Íñigo Aragón Niño

Control of the pterygomaxillary junction (PMJ) fracture is critical in Le Fort I osteotomy. We tested whether a directed PMJ disjunction (osteotome-assisted intermediate release) improves fracture quality, symmetry, and alignment versus direct downfracture. Single-center retrospective comparative cohort (January 2019-April 2025). Two hundred five consecutive patients underwent Le Fort I: directed disjunction (n=127) or direct downfracture (n=78). Postoperative cone-beam computed tomography at day 90-110 was scored with a bilateral ten-point map. Primary outcomes were per-side quality (poor/good/excellent) and a patient-level overall quality status (poor/fair/good/very good/excellent). Inclusive and strict "clean-cut," symmetry, and alignment were predefined. Group comparisons used chi-square or Fisher's exact tests (two-sided α=0.05). Directed disjunction shifted side-level quality toward inferior, contained patterns: "excellent" 59.1% vs 6.4% (right) and 48.0% vs 12.8% (left); "poor" 22.0% vs 91.0% and 29.9% vs 85.9% (all p<0.001). Patient-level status improved (poor 38.6% vs 98.7%; excellent 37.8% vs 1.3%; p<0.001). Perfect symmetry rose to 49.6% vs 1.3% and correct alignment to 61.4% vs 1.3% (p<0.001). Maxillary tuberosity involvement decreased from 60.3%/56.4% (right/left) without disjunction to 2.4%/5.5% with disjunction. Inclusive and strict clean-cut were higher with directed disjunction (69.3% vs 37.2% and 53.5% vs 9.6%; p<0.001). Within a standardized early postoperative window, directed PMJ disjunction was associated with superior fracture quality, greater bilateral coordination, and fewer undesired trajectories than downfracture. Adoption of a targeted release and standardized reporting is supported. Interpretation is limited by the retrospective single-center design and focus on fracture behavior without complication or long-term outcome analysis.

Organic room temperature phosphorescence (RTP) materials offer high tumor‐to‐background imaging contrast owing to their long afterglow and minimal autofluorescence interference. In this work, a targeted phosphorescent nanoprobe is prepared based on a pyrene/benzophenone (PyBP) guest–host system and further functionalized it with folic acid and cyclic Arg‐Gly‐Asp peptide for enhanced tumor specificity. In oral squamous cell carcinoma (OSCC) xenograft models, this dual‐ligand nanoprobe can help achieve a four–fivefold increase in the tumor signal over the background. Notably, the previously unexplored relationship between tumor stiffness and RTP emission is studied. Mechanical and histological analyses confirmed increased stiffness in OSCC tissues. By modulating the rigidity of tumor phantoms and treating the xenografts with collagenase, a direct correlation is revealed between tumor stiffness and phosphorescence intensity. This study suggests the effectiveness of dual targeting in improving tumor visualization using guest–host‐doped RTP nanoprobes. The findings demonstrate that the biomechanical features of the tumor microenvironment enhance phosphorescence emission, highlighting tumor stiffness as a natural amplifier for RTP imaging.

The anterolateral thigh (ALT) flap is widely used in reconstructive surgery due to its versatility and favorable donor site characteristics. However, its harvest remains technically challenging, primarily due to the anatomical variability of the perforators. Experienced surgeons make intraoperative decisions based on anatomical knowledge, tactile feedback, and visual cues, but these skills may be underdeveloped in surgeons in training, increasing the risk of complications. To address this issue, we present “The Safety Check,” a simple and reproducible intraoperative test designed to assist trainees in decision-making during ALT flap harvest. This method is based on the visual assessment of arterial pulsatility along the course of perforators and the pedicle, formalizing a step that is often intuitive for experienced surgeons. The technique was applied in 52 cases over a 6-month period, with perforators monitored in three phases: before dissection, during dissection, and after dissection until flap elevation. Preliminary results showed that “The Safety Check” improved trainee confidence, facilitated the early identification of compromised perforators, and increased surgical efficiency without adding significant time to the procedure. Additionally, the method served as an educational tool, fostering active learning and intraoperative discussions. While no quantitative data were collected, qualitative feedback supported its value as an adjunct to training in perforator flap techniques.

This article presents a case of recurrent mandibular ameloblastoma treated with customized reconstructive surgery using a microvascularized DCIA bone flap. Virtual surgical planning and customized surgery, which has become increasingly adopted in head and neck reconstruction, enhances precision in tumor resection, flap design, and fixation, leading to superior functional and aesthetic outcomes. The patient, initially treated with curettage in China (2017) and Japan (2021), presented with recurrence upon relocating to Shanghai. Imaging confirmed the diagnosis, and customized surgery was planned due to the complexity of the case. The surgical approach involved patient-specific cutting guides for both the mandibular resection and iliac crest flap harvesting, ensuring precise bone segmentation and reconstruction. Contouring guides were used to optimize bone alignment, and a pre-bent titanium reconstruction plate was employed. Despite the advantages of customized surgery, its widespread implementation in China faces regulatory and financial challenges. Restrictions on patient-specific implants and high costs limit accessibility, but alternative techniques, such as contouring guides, help improve outcomes. As regulations evolve and technology advances, customized surgery is expected to become a standard approach, improving reconstructive care in complex cases.

Orthognathic surgery is performed to correct malocclusion and facial asymmetry. Although it usually involves young, healthy patients, it is important to bear in mind that facial deformities are sometimes a characteristic of many different syndromes. The aim of this paper is to analyze the main factors involved in the anaesthesia management of these patients. The anaesthesia management has an important influence on the results. This review analyzed key factors involved in the perioperative care of orthognathic surgery patients, including surgical procedure, airway and anaesthesia management. The discussion extended to bleeding control, postoperative nausea and vomiting (PONV), antibiotic prophylaxis, analgesia, and deep venous thrombosis prophylaxis (DVT). A comprehensive and careful anaesthesia management, with a multidisciplinary approach and the implementation of protocols, is essential for optimizing outcomes and accelerating recovery in orthognathic surgery.

Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures, including reconstruction, implantation, and craniofacial surgery. Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures, with the former demonstrating superior cost-effectiveness and reduced comorbidity rates, particularly in cases involving donor zones. However, a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens, with existing tools often yielding coarse particles at a high cost. Consequently, commercial bone xenograft solutions are frequently favored despite lower standards. This technical note introduces a novel technique for swiftly, safely, and efficiently obtaining autologous particulate bone specimens. The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles. The continuous irrigation with saline maintains a clear surgical field during the milling process. The collected bone particles are then transferred to a metal capsule for further use. This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods, providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.