiological data are, particularly in oncological fields. Future prospects are promising. Further development of deep learning algorithms capable of analyzing image sequences, integrating multimodal data, i.e., combining information from different sources, and developing human–machine interfaces to facilitate the integration of these tools with clinical reality are expected. In conclusion, these models have proven to be versatile and potentially effective tools on different types of data, from photographs of intraoral lesions to histopathological slides via MRI scans.

Virtual surgical planning (VSP) in craniofacial trauma features unique challenges due to the complexity of fracture patterns and anatomic considerations. Among the most challenging tasks are segmenting trauma models, performing complex virtual reductions to restore anatomic integrity and functional occlusion, and utilizing technology to enhance surgical accuracy. The authors propose a classification model categorizing craniofacial trauma into 2 main classes: occlusion-impairing (eg, mandibular and Le Fort fractures) and occlusion-nonimpairing (eg, zygomaticomaxillary complex and orbital fractures). A general workflow for VSP, including advanced imaging and 3 dimensional printing, is outlined to address these challenges, particularly in panfacial trauma.

BACKGROUND:Human papilloma virus (HPV) is a DNA virus capable of infecting mucous membranes. In most cases, the infection is cleared by the immune system, but a prolonged exposure to HPV can progress to cancer. 40%-60% of head and neck squamous cell carcinomas (HNSCC) are linked to HPV, which is considered a risk factor especially among young people in industrialized countries. HNSCC are not identified early due to their slow growth and their locations not being easy to see. Despite the prognostic value of HPV, the use of HPV-DNA as a diagnostic marker is not fully developed. HPV-DNA can be detected in saliva specimens of patients with HPV-driven cancers. Considering this, we employed saliva samples to optimize a non-invasive RT-PCR assay for HPV infection and prove the hypothesis that the presence of HPV DNA represents a risk factor for Oral Cavity Squamous Cell Carcinoma (OCSCC). The potential of this work is to highlight how an HPV screening program based on salivary testing can be useful for early cancer detection and patient monitoring. METHODS:In this retrospective study, 127 patients and 93 control samples were tested for the presence of HPV in self-collected saliva specimens. Viral DNA was extracted from saliva using an automated instrument. A multiplex RT-PCR was employed for the detection of the (28 most frequent HPV Types). Patients' demographics were collected in a clinical database. Statistics were performed by STATA16, and significance was set at p < 0.05. RESULTS:Most patients had a diagnosis of OCSCC (49.1%), 38%-9% of which involved the tongue. 9.6% resulted positive for HPV DNA in saliva, specifically for high-risk subtypes (42.9% type 58; 28.6% types 45, 59, 39 and 9.6% type 16, 18). HPV+patients were compared to those who were found negative. HPV infection was related to the TNM stage, especially with pT2N1 (p ≤ 0.002) and with primary vs. relapsed tumors (p = 0.004). Independent of site, the assay reached a sensitivity of 91.7%, a specificity of 100%, and an agreement of 98.5%, compared to the oropharyngeal swab (Cohen's Kappa = 0.947; n = 65). Test PPV was 100% (95% CI 71.5-100), while NPV was 98.1% (95% CI 90.1-100). CONCLUSIONS:Our findings indicate that salivary HPV testing is a non-invasive and convenient test that could become part of routine clinical management for HPV infection of the oral cavity. This test represents an ideal mode of screening of asymptomatic individuals and a long-term monitoring tool for HPV-driven cancer patients.

Background: The integration of 3D bioprinting, biomaterials science, and cellular biology presents a viable strategy for maxillofacial bone regeneration, overcoming the constraints of traditional graft techniques. This review offers a thorough examination of the present condition, obstacles, uses, and future outlook of 3D bioprinting technology in maxillofacial bone regeneration. An essential understanding has been attained by analyzing the technological constraints, specifically in vascularization and neuro-integration, and by delineating the vital translational pathway from benchtop models to clinical application. We have examined several bioprinting techniques—namely extrusion, inkjet, and laser-assisted methods—and the requisite bioinks, emphasizing their physicochemical and biological features vital for osteogenesis. Significant clinical applications, including the treatment of trauma-induced abnormalities and the reconstruction of oncology-related resections, have been emphasized. This review highlights the urgent necessity for established regulatory frameworks and refined printing settings to guarantee effective, functional, and durable bone substitutes, providing a distinct pathway for future research and clinical implementation in this specialized surgical domain. Aim: The purpose of this review was to present a general overview of the current clinical and diagnostic applications of bioprinting in bone tissue engineering for the reconstruction of bone defects. Methods: A search of major scientific databases, including PubMed, Science Direct, Embase, and Cochrane, was conducted. Articles published within the last 10 years that analyze the possible applications of bioprinting in bone tissue fabrication were included. Results: Several bioinks, based on hydrogels and stem cells, can enable the fabrication of such tissues using this technology. This review reports on the processes adopted for the bioprinting of bone tissue, the bioinks used, and cell cultivation methods. Conclusions: Bioprinting represents a promising solution for bone regeneration with potential applications that could revolutionize current surgical practices, despite the many challenges that future research will face.

Background: Diseases of the orbit, particularly tumors, present complex diagnostic challenges due to the variability of clinical manifestations and the delicate anatomical region. Artificial intelligence could be the appropriate tool to assist the physician in clinical decision making. This review aims to investigate the potential applications of such technology for the analysis and management of orbital pathologies, investigate the advantages and limitations, and offer suggestions for future research. Methods: Selected studies were included for the conduct of this review by adopting the PRISMA guidelines. Results: AI algorithms represent an innovative tool for orbital diagnostics with potential applications in screening, surgery planning, and follow-up. Despite this, limitations and challenges persist that need to be addressed with future research. Conclusions: Clinical decision systems are proving to be a useful tool for the management of orbital pathology. For full integration into clinical reality, some actions are needed, including the standardization of protocols and the implementation of multicenter studies.

Background and Objectives: Robotic surgery represents one of the most significant innovations in the field of surgery, offering new opportunities for the treatment of complex pathologies that require greater accuracy and precision. It is a technology that has become widely used in general, urologic, gynecologic, and cardio-thoracic surgery, but has a limited evidence in the head and neck region. This review explores the use of robotic surgery in orbital pathology, focusing on its applications, benefits, and limitations. Materials and Methods: A cross-sectional search method was performed in multiple databases to answer the following question: “What are the applications of robotic surgery in the management of orbital pathologies?” Studies were carefully reviewed by two simultaneous researchers, and, in case of disagreement, a third researcher was engaged. Care was taken to identify the surgical hardware (robotic station) used to perform the surgical procedure. Results: Out of 491 records, eight studies met the inclusion criteria. These included cadaveric, preclinical, in vitro, and early clinical investigations assessing robotic approaches for fronto-orbital advancement, tumor resection, orbital decompression, and other surgical procedures such as lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. The robotic systems evaluated included the Da Vinci Xi, Da Vinci SP, Medineering Robotic Endoscope Guiding System, and a modular multi-arm concentric tube robot, each with specific advantages and limitations. Conclusions: Robotic surgery provides significant advantages for orbital pathologies such as improved precision, visualization, and tissue preservation, with reduced complications and faster recovery, although some limitations still exist. Future advancements, such as smaller instruments and AI integration, promise to improve outcomes, making robotic surgery more effective in treating orbital conditions.