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

BackgroundMaxillofacial 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.MethodsA 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).ResultsA 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.ConclusionsIn 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.