Search Results (1,314)

Background: Bunionette deformity is commonly treated with distal or diaphyseal osteotomy, but concerns remain regarding correction loss, implant irritation, and metatarsal shortening. This study evaluated outcomes of mini-open fifth metatarsal osteotomy stabilized with intramedullary rigid fixation in symptomatic Coughlin type II and III deformity. Methods: This single-center retrospective observational study included 32 consecutive patients treated between February 2018 and February 2023. Radiographic outcomes included the fourth-to-fifth intermetatarsal angle (IMA), fifth metatarsophalangeal angle (MPA), maintenance of correction, and fifth metatarsal shortening. Clinical outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, and complications. An exploratory subgroup analysis compared isolated correction with combined procedures. Results: The mean follow-up was 31.5 ± 6.8 months. The mean AOFAS score improved from 52.5 ± 4.2 to 93.4 ± 3.4, and the mean VAS score decreased from 7.8 ± 0.9 to 1.2 ± 0.6 (both p < 0.001). The mean MPA improved from 19.4° ± 3.6° to 2.3° ± 1.1°, and the mean IMA improved from 14.0° ± 1.4° to 4.5° ± 2.5° (both p < 0.001). Minor but statistically significant correction loss occurred between early postoperative and final follow-up radiographs. Mean fifth metatarsal shortening was 1.3 ± 0.8 mm. One patient required implant removal for hardware irritation. No nonunion, transfer metatarsalgia, or wound complications were observed. Conclusions: Mini-open fifth metatarsal osteotomy with intramedullary rigid fixation was associated with pain relief, functional improvement, maintained radiographic correction, limited shortening, and a low observed complication rate in this series. Full article

Background/Objectives: Odontogenic infections range from localized abscesses to life-threatening deep neck infections and are a frequent cause of emergency admission. We aimed to identify prognostic factors for postoperative complications after their surgical treatment. Methods: We retrospectively analyzed 194 adults (59.3% male) treated at the Department of Cranio-Maxillofacial Surgery in Cracow between 2020 and 2025. The primary outcome was any postoperative complication, graded by the Clavien–Dindo classification and dichotomized into minor (grade I–II) and major (grade ≥ III). Prolonged hospitalization and prolonged irrigation (>7 days) were secondary outcomes. Pre-specified main factors (advanced age, diffuse phlegmonous spread, diabetes mellitus) and covariates (sex, maxillary location, systemic disease) were tested by uni- and multivariable logistic regression. Results: Comorbidities were present in 69.1%. Complications occurred in 49 patients (25.3%): 19 (9.8%) minor and 30 (15.5%) major, including 12 grade IV intensive-care events and two deaths (grade V). In multivariable analysis, diffuse phlegmonous spread independently predicted any complication (adjusted OR 11.7), major complication (OR 23.4), prolonged hospitalization (OR 5.02) and prolonged irrigation (OR 4.39; all p ≤ 0.004). Advancing age independently predicted major complications (OR 1.03 per year, p = 0.037). Both fatal cases shared phlegmon, maxillary location and diabetes. Conclusions: Diffuse phlegmonous spread was the principal prognostic factor across all adverse outcomes, with advancing age additionally predicting major complications. Because intensive-care admission occurred almost exclusively in phlegmon patients, this association is partly definitional. Early identification of diffuse spread and advanced age may support effective triage. Full article

Objective: Intracranial infection is a severe complication that can occur following neurosurgery, and early diagnosis is crucial for improving patient prognosis. In this study, we aimed to investigate, from an exploratory perspective, whether the immune microenvironment of intraoperative cerebrospinal fluid (CSF) is associated with postoperative intracranial infection (PII) in patients undergoing craniotomy for benign brain tumors. Methods: A total of 134 patients undergoing neurosurgery for benign brain tumors were included and categorized into an infection group (n = 18) and a non-infection group (n = 116). CSF samples were collected aseptically immediately after dural opening during surgery. The concentrations of 16 cytokines, including monocyte chemoattractant protein-1 (MCP-1); macrophage inflammatory protein-1α (MIP-1α) and MIP-1β; interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, and IL-17; interferon (IFN)-α and IFN-γ; tumor necrosis factor-α (TNF-α); and granulocyte colony-stimulating factor (G-CSF), were quantified using Cytometric Bead Array (CBA) technology. An independent samples t-test was used for normally distributed data, while the Mann–Whitney U test was applied for non-normally distributed data. Group comparisons were performed using independent-samples t-tests or Mann–Whitney U tests for continuous variables and χ² tests or Fisher’s exact tests for categorical variables. The Benjamini–Hochberg false discovery rate (FDR) correction was applied to all 16 cytokines to control for multiple testing. Receiver operating characteristic (ROC) curve analysis was performed to assess discriminatory capacity. Statistical significance was defined as p < 0.05. Results: PII developed in 18 of 134 patients (13.4%). Age (47.78 vs. 54.86, p = 0.028) and operative duration (390 vs. 244 min, p = 0.005) showed differences in unadjusted analyses. In the unadjusted comparisons, MCP-1 and IL-4 levels were found to be significantly lower in the infection group (MCP-1: 57.78 vs. 116.03 pg/mL, p = 0.003; IL-4: 24.38 vs. 28.18 pg/mL, p = 0.032). No cytokine remained significant after FDR correction. The ROC analysis showed that age and IL-4 demonstrated mild discriminatory performance, with AUC values of 0.665 (95% CI 0.526–0.803, p = 0.025) and 0.657 (95% CI 0.540–0.774, p = 0.032), while MCP-1 and operative duration demonstrated modest discriminatory performance, with AUC values of 0.716 (95% CI 0.595–0.838, p = 0.003) and 0.708 (95% CI 0.578–0.838, p = 0.002). Conclusions: In this study, single-point intraoperative CSF cytokines were not significantly associated with PII after stringent correction for multiple testing, and did not provide a validated clinical prediction tool. The unadjusted and direction-corrected findings for MCP-1 and IL-4 remain exploratory and require validation. Full article

Objectives: The incidence of distal gastric cancer has declined worldwide owing to successful Helicobacter pylori eradication and improvements in environmental and dietary factors. In contrast, adenocarcinoma of the esophagogastric junction (AEG) and proximal gastric cancer have become increasingly prevalent, creating a growing need for function-preserving surgical approaches. Proximal gastrectomy has emerged as an attractive alternative to total gastrectomy because of its potential advantages in nutritional preservation and postoperative quality of life. However, concerns regarding postoperative reflux esophagitis have historically limited its widespread adoption. This review aimed to summarize the evolution of reconstruction after proximal gastrectomy and evaluate the advantages, limitations, and clinical outcomes of contemporary reconstruction techniques. Methods: A narrative review of the current literature was performed, focusing on reconstruction strategies following proximal gastrectomy. Major contemporary techniques, including double-tract reconstruction (DTR), double-flap reconstruction (DFT; Kamikawa method), side-overlap fundoplication by Yamashita (SOFY), and Toupet-like fundoplication reconstruction, were reviewed. Comparative evidence regarding reflux control, nutritional outcomes, operative complexity, anastomotic complications, and postoperative quality of life was examined. Results: Substantial advances in reconstructive techniques have significantly improved functional outcomes after proximal gastrectomy. DTR provides reliable reflux prevention, reproducibility, and broad applicability in minimally invasive surgery. DFT achieves excellent anti-reflux efficacy while preserving physiological food passage through the remnant stomach. SOFY offers favorable functional outcomes with reduced technical complexity and is particularly suited to laparoscopic and robotic surgery. Toupet-like reconstruction represents a promising alternative with encouraging early clinical results. Comparative studies indicate that all contemporary anti-reflux reconstruction methods substantially reduce reflux esophagitis compared with conventional esophagogastrostomy. Although each technique demonstrates specific advantages and limitations, no single reconstruction method has consistently shown superiority across all clinically relevant outcomes, including reflux prevention, nutritional preservation, operative complexity, and quality of life. Conclusions: Modern reconstruction techniques have expanded the role of proximal gastrectomy as a function-preserving alternative to total gastrectomy for proximal gastric cancer and AEG. Current evidence suggests that DTR, DFT, SOFY, and Toupet-like reconstruction can all achieve satisfactory oncological and functional outcomes when appropriately applied. Rather than identifying a universally superior procedure, contemporary practice should emphasize individualized reconstruction based on patient characteristics, surgeon expertise, and institutional experience. Future advances in robotic surgery, perioperative care, and standardized outcome assessment are expected to further optimize long-term outcomes following proximal gastrectomy. Full article

Background: The prevalence of sacral insufficiency fractures resulting from minor trauma has been on the rise in parallel with the globally aging population. For similar injuries typical to the elderly population, such as hip fractures, surgery and early mobilization have been shown to improve postoperative mortality and morbidity rates. As such, there has been a recent increase in the literature in studies advocating for early surgical fixation for sacral insufficiency fractures. However, traditional fluoroscopic techniques are technically demanding and bear an inherent complication risk even in experienced hands. Robotic-assisted surgery has emerged as a promising technological advancement in spinal and pelvic surgery. We share our experience with this surgical technique. Methods: We conducted a retrospective analysis of five consecutive patients with sacral insufficiency fractures who failed non-operative management. Using the Mazor X robotic system, patients underwent CT-planned, guided placement of fenestrated sacroiliac screws followed by cement augmentation. Primary outcomes included surgical time, radiation exposure, complications, and mobilization, with a minimum three-month follow-up. Results: The cohort consisted of five females with a mean age of 78 years. The mean operative time was 36 min (15–47), and the median fluoroscopy count was 13 shots (6–19). All patients reported significant pain relief and achieved successful mobilization on postoperative day 1. No operative or postoperative complications were recorded. Conclusions: This pilot study suggests that robotic-assisted percutaneous sacroiliac fixation with cement augmentation is a safe, efficient, and minimally invasive approach for the treatment of sacral insufficiency fractures. The precision of the robotic system facilitates stable fixation, providing immediate pain relief and early mobilization with a favorable complication profile. Further studies should be performed to verify these findings. Full article

Background: Older adults undergoing non-cardiac surgery are vulnerable to perioperative complications, but the prognostic value of routine echocardiographic markers in high-acuity cohorts remains incompletely defined. Methods: This secondary analysis of a prospective cohort included 503 consecutive adults with known cardiovascular disease undergoing non-cardiac surgery, characterized by a high proportion of urgent presentations. Patients were stratified by age (geriatric, ≥65 years; non-geriatric, <65 years). The primary endpoint was major in-hospital adverse events (MIAEs), defined as a composite of in-hospital death, surgical reintervention, and postoperative acute kidney injury (AKI). Postoperative creatinine was not routinely measured in stable patients discharged early; therefore, renal outcomes were interpreted strictly as available-case analyses (n = 364). Results: MIAEs occurred more frequently in geriatric than in younger patients (45.5% vs. 30.8%). Within the geriatric cohort, patients with reduced LVEF (<50%) had lower MAPSE values and higher crude rates of AKI, death, and MIAE than those with LVEF ≥ 50%. In multivariable analyses, reduced LVEF was associated with MIAE, although this small subgroup was susceptible to statistical overfitting. MAPSE reflected longitudinal systolic dysfunction but did not retain independent prognostic value after adjustment. Conclusions: In this pilot subgroup analysis of high-acuity patients, reduced preoperative LVEF (<50%) served as a clinical flag identifying a high-risk geriatric phenotype with increased cardiorenal vulnerability. Given the event-enriched available-case denominator, these findings should be considered hypothesis-generating observations intended to increase clinical awareness. Full article

Phimosis is rarely reported in cats and involves the inability to exteriorize the penis through an absent or abnormally narrowed preputial orifice. This case report describes the clinical presentation, surgical management, and outcome of two male domestic shorthair kittens with suspected congenital type II phimosis. Both cats presented with recurrent stranguria and dysuria, preputial swelling, urine pooling or dribbling, a markedly stenotic preputial orifice, and penile–preputial adhesions. In Case 1, cystic struvite urolithiasis was also identified; treatment included cystotomy and ventrally performed modified preputial urethrostomy because of extensive adhesions, penile hypoplasia, and limited penile mobility. In Case 2, adhesions were limited to the distal penis and were released, allowing circumferential preputioplasty. No postoperative complications occurred. Clinical signs resolved, and normal urination was recorded during available follow-up, which was 12 months in Case 1 and 2 months in Case 2. The congenital origin was suspected based on early onset of clinical signs but could not be definitively confirmed. These cases suggest that selected feline type II phimosis cases can be managed successfully by tailoring surgery to anatomical abnormalities, using ventral-modified preputial urethrostomy when adhesions and penile hypoplasia restrict mobilization, or circumferential preputioplasty when adhesions are limited distally. Full article

Background/Objectives: Iatrogenic nerve injury is a significant challenge in urologic surgery, with radical prostatectomy posing a high risk due to complex pelvic neural anatomy. Despite advances in robotic-assisted and nerve-sparing techniques, postoperative urinary incontinence and erectile dysfunction remain prevalent, adversely affecting patients’ quality of life and imposing substantial healthcare costs. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library (searches through February 2026) for studies on radical prostatectomy epidemiology, mechanisms of nerve injury, functional outcomes, and economic burden. Emerging intraoperative fluorescence imaging technologies, surgical strategies to mitigate iatrogenic nerve injuries, and the financial costs of post-prostatectomy complications were assessed. Results: Robotic-assisted radical prostatectomy now accounts for >80% of procedures in the United States, and has been associated in observational studies with improved early recovery of erectile function compared with open and laparoscopic approaches. However, the lack of real-time nerve visualization remains a limiting factor. Recent milestones (January 2026) include the Food and Drug Administration Investigational New Drug clearance for the nerve-specific fluorophore LGW16-03 (NerveTrace), which enables real-time identification of sub-millimeter nerve branches, and the 510(k) premarket clearance of Dendrite imaging (November 2025). Conclusions: Enhanced intraoperative nerve discrimination via molecularly targeted imaging has the potential to reduce iatrogenic complications and improve long-term functional and economic outcomes in prostate cancer surgery, although these benefits have yet to be demonstrated in prospective clinical and health-economic studies. Full article

Objective: To evaluate the clinical outcome, safety and efficacy of the APrevent Vocal Implant System (VOIS) in patients with unilateral vocal fold paralysis (UVFP), with particular emphasis on the timing and impact of postoperative saline adjustments. Methods: This retrospective−prospective longitudinal study included 11 patients with chronic UVFP who underwent VOIS medialization thyroplasty (MT) under local anesthesia (n = 2) and general anesthesia (n = 9). Multidimensional voice parameters were analyzed preoperatively and at 1, 3, 6, and 12 months postoperatively. Statistical analyses included the Friedman test for repeated measures and the comparison of outcomes between pre- and each postoperative timepoints was evaluated with the Wilcoxon signed-rank test. Results: Significant and sustained improvements were observed across all multidimensional voice parameters. Mean mVHI-10 decreased from 31.7 ± 4.5 preoperatively to 5.8 ± 5.1 at 12 months, while mean MPT increased from 7.1 ± 3.8 to 14.4 ± 4.5 s (p < 0.05, r > 0.7). Acoustic parameters, including jitter, shimmer, and NHR, demonstrated progressive improvement over 12 months. A high proportion of patients (72.73%) underwent postoperative saline adjustment at a mean interval of 6.23 ± 1.23 months, beyond the early postoperative edema phase, with each adjustment yielding further enhancement in voice outcomes. No major complications, including airway obstruction or hematoma, were observed. Conclusions: VOIS MT is safe and effective, providing sustained improvements in multidimensional voice outcomes. The ability to perform postoperative saline adjustments enables dynamic optimization of glottal closure, reducing the need for revision surgery and addressing evolving laryngeal biomechanics. These findings support VOIS as a flexible, adjustable alternative to static medialization techniques and provide dynamic voice optimization in patients with UVFP. Full article

Objective: To assess the anatomical and clinical outcomes of a novel, mesh-free cerclage pectopexy technique that uses the round ligament for apical support following total laparoscopic hysterectomy in women with stage II uterine prolapse. Methods: This retrospective observational study included 120 women with stage II uterine prolapse who underwent total laparoscopic hysterectomy followed by laparoscopic non-mesh pectopexy between October 2023 and August 2024. In this procedure, the distal portion of each round ligament was fixed to the pectineal ligament using Ethibond sutures. Multiple plicating stitches were then placed to reinforce the ligament’s tensile strength, creating a biological suspension bridge between the pectineal ligament and the vaginal cuff. All patients were examined preoperatively and at 1, 3, 6, and 12 months postoperatively using the POP-Q system. Anatomical success was defined as an apical stage ≤ I at 12 months. Results: At the twelve-month follow-up, anatomical success was achieved in 95 percent of patients, with six cases of apical recurrence. POP-Q measurements showed significant improvement from baseline, and total vaginal length was preserved. Functional outcomes, including postoperative pain and dyspareunia, were favorable. Early complications were uncommon, and no intraoperative or mesh-related complications occurred. Conclusion: Round-ligament-based non-mesh cerclage pectopexy provides reliable apical support with minimal surgical morbidity following total laparoscopic hysterectomy. This technique appears to provide effective apical support with low surgical morbidity while avoiding synthetic mesh. Preservation of vaginal length and favorable short-term clinical outcomes were observed; however, longer-term comparative studies are required. Future prospective studies combining this procedure with other minimally invasive suspension techniques, such as McCall culdoplasty or uterosacral plication, may broaden its applicability to more advanced prolapse cases. Full article

Background: Acute pain after video-assisted thoracoscopic surgery (VATS) promotes respiratory splinting, impaired cough, and pulmonary complications, and predicts persistent opioid use. Surgeon-administered intercostal nerve block (ICNB) is a simple regional technique, but its independent effect on early pain and opioid requirement in a contemporary uniportal VATS (UVATS) pathway is incompletely defined. Methods: We performed a retrospective cohort study of 456 consecutive patients undergoing UVATS at a single Israeli center between 2017 and 30 May 2025. Patients receiving an intercostal block were compared with those who did not. Baseline covariates were balanced by 1:1 nearest-neighbor propensity-score matching (caliper 0.2 SD of the logit propensity score). The primary endpoints were pain on postoperative day (POD) 1 (visual analog scale, VAS) and postoperative opioid use; secondary endpoints included later pain, analgesic regimen, postoperative pneumonia, and mortality. Results: Matching yielded 159 patients per group (n = 318) with all clinically relevant covariates balanced (standardized mean difference [SMD] < 0.13). Median POD1 VAS was lower with the block (4 [IQR 3–4] vs. 5 [5–7]; p < 0.001), and 76.1% of block patients were opioid-free versus 10.7% who were not (p < 0.001). The effect was concentrated early and attenuated by POD3. In multivariable analysis the block was independently associated with lower POD1 VAS (adjusted β = −1.64, 95% CI −2.00 to −1.29; p < 0.001). Postoperative pneumonia was less frequent in the block group (5.7% vs. 20.1%; p < 0.001). Thirty-day and one-year mortality did not differ significantly. Conclusions: In UVATS, a surgeon-placed intercostal nerve block was associated with lower early postoperative pain that persisted after adjustment for operating surgeon and surgical era, concordant with pooled meta-analytic estimates; associated reductions in opioid use and pneumonia were confounded with surgeon and secular trend and are hypothesis-generating. These single-center, retrospective findings require prospective, protocol-randomized confirmation. Full article

Background: This narrative literature review aims to evaluate the evolution, current concepts, indications and clinical evidence of total scaphoid replacement as a treatment option for non-reconstructable scaphoid pathology. Particular emphasis is placed on implant design, materials, fixation strategies, and the biomechanical rationale underlying modern patient-specific prosthetic approaches. Methods: A comprehensive literature search was performed in PubMed, Scopus, Embase, and Google Scholar and was supplemented by reference screening and relevant book chapters. Studies reporting full scaphoid replacement were included, while partial replacements, non-original articles, and publications outside predefined languages were excluded. Data were synthesized qualitatively with respect to anatomy, biomechanics, implant materials, surgical techniques, fixation strategies, and clinical outcomes. Results: A total of 397 records were identified through database and manual searches. After removal of duplicates, non-topic-related articles, and non-retrievable studies, 33 publications were included in the final analysis. Early acrylic and silicone prostheses showed high complication rates, with implant removal required in up to 70% of early acrylic series and secondary procedures reported in approximately 24% of silicone implant cases. Radiographic abnormalities, including cyst formation and carpal malalignment, were reported in up to 43% of silicone implants despite acceptable short-term clinical outcomes. Modern metallic and patient-specific prostheses demonstrated improved resultsand implant removal required in a minority of cases. Functional outcomes, assessed by DASH and PRWE scores where available, showed significant postoperative improvement, and pain relief was reported in more than 90% of patients in larger titanium implant series. However, follow-up durations varied widely, ranging from 6 months to 43 years, and most studies consisted of small retrospective case series. Conclusions: Total scaphoid replacement has progressed from a spacer-based salvage concept to a patient-specific reconstructive strategy informed by anatomy and biomechanics. Quantitative evidence suggests that modern prostheses can achieve high rates of pain relief and acceptable complication profiles in carefully selected patients. Nevertheless, the current literature is limited by small sample sizes, heterogeneous methodologies, and a lack of long-term prospective data. Further studies with standardized outcome measures and dynamic assessment of wrist kinematics are required to define the long-term role of total scaphoid replacement. Full article

Background/Objectives: Postoperative monitoring of microvascular free flaps is critical for early detection of vascular complications and flap survival. Nurses play a central role in this process; however, qualitative evidence on their experiences and challenges remains limited. This study explored nurses’ experiences in free tissue flap care to identify clinical practices, challenges, and improvement needs. Methods: A phenomenological qualitative design was used. Data were collected through semi-structured interviews with nine nurses experienced in free tissue flap care, recruited via purposive and snowball sampling. Interviews were conducted online and lasted 30–45 min. Data were analyzed using content analysis with MAXQDA 2025. Inter-researcher reliability was 97%. Results: The findings were categorized into four main themes and seventeen subthemes: (1) clinical monitoring and evaluation in the care process, (2) challenges and difficulties, (3) emotional and professional reflections, and (4) suggestions for improving care. Nurses reported that flap care requires intensive monitoring, rapid decision-making, and close collaboration with physicians, especially within the first 24–48 h. Monitoring was largely based on observation and experience due to the lack of standardized protocols. Major challenges included high workload, frequent assessments, and donor site management. Emotional burden, stress, and responsibility were also prominent. Conclusions: Free flap care is a complex and demanding process for nurses. The lack of standardized monitoring tools and protocols is a key gap. Developing structured tools, improving training, and strengthening multidisciplinary collaboration may enhance patient safety and care quality. Full article

Background: Stabilization of surgical guides in fully edentulous patients remains a clinical challenge due to mucosal resilience and potential micromovement, even when fixation pins are used. Guide instability may affect drilling accuracy and overall workflow predictability. This proof-of-concept case series describes a stabilization approach based on pre-placed tripod reference implants with multi-unit coupling, designed to create a mechanically defined prosthetic docking platform for fully guided implant surgery. Methods: Three fully edentulous patients requiring implant-supported rehabilitation were treated using a two-stage protocol. Three temporary reference implants were inserted in a tripod configuration 7–10 days prior to definitive surgery. Multi-unit abutments were mounted on the reference implants, and intraoral scanning was performed to design a surgical guide indexed to the prosthetic interfaces. During implant placement, the guide was screw-retained to the reference implants via the multi-unit connections. Postoperative implant positions were evaluated radiographically by superimposing postoperative datasets onto the preoperative planning model. Intraoperative guide stability, surgical events, and early postoperative outcomes were recorded. Results: Stable guide fixation was achieved in all three cases without detectable intraoperative displacement. Implant placement was completed as planned in each patient, and removal of the temporary reference implants was uneventful. No intraoperative or early postoperative complications were observed. Mean coronal, apical, and angular deviations between planned and achieved implant positions were 0.70 ± 0.16 mm, 0.39 ± 0.13 mm, and 3.30 ± 0.59°, respectively. These preliminary findings, derived from four treated arches, were comparable to ranges reported in selected studies on fully guided implant surgery; however, no direct statistical comparison with previously published datasets was performed. Conclusions: Within the limitations of this proof-of-concept case series, temporary reference implants arranged in a tripod configuration provided a stable and reproducible prosthetic indexing platform for guided implant surgery in fully edentulous patients. Further prospective studies involving larger patient cohorts and controlled comparative designs with conventional mucosa-supported or fixation-pin-supported surgical guides are required to evaluate the reproducibility, clinical performance, and long-term applicability of this stabilization concept. Full article

Mucopolysaccharidosis (MPS) are a group of inherited lysosomal storage genetic disorders that affect the body’s ability to break down glycosaminoglycans (GAGs) due to the deficiency of required enzymes. This leads to depositions of these GAGs in various tissues and organs resulting in multi-systemic manifestations including pulmonary and sleep related issues. In recent years, there have been significant advancements in therapeutic options and supportive management which have led to the overall improvement in respiratory care, culminating in improved quality of life for MPS patients. Management of pulmonary and sleep disorders in mucopolysaccharidosis requires a multidisciplinary approach due to the multi-systemic affectation of the genetic disorders. Therapeutic options such as enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT) have yielded varying success in mitigating respiratory complications. Emerging treatments such as gene therapies have shown exciting and promising results thus far. Supportive therapies such as airway clearance, regular vaccination and use of positive airway pressure devices are also essential. Pre-operative airway and anesthesia planning is critical to mitigate peri-operative and post-operative complications. Early diagnosis, close monitoring and a patient focused individualized approach are essential for respiratory optimization and overall improvement in clinical outcomes. This review article aims to discuss these advancements in a comprehensive format, making it accessible to medical providers who care for this subset of patients. Full article