Surgeries

Orthognathic surgery, particularly maxillomandibular advancement (MMA), has emerged as an effective therapeutic option for patients with moderate to severe OSA who are refractory to conventional treatments. The wedge osteotomy of the maxilla, often performed in combination with mandibular surgery, can be a surgical treatment for obstructive sleep apnea (OSA). This case series report describes 6 OSA patients without anteroposterior maxillary deficiency who were treated with wedge osteotomy of the maxilla. Material and Methods: We conducted a retrospective analysis of 6 patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2018 and 2024 at the Maxillofacial Surgery of San Camillo-Forlanini Hospital, in Rome, Italy. Patients were evaluated using a CAD/CAM-assisted approach. A pre- and postoperative comparative analysis was conducted to assess the effectiveness of the surgical treatment in improving OSA-related parameters. Maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus were digitally planned. Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions generated using dedicated software, revealed a counterclockwise rotation of the occlusal plane, resulting in a mandibular advancement of approximately 13 mm. The CT shows a significant increase in airway volume following the skeletal repositioning. The airway volume increased from 20.665 ± 546 mm³ to 27.177 ± 446 mm³. Conclusions: Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to effectively enlarge the posterior pharyngeal space while also delivering excellent esthetic outcomes. Full article

Background: With the advancement of AI-powered online tools, patients are increasingly turning to AI for guidance on healthcare-related issues. Methods: Acting as patients, we posed eight direct questions concerning a common clinical condition—liver cysts—to four AI chatbots: ChatGPT, Perplexity, Copilot, and Gemini. The responses were collected and compared both among the chatbots and with the current literature, including the most recent guidelines. Results: Overall, the responses from the four chatbots were generally consistent with the literature, with only a few inaccuracies noted. For questions addressing “grey areas” in clinical research, all chatbots provided generalized answers. ChatGPT, Copilot, and Gemini highlighted the lack of conclusive evidence in the literature, while Perplexity offered speculative correlations not supported by data. Importantly, all chatbots recommended consulting a healthcare professional. While Perplexity, Copilot, and Gemini included references in their responses, not all cited sources were academic or of medium/high evidence quality. An analysis of Flesch Readability Ease Scores and Estimated Reading Grade Levels indicated that ChatGPT and Gemini provided the most readable and comprehensible responses. Conclusions: The integration of chatbots into real-world healthcare scenarios requires thorough testing to prevent potentially serious consequences from misuse. While undeniably innovative, this technology presents significant risks if implemented improperly. Full article

Objectives: Surgical site infection (SSI) is a demanding post-surgical complication. SSI has been linked to significant morbidity, mortality, and rising healthcare expenditure. Staples and sutures are the most utilized methods in orthopedic skin closure. The aim of this study was to compare the rate of SSI in sutured versus stapled wound closure after orthopedic limb surgeries. Methods: A prospective cohort study was conducted between September 2019 and March 2021. Patient demographics, method of wound closure, and potential risk factors associated with SSI were recorded. A multivariate logistic regression analysis was performed to identify independent risk factors associated with SSI. Results: A total of 775 patients were included. Eighteen patients (2.3%) acquired an SSI. 3.5% of the staples group and 1.1% of the suture group contracted an SSI (p = 0.028, univariate analysis). Length of hospital stay (LOS) was significantly higher in the staples group (p < 0.001). Use of antibiotics (AOR 5.938; 95%CI 1.693–20.820), LOS (AOR: 1.047, 95% CI:1.013–1.083), and duration of antibiotic prophylaxis (AOR:1.076, 95% CI: 1.010–1.147) were independent risk factors of SSI. Conclusions: The use of staples was associated with longer hospital stays. Use of antibiotics, prolonged hospital stays, and extended antibiotic prophylaxis were independent risk factors for SSI. These findings suggest that the choice of closure method may impact hospital stay, which could influence SSI risk. Full article

Objectives: In localized upper-tract urothelial carcinoma (UTUC), radical nephroureterectomy (RNU) represents the surgical gold standard, but kidney-sparing surgery (KSS) offers an alternative. The surgical perspective, including complications, remains understudied in this context. This study aimed to compare KSS and RNU, assess kidney function and survival, and identify the surgical risk factors. Methods: This retrospective analysis included UTUC patients undergoing KSS (n = 46) or RNU (n = 46) at a single center from 2016 to April 2024, matched by propensity scores. The primary endpoint was Clavien–Dindo complications. Other endpoints included Days Alive and Out of the Hospital within 30 days (DAOH30), changes in the eGFR, cancer-specific survival (CSS), and disease-free survival (DFS). A UTUC Surgery Risk Score was developed to identify the surgical risk factors for severe complications. Results: KSS was significantly associated with higher rates of Clavien–Dindo grades ≥ 3 (KSS: 14; RNU: 3). DAOH30 was significantly longer following RNU. The UTUC Surgery Risk Score, based on a non-endoscopic KSS approach, an ASA score ≥ 3, and preoperative creatinine > 0.9 mg/dL, was significantly associated with overall and severe complications and DAOH30 (both p < 0.001). KSS showed significantly better early postoperative eGFR preservation (+0.55 mL/min vs. −4.3 mL/min for RNU, p = 0.015). No significant differences were observed in the median CSS or DFS between the groups. Conclusions: KSS is associated with a higher rate of certain postoperative complications, but offers superior kidney function preservation, with comparable oncological outcomes to RNU. The novel UTUC Surgery Risk Score can aid in patient counseling and personalized decision-making prior to surgery. Full article

Aim of the Study: To determine whether adding a lateral extra-articular tenodesis (LET) to primary anterior cruciate ligament reconstruction (ACLR) lowers graft-failure risk and improves functional recovery in competitive athletes with high-grade pivot-shift. Methods: Multicentre retrospective cohort with 1:1 propensity-score matching (age, sex, sport, graft, centre). Competitive athletes with pivot-shift grade ≥ 2 who underwent primary ACLR with hamstring or bone–patellar tendon–bone (BPTB) autografts (2018–2024) were eligible. The primary outcome was graft failure within 24 months (composite of revision ACLR, symptomatic rotatory laxity with pivot-shift ≥ 2 plus KT-1000 > 5 mm, or MRI-confirmed rupture). Time-to-event was summarised with Kaplan–Meier (KM) curves and log-rank tests. Secondary outcomes included residual rotatory laxity and functional performance (single-leg hop, side hop, Y-Balance) analysed as the proportion achieving Limb Symmetry Index ≥ 90% at 6 and 24 months and as continuous LSI means. Two-sided α = 0.05; secondary outcomes were prespecified without multiplicity adjustment. Results: Of 1368 ACL reconstructions screened, 97 eligible athletes were identified; 92 were analysed after matching (46 isolated ACLR; 46 ACLR + LET; mean follow-up 30.0 ± 4.2 months). KM survival at 24 months was 95.7% after ACLR + LET versus 82.6% after isolated ACLR (log-rank p = 0.046). The absolute risk reduction was 13.0% (Number Needed to Treat 8; 95% CI 4→∞). In graft-type subgroups, failures were 6/32 vs. 1/30 for hamstring and 2/14 vs. 1/16 for BPTB (ACLR vs. ACLR + LET, respectively); there was no evidence of interaction (Breslow–Day p = 0.56). At 6 months, a higher proportion of ACLR + LET athletes achieved LSI ≥ 90% across tests—single-leg hop 77.8% vs. 40.9% (p = 0.0005), side hop 62.2% vs. 34.9% (p = 0.012), Y-Balance 84.4% vs. 59.1% (p = 0.010), with a larger mean LSI (between-group differences +8.2 to +9.1, all p < 0.001). By 24 months, threshold attainment largely converged (all p ≥ 0.06), while mean LSI differences persisted but were smaller (+3.9 to +4.9, all p ≤ 0.001). Conclusion: In competitive athletes with high-grade pivot-shift undergoing accelerated, criteria-based rehabilitation, adding LET to primary ACLR was associated with lower graft-failure risk and earlier functional symmetry, with consistent effects across hamstring and BPTB autografts. Given the observational design, causal inference is limited; confirmation in randomized and longer-term studies is warranted. Full article

Background: Tranexamic acid is an antifibrinolytic medication often used to prevent hemorrhage. The dosage and route of administration can vary depending on specialty and indication, although one of the most common routes includes intravenous application. Other possible administration modalities include intramuscular and topical applications or irrigation. Although not the most common method, more research is emerging on the topical application of the drug to prevent bleeding. Methods: Specific search terms regarding the topical administration of tranexamic acid were input into PubMed and were reviewed via Covidence. Selected studies were stratified based on specialty (ears, nose, and throat; cardiology; plastic surgery; and orthopedics), and hematologic outcomes regarding tranexamic acid use were reviewed. Results: An evaluation of the studies demonstrated the feasibility of tranexamic acid in the topical form; however, it can depend on the specialty-specific indications. Each field utilizes unique procedures or surgeries, which can play a role in the effectiveness of the medication. Conclusions: While the current literature demonstrates the feasibility of tranexamic acid, further research is needed to understand its viability in other fields, such as obstetrics. Full article

Background/Objectives: Penetrating intraocular foreign bodies (IOFBs) are ocular emergencies, often leading to preventable vision loss. This case report highlights a unique presentation of a work-related penetrating IOFB that mimicked a golden hypopyon. Methods: A 35-year-old male presented to the emergency department with sudden-onset pain and vision loss in the left eye while he was cutting a tree with metallic scissors. He had a visual acuity of 20/30 in the right eye and counting fingers in the left eye. A dilated slit-lamp examination and CT scan confirmed the presence of a 6–8 mm metallic IOFB in the anterior chamber, with no involvement of the lens or the posterior segment. Surgical removal was performed. Results: The metallic IOFB was removed surgically with IOFB forceps using a single paracentesis. The patient reported resolving pain and regained baseline visual acuity of 20/20 postoperatively, which remained stable at one-month follow-up. Conclusions: This case illustrates the successful surgical management of a penetrating metallic IOFB with a unique presentation mimicking a hypopyon. Emphasis on unique presentations of IOFBs can aid in timely management, ultimately reducing the risk of complications. Full article

Background: Pain is a problem faced by critically ill surgical patients and has a major impact on their outcomes. Pain assessment is therefore essential for effective pain management, with a combination of pharmacological and non-pharmacological treatment. Clinical supervision, supported by models such as SafeCare, can improve professional development, safety and the quality of care in intensive care units. Objectives: This study aimed to: (1) assess current pain assessment practices in a polyvalent Intensive Care Unit (ICU) in the Porto district; (2) identify nurses’ training needs regarding the Clinical Supervision-Sensitive Indicator—Pain; and (3) evaluate the impact of clinical supervision sessions on pain assessment practices. Methods: A quantitative, quasi-experimental, cross-sectional study with a pre- and post-intervention design was conducted. Based on the SafeCare model, it included a situational diagnosis, 6 clinical supervision sessions (February 2023), and outcome evaluation via nursing record audits (November 2022 and May 2023) in 31 total critical ill patients. Pain was assessed using standardised tools, in line with institutional protocols. Data was analysed using Software Statistical Package for the Social Sciences v25.0. Results: Pain was highly prevalent in the first 24 h, decreasing during hospitalisation. Generalised acute abdominal pain predominated, with mild to moderate intensity, and was exacerbated by wound care and mobilisation/positioning. Pain management combined pharmacological and non-pharmacological treatment. There was an improvement in all the parameters of the pain indicator post-intervention. Conclusions: Despite routine assessments, gaps remained in reassessing pain post-analgesia and during invasive procedures. Targeted clinical supervision and ongoing training proved effective in improving compliance with protocols and supporting safer, more consistent pain management. Full article

Background and Clinical Significance: Angioleiomyoma (ALM) is a benign tumor that generally presents as a single lesion and, according to the updated WHO classification, includes the following three histological subtypes: solid (or capillary), cavernous, and venous. Typically, ALMs are described as well-defined nodules in the lower extremities but are unusually located in the acral locations and toes. We summarize two cases of ALM and perform a systematic review to provide foot surgeons with the most up-to-date and useful information on the epidemiological aspects, anatomical distribution, and specific histological subtypes of ALM in the foot. Materials and Methods: A systematic review was carried out according to the criteria of a PICO framework, and a systematic search and data processing were carried out according to the PRISMA guidelines. We analyzed patient demographics, clinical characteristics, diagnostic workup, treatment, and clinical outcomes. Each one of the included articles was independently assessed for methodological quality and risk of bias by an independent evaluator. The risk of bias of the included studies was assessed based on their characteristics. Results: This systematic review included 14 case series with 172 reported cases of ALM. One hundred and seventy-two (18.57%) were cases of ALM located on foot, excluding the ankle region. The female-to-male ratio was 1.48. The most common location was the hindfoot (41.5%), followed by the forefoot (20.2%) and the midfoot (8.9%). In 29.4% of cases, the location of the lesions could not be determined. The most frequent location of the lesions was subcutaneous (69%), followed by subaponeurotic (16.5%) and skin (14.5%) locations. The most frequent histological presentation was the solid histologic subtype (65%), followed by the venous subtype (21%) and the cavernous subtype (14%), respectively. Of the total reported cases of ALM located in foot, 63.1% presented as solid painful lesions. Calcified presentations occurred in 7% of cases, with more than half of the cases located in the hindfoot. Surgical excision was the treatment of choice in the two herein reported cases of solid ALM located in the hindfoot, one of them with a calcified presentation. No recurrence was observed in either case after two and five years of follow-up, respectively. All cases reviewed after surgical excision showed a low recurrence rate with a favorable prognosis regardless of the histological subtype and a very rare tendency toward malignancy. Conclusions: ALMs of the foot present as well-defined, painful nodules in the subcutaneous tissue of middle-aged women. Solid histological subtypes are the most prevalent. Histopathological analysis is usually essential for confirmation. Treatment consists primarily of direct excision, with remarkably low recurrence rates. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. Full article

Background: Esophageal achalasia is a rare motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and food stasis. Surgical interventions, including Heller myotomy with fundoplication or peroral endoscopic myotomy (POEM), effectively alleviate symptoms but induce significant anatomical and functional alterations. In various gastrointestinal surgeries, microbiota have been implicated in modulating clinical outcomes; however, their role in achalasia surgery remains unexplored. Methods: We performed a narrative literature search of various databases to identify studies exploring potential interactions between the gastroesophageal microbiota, achalasia pathophysiology, and surgical treatment, proposing clinical implications and future research avenues. Results: Chronic esophageal stasis in achalasia promotes local dysbiosis by facilitating aberrant bacterial colonization. Surgical restoration of esophageal motility and gastroesophageal transit induces substantial shifts in the microbial ecosystem. Analogous microbiota alterations following procedures such as fundoplication, gastrectomy, and bariatric surgery underscore the significant impact of mechanical modifications on microbial composition. Comprehensive microbiota profiling in patients with achalasia may enable the identification of dysbiotic phenotypes predisposed to complications, thereby providing personalized therapeutic interventions including probiotics, prebiotics, dietary modulation, or targeted antibiotic therapy. These insights hold promise for clinical benefits, including the mitigation of inflammation and infection, monitoring of surgical efficacy through microbial biomarkers, and optimization of postoperative nutritional strategies to reestablish microbial homeostasis, ultimately enhancing patient outcomes beyond conventional treatment paradigms. Conclusions: The gastroesophageal microbiota is a compelling mediator of surgical outcomes in achalasia. Future investigations integrating microbiological and inflammatory profiling are warranted to elucidate the functional role of the gastroesophageal microbiota and assess its potential as a biomarker and therapeutic target. Full article

Background/Objectives: The field of tracheal reconstruction has undergone significant developments in the last few decades. Accordingly, this bibliometric review aims to identify the most influential publications within the field and their citation characteristics. Methods: A comprehensive search for “tracheal reconstruction” was conducted with the Clarivate’s Web of Science database. The resulting search results were filtered for relevant publications and evaluated to identify the 50 publications with the highest citation counts. Further analysis of these publications was conducted based on the following parameters: authorship, institutional affiliations, country of origin, citation density, year of publication, article type, and level of evidence. VOSviewer (version 1.6.20) was utilized to create co-occurrence maps of authors and keywords. Results: The top 50 publications were cited a total of 6449 times with an average of 128.98 citations per publication. The top three most cited articles were all by Grillo (primarily focused on tracheal stent repair and post-oncologic reconstruction). The majority of the top cited publications articles featured in The Annals of Thoracic Surgery (n = 10) were basic science in nature (32%) and had a level of evidence of Level IV (62%). The publication with the greatest citation density was by Kang et al. focusing on tracheal tissue engineering (TTE). Conclusions: This bibliometric review provides a thorough overview of the key publications that have influenced the field of tracheal reconstruction. Most predominantly, our analysis highlights a shift in focus from primary tracheal reconstruction techniques to more innovative repair paradigms such as TTE. Full article

Background: Surgical site infections (SSIs) are among the most common postoperative complications. Environmental factors, including intraoperative traffic and door openings in the operating room (OR), have been identified as critical contributors to microbial air contamination. Nurses play a pivotal role in managing these factors, directly influencing infection control practices. Methods: An integrative review was conducted to synthesize current evidence on the association between intraoperative traffic, door openings, and SSIs. A structured methodology was employed to identify, assess, and analyze the existing literature, with a specific focus on the nursing role in infection prevention. Results: Findings from a single-center prospective cohort study indicate that ORs with more than 10 personnel present exhibit a threefold increase in SSI risk [Relative Risk (RR) = 3.12; 95% Confidence Interval (CI): 0.71–13.66] compared to ORs with fewer personnel. Additionally, every five door openings per procedure were associated with a significant increase in SSI incidence [Hazard Ratio (HR) = 2.00; 95% CI: 1.24–3.20, p = 0.005]. Conclusions: These findings underscore the importance of strict protocols to limit intraoperative traffic and unnecessary OR access. A multidisciplinary approach plays a crucial role in ensuring surgical safety and preventing SSIs by regulating OR access and adhering to infection control best practices. Full article

Background/Objectives: Treatment strategies in pilonidal sinus disease differ substantially between adults and children. While a single surgery with off-midline flap closure is recommended for adults, minimally invasive procedures are preferred in children due to their much higher recurrence rates. Recently, this strategy has been extended to young adults, but long-term recurrence rates in this age group are unknown. Methods: An established database of studies on pilonidal sinus disease was used for the present study. All entries providing information on age and recurrence over time were included. We compared recurrence rates between children (<18 years), young adults (18 to 21 years), and older adults (>21 years) using Kaplan–Meier curves. Between-groups testing employed the two-tailed log rank test. Results: We included 856 entries with 88,348 patients, of which 5635 were children and 3999 young adults. The 5-year recurrence rate in children was 45.1% (95% confidence interval: 40.2–49.7%). For older adults it was 11.5% (95% confidence interval: 11.1–11.8%) and 8.7% (95% confidence interval: 7.4–10%) in young adults. The recurrence rate in young adults was lower than in children (log rank p < 0.001) and comparable, albeit slightly lower, to older adults (log rank p < 0.001). Conclusions: Our results indicate that recurrence rates between young and older adults are similar. Consequently, treatment strategies for young adults could follow the recommendations for adults instead of those for children. Due to the limited quality of available evidence, this requires validation in primary studies with sufficiently long follow-up. Full article

Background and Objective: Benign prostatic hyperplasia (BPH) and urethral stricture (US) are common causes of lower urinary tract symptoms in ageing men, often requiring repeated interventions. Conventional treatments of US, such as urethrotomy and mechanical dilation, have high recurrence rates. The Optilume drug-coated balloon catheter system, which combines mechanical dilation with paclitaxel delivery, has emerged as a minimally invasive alternative. This systematic review assesses its efficacy and safety in the management of BPH and US. Methods: A systematic search of PubMed was conducted for studies published between August 2020 and October 2023. Eligible studies included randomised controlled trials (RCTs), cohort studies, and case reports evaluating Optilume’s therapeutic effects. Key outcomes analysed included symptom relief, urinary flow improvement, recurrence rates, and adverse events. Results: Seven studies met the inclusion criteria, including five on US and two on BPH. The ROBUST trial series demonstrated sustained improvements in urinary flow rates and symptom scores in US patients over follow-up periods of up to four years. The EVEREST-1 and PINNACLE trials reported significant symptom relief and preserved sexual function in BPH patients, with a favourable safety profile and minimal complications. Conclusions: Optilume appears to be a promising alternative to conventional endoscopic treatments for US and BPH, offering durable symptom relief with a low complication rate. Further long-term studies are required to confirm its efficacy and cost-effectiveness in routine clinical practice. Full article

Background: Iatrogenic nerve injuries (NIs) are an under-recognized complication of urological surgery. Though less common than vascular or organ damage, they may cause lasting sensory and motor deficits, significantly affecting patients’ quality of life. With increasing complexity in pelvic procedures, a consolidated understanding of nerve injuries is essential. Purpose: This review aims to synthesize current knowledge regarding peripheral and autonomic NIs in urological surgery, highlighting mechanisms of injury, associated procedures, preventative strategies, and treatment options. Scope: Focused on common urological interventions such as radical prostatectomy, cystectomy, pelvic lymphadenectomy, and reconstructive techniques, the review explores injuries from positional compression, traction, and intraoperative transection to their surgical management. Key Findings: The review categorizes nerve injuries into crush and transection types and details intraoperative signs and repair techniques. Skeletonization of nerves, avoidance of energy devices near neural structures, and prompt end-to-end anastomosis using 7-0 polypropylene are central to management. Adoption of novel sutureless nerve coaptation devices have also been described with promising outcomes. Early repair offers a better prognosis. New intraoperative technologies like NeuroSAFE during robotic-assisted procedures may enhance nerve preservation. Conclusion: Iatrogenic NIs, although rare, are clinically significant and often preventable. Prompt intraoperative recognition and repair are critical. Further research is warranted to develop standardized preventative protocols and enhance intraoperative nerve monitoring. A multidisciplinary approach, extended across surgical specialties, could improve outcomes and guide timely treatment of nerve injuries. Full article

Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article

Background: Venous malformation, formerly designated as cavernous hemangioma, is a rare vascular lesion characterized by significant endothelial cells proliferation, predominantly affecting young females. Diagnosis is challenging due to its low incidence and variety of clinical, radiological, and histological presentations. Objectives: The aim was to review the current scientific understanding of maxillary venous malformation based on the available literature and present an additional rare case of venous malformation of the upper maxilla. Methods: A systematic review was conducted across PubMed, Google Scholar, and Embase databases for studies published between January 1990 and April 2025. Inclusion criteria encompassed meta-analyses, systematic reviews, randomized controlled trials, non-randomized controlled trials, cohort studies, and case reports describing cavernous hemangiomas and venous malformation of the maxilla. All clinical and radiological characteristics were considered. Results: Out of 10,021 studies identified through our database search, 22 met the inclusion criteria, describing 28 (29 with our case) clinical cases of maxillary venous malformation. Conclusions: Maxillary venous malformation presents complex and varied clinical and radiological aspects, which are crucial for preoperative assessment and management. Appropriate measures may be necessary to prevent bleeding complications during lesion removal. To the best of our knowledge, this is the first comprehensive review on venous malformation of the maxilla. In addition, we report an unusual case identified incidentally during implant planning and successfully removed through isolated bone augmentation. Full article