Telemedicine in maxillofacial traumatology: A tertiary referral center 30-month experience

Abstract

Background

Maxillofacial trauma requires timely recognition of urgent conditions, yet specialized expertise is often limited in rural settings. Hub-and-spoke trauma networks supported by telemedicine may optimize triage, reduce unnecessary transfers, and integrate advanced workflows. Evidence for maxillofacial trauma teleconsultation, however, remains sparse.

Methods

A retrospective study of all teleconsultations for maxillofacial trauma between January 2023 and August 2025 within the major trauma network of South-Eastern Vast Area of Tuscany (AV-TSE) (population ∼809,000) was conducted. Thirteen spokes hospitals from 13 peripheral Azienda Unità Sanitaria Locale Toscana Sud-Est (AUSL-TSE) are connected to the tertiary hub in Siena, for example, the Azienda ospedaliero-universitaria Senese (AOUS). Teleconsultations used a secure platform provided by Ente di supporto tecnico amministrativo regionale (ESTAR) enabling safe exchange of clinical data, photographs/videos, and radiological images. Patients were triaged as emergency (immediate transfer), urgency (hub evaluation within 72 h), or elective (spoke follow-up). Primary outcomes were: avoided transfers, efficiency, and equity of access. Multivariable logistic regression assessed predictors of avoided transfer and loss to follow-up (LTFU).

Results

A total of 670 patients were analyzed (mean age = 64.4 years; 43.9% female). Zygomaticomaxillary complex (29.1%), orbital (19.4%), and maxillary fractures (15.1%) predominated. Overall, 174 patients (26.0%) were managed locally, avoiding ∼4520 km and 75 h of travel. Conservative outpatient care was most frequent (57.6%), while 13.7% required surgery under general anesthesia. Older age independently predicted both avoided transfer (OR = 1.03/year, 95% CI = 1.02–1.04) and LTFU (OR = 1.023, 95% CI = 1.010–1.035). No duplicate CT scans were required. Virtual surgical planning by computer-aided design (CAD) and computer-aided manufacturing (CAM) enabled preoperative workflows to begin before transfer, reducing delays.

Conclusions

In the experience of AV-TSE, a pragmatic telemedicine teleconsultation pathway between AOUS and AUSL-TSE decentralized one-quarter of cases, reducing transfers while ensuring safety. Integration with CAD/CAM planning enhanced surgical readiness. Improving follow-up reliability, especially in older patients, remains a priority for future network optimization.