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        <title>Frontiers in Surgery | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery</link>
        <description>RSS Feed for Frontiers in Surgery | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-10-25T23:44:38.31+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1949189</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1949189</link>
        <title><![CDATA[Chiari I malformation risk across anatomical subtypes of sagittal synostosis]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chenxu Kong</author><author>Linzhao Min</author><author>Jiajia Wang</author><author>Jia Wei</author><author>Zhenjiang Li</author><author>Xiaoqiang Wang</author>
        <description><![CDATA[BackgroundSagittal synostosis is increasingly recognized as a heterogeneous condition. Whether distinct anatomical phenotypes differ in Chiari type I malformation (CM-I) burden, and how posterior fossa morphology contributes to this heterogeneity, remains unclear.MethodsWe retrospectively studied 241 children with sagittal synostosis who underwent preoperative three-dimensional CT volumetry and MRI between January 2023 and December 2025. Patients were classified as anterior fossa–involved (Group A, n = 63), posterior fossa–involved (Group B, n = 53), or isolated sagittal synostosis (Group C, n = 125). Residualized posterior fossa volume (PFV_adj) was derived from PFV regressed on preoperative intracranial volume and age at surgery. ANCOVA and sequential logistic regression models were used, with Firth penalized regression as a sensitivity analysis.ResultsCM-I prevalence differed across subtypes (P = 0.012) and was highest in Group B (28.3%) versus Group A (11.1%) and Group C (12.0%). In the subtype-only model, Group B had higher CM-I odds than Group C (OR = 2.89, 95% CI 1.29–6.48; P = 0.010). Group B also showed significantly lower PFV_adj (P < 0.001). In morphology-adjusted analyses, greater tentorial angle (OR = 3.20 per 5°, 95% CI 2.10–4.88; P < 0.001) and lower PFV_adj (OR = 0.74 per 10 mL, 95% CI 0.62–0.89; P = 0.002) were associated with CM-I. Model AUC increased numerically from 0.869 to 0.885 after adding PFV_adj. Firth regression yielded consistent results.ConclusionsThe posterior fossa–involved phenotype carries the greatest overall CM-I burden and is characterized by relative posterior fossa deficiency and a steeper tentorial configuration. PFV_adj provides a developmentally adjusted measure that complements anatomical subtype classification.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1948532</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1948532</link>
        <title><![CDATA[Femoral nerve compression by an iliopsoas bursal cyst coexisting With lumbar spinal stenosis: a case report]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yongdong Zhou</author><author>Shanzhi Li</author><author>Hongyi Kang</author><author>Bangjian Zhou</author><author>Wenping Liu</author><author>Haoduan Dou</author><author>Rui Tang</author>
        <description><![CDATA[BackgroundIliopsoas bursal cysts are rare synovial proliferative lesions, most commonly associated with osteonecrosis of the femoral head, osteoarthritis, and rheumatoid arthritis. When a cyst compresses the femoral nerve, it may cause groin pain, radiating anterior thigh pain, and an antalgic gait, closely mimicking lumbar spinal stenosis (LSS). Only approximately 20 comparable cases of femoral nerve compression have been documented worldwide. Concomitant LSS and femoral nerve compression by an iliopsoas bursal cyst have not previously been reported. The coexistence of LSS and femoral nerve compression caused by an iliopsoas bursal cyst may result in delayed or missed diagnosis.Case presentationWe report a patient with concomitant LSS and femoral nerve compression caused by an iliopsoas bursal cyst who was initially treated for LSS alone. After 3 days of integrative conservative treatment for LSS, the low-back, posterior thigh, and lateral calf pain improved substantially; however, the right anterior thigh and groin pain became intolerable. Subsequent hip ultrasonography and magnetic resonance imaging (MRI) demonstrated an iliopsoas bursal cyst adjacent to the femoral nerve. Available electromyography findings showed a reduced right femoral nerve response amplitude. Considering the patient's overall clinical presentation, we considered right femoral nerve injury to be the most likely diagnosis. The patient underwent open anterior cyst excision to achieve complete neural decompression. The anterior thigh pain improved rapidly, with the visual analog scale (VAS) score decreasing from 8 to 2 on postoperative day 1. No symptom recurrence was observed during 12 months of follow-up.ConclusionThis case provides an important clinical warning. In older patients with chronic occupational musculoskeletal overuse, extraspinal femoral nerve compression should be considered when treatment for LSS relieves low-back and posterior thigh pain but severe anterior thigh or groin pain persists or worsens. Hip Doppler ultrasonography, MRI, and electromyography/nerve conduction studies should be performed to exclude extraspinal femoral nerve compression. In patients with severe cyst-related femoral nerve compression, open cyst excision can provide rapid neural decompression.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1877169</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1877169</link>
        <title><![CDATA[Perioperative outcomes and tissue trauma after uncomplicated total hysterectomy for benign uterine disease: a retrospective study]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Corrado Terranova</author><author>Andi Stermasi</author><author>Roberto Montera</author><author>Carlo De Cicco Nardone</author><author>Daniela Luvero</author><author>Federica Guzzo</author><author>Gianna Barbara Cundari</author><author>Adele Silvagni</author><author>Arianna Martinelli</author><author>Erika Notaro</author><author>Nicola Alboré</author><author>Roberto Angioli</author><author>Francesco Plotti</author>
        <description><![CDATA[BackgroundHysterectomy is the most frequently performed non-obstetric gynecological surgery for benign disease, and the surgical route affects perioperative outcomes and recovery. While minimally invasive approaches reduce surgical morbidity, their relative effect on the systemic inflammatory response remains incompletely characterized, particularly when indication and case complexity are accounted for. We compared tissue trauma, operative data, and early postoperative outcomes after uncomplicated vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and abdominal hysterectomy (AH).MethodsWe retrospectively reviewed women aged 25–80 years who underwent total hysterectomy for benign indications at our institution (2021–2024). Patients with malignant disease, chronic inflammatory conditions, prophylactic drains, or complicated postoperative courses were excluded. Primary endpoints were postoperative C-reactive protein (CRP) levels and white blood cell (WBC) and neutrophil (Neu) count trajectories over the first three postoperative days; secondary endpoints were hemoglobin drop, operative time, blood loss, bowel function recovery, and length of stay. Multivariable models adjusted for age, body mass index, American Society of Anesthesiologists (ASA) physical status, surgical indication, and previous abdominal surgery, with uterine weight assessed in a sensitivity analysis; trajectories were modelled with linear mixed-effects models, and the route effect was examined within a single-indication (fibromatosis) subgroup.ResultsWe included 281 patients (84 VH, 86 LH, 111 AH). AH and LH required longer operative times than VH, and AH was additionally associated with higher blood loss, delayed gastrointestinal recovery, and longer hospitalization. In unadjusted analyses AH showed the highest CRP at all three days and higher WBC and neutrophil counts on Days 1 and 2; the haematological differences were attenuated after adjustment, whereas the CRP elevation persisted. Because route, indication, and uterine size were strongly collinear, the route effect was examined within the fibromatosis subgroup, where AH remained independently associated with higher CRP than LH across all postoperative days.ConclusionsAfter uncomplicated hysterectomy for benign disease, surgical route was independently associated with the postoperative systemic inflammatory response. AH carried a greater inflammatory burden and slower functional recovery, whereas VH and LH were broadly comparable; compared with LH, VH showed faster recovery and certain perioperative advantages. Minimally invasive techniques should be prioritized when clinically feasible.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1860161</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1860161</link>
        <title><![CDATA[Association of composite liver function indices with trauma-induced coagulopathy in adult trauma patients]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jiejun Hu</author><author>Xinxin Chen</author><author>Jiao Bao</author><author>Weichao Lu</author><author>Manzhen Ying</author>
        <description><![CDATA[ObjectiveTrauma-induced coagulopathy (TIC) is a life-threatening complication associated with uncontrolled hemorrhage and high mortality in critically ill trauma patients. This study aimed to evaluate the associations and discriminative performance of four composite liver-function indices—ALBI, TBil/ALB, DBil/TBil, and GGT/ALP—with TIC-related outcomes in adult trauma patients.MethodologyThis single-center retrospective cohort study included 634 adult trauma patients. Laboratory data were collected at baseline, 24 h after admission, and 48 h after admission. The primary outcome was the continuous ISTH DIC score assessed 48 h after admission. Overt DIC, non-overt DIC, and ATC were analyzed as secondary or exploratory TIC-related outcomes. Multivariable models adjusted for age, sex, admission lactate, admission pH, admission temperature, traumatic brain injury, hepatic injury, and surgery. Associations between each index and TIC-related outcomes were examined using multivariable linear and logistic regression analyses.ResultsALBI showed the most consistent associations with TIC-related outcomes and the strongest index-alone discrimination for non-overt DIC among the evaluated indices. The TBil/ALB ratio retained independent predictive value, though with somewhat lower overall consistency. The DBil/TBil and GGT/ALP ratios, by contrast, exhibited weaker associations that varied across time points and outcome definitions. Serial measurements over the first 24 h contributed incremental prognostic information; however, no dynamic index outperformed the baseline ALBI score in predictive strength.ConclusionALBI was consistently associated with TIC-related outcomes assessed 48 h after admission, and this association remained stable across the examined clinical subgroups. ALBI may serve as a readily available adjunctive risk marker for early coagulopathy risk stratification. Prospective validation is warranted before clinical implementation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1997449</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1997449</link>
        <title><![CDATA[Case Report: Simultaneous continuous renal replacement therapy and endovascular coiling in a poor-grade ruptured distal anterior cerebral artery aneurysm with ESKD and life-threatening hyperkalemia]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhifu Song</author><author>Yulan Gan</author><author>Xueping Huang</author><author>Wenyou Wu</author>
        <description><![CDATA[BackgroundPoor-grade aneurysmal subarachnoid hemorrhage (aSAH) in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis has traditionally been considered futile. Uremic platelet dysfunction and coagulopathy, electrolyte disturbances, and poor multi-organ reserve make these patients poor candidates for aggressive intervention. When a ruptured aneurysm coexists with life-threatening hyperkalemia, the therapeutic window narrows further, because severe hyperkalemia significantly increases the risk of perioperative arrhythmia and cardiac arrest and requires urgent correction. Continuous renal replacement therapy (CRRT) may offer advantages in this setting, but its use during neurointerventional procedures has rarely been reported.Case reportA 43-year-old woman with polycystic kidney disease and ESKD on regular hemodialysis presented with sudden coma and was diagnosed with Hunt-Hess grade V aSAH from a ruptured distal anterior cerebral artery (DACA) aneurysm. After 5 days of intensive care, her neurological status improved sufficiently to consider intervention. However, she developed life-threatening hyperkalemia (potassium 7.6 mmol/L). We performed simultaneous continuous renal replacement therapy (CRRT) and endovascular coiling. No anticoagulation was used in the CRRT circuit; intravenous heparin 0.67 mg/kg was administered separately for the neurointerventional procedure. CRRT was delivered in CVVHDF mode with a net ultrafiltration rate of 1−2 mL/kg/h and a total clearance of approximately 57 mL/kg/h, maintaining hemodynamic and intracranial stability throughout the 2-hour procedure. The aneurysm was completely obliterated (Raymond class I), and potassium decreased to 5.2 mmol/L. The patient recovered neurologically postoperatively but developed refractory bleeding during tracheostomy due to uremic platelet dysfunction and coagulopathy, ultimately leading to airway complications and death at 3 months.ConclusionSimultaneous CRRT and endovascular coiling was technically feasible in this carefully selected patient with poor-grade aSAH, ESKD, and life-threatening hyperkalemia. However, this is a single-case experience and cannot be generalized, and perioperative bleeding and airway management remained challenging.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1911891</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1911891</link>
        <title><![CDATA[Correlation of opportunistic bone mineral density assessment derived from CT images with physical functioning in long-term follow-up in patients with rib fractures]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Benedikt Heyart</author><author>Daniele Romeo</author><author>Ulrich Spiegl</author><author>Christian Kleber</author><author>Sebastian Krämer</author><author>Timm Denecke</author><author>Hans-Jonas Meyer</author>
        <description><![CDATA[ObjectiveQuality of life assessment is strictly related to patients physical functioning. Despite the fact that earlier research has concentrated on the role of osteoporosis, the question of whether opportunistic bone mineral density (BMD) assessment can assist in determining physical functioning remains unresolved. This exploratory analysis aims to elucidate whether the opportunistic BMD assessment defined by computed tomography (CT) images is associated with quality of life in long-term follow-up in patients with traumatic rib fractures.MethodsAll patients had rib fractures without polytrauma. A total of 72 patients, including 27 female patients (37.5%), with a median age of 60 years, were included in the present study. Contrast-enhanced CT imaging was obtained and vertebral trabecular attenuation in HU at Th12 level was measured. CT scans were perfomed using a tube voltage of 120 kVp. Quality of life was assessed using the Short Form 36-Item Health Survey (SF-36) no earlier than four years after trauma.ResultsOpportunistically measured BMD obtained at 120 kVp showed a moderate correlation with the physical functioning (PF) with a r = 0.43 (p ≤ 0.001). The severely impaired PF group showed a significantly lower level of vertebral trabecular attenuation with a median value of 118 HU compared to 172 HU of the non-impaired group (p = 0.004). CT-derived BMD showed a moderate predictive ability for severely impaired PF (AUC = 0.78) with a cut-off level of 132 HU.ConclusionCT-derived opportunistic BMD measurement at Th12 level is correlated with severe physical functioning impairment in patients with rib fractures in long-term follow-up. The potential role of CT images in patients with traumatic rib fractures, beyond diagnostic purposes, needs further assessment.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1979979</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1979979</link>
        <title><![CDATA[Catastrophic acetabular wear following polyethylene liner dissociation with locking-tab damage after total hip arthroplasty: a case report]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Weida Li</author><author>Zhixing Liang</author><author>Zhuangzhuang Dong</author><author>Qian Sun</author><author>Yu Hou</author>
        <description><![CDATA[BackgroundPolyethylene liner dissociation is an uncommon but potentially severe complication of total hip arthroplasty (THA). Loss of the intended bearing interface can permit direct femoral-head–acetabular-shell articulation, with progressive shell wear, metallic debris deposition, and acetabular bone loss.Case presentationA 73-year-old woman developed left hip pain after an accidental sprain in February 2025, having reported no hip-related symptoms after primary THA in 2020. The index Mindray implants included a 48-mm acetabular shell, a highly cross-linked polyethylene liner, a 28-mm femoral head, and a size-10 stem. Radiographs and CT with three-dimensional volume-rendered reconstruction were used to assess acetabular bone loss, classified as Paprosky type IIA. Revision revealed polyethylene liner dissociation, catastrophic shell wear-through, extensive black metallic debris deposition, and a well-fixed femoral stem. Partial locking-tab damage was identified on gross inspection, but formal retrieval analysis was not performed. Acetabular revision with iliac-crest autografting was performed while retaining the femoral stem. At 6 months, the Harris Hip Score improved from 46 to 82, and radiographs showed a stable acetabular component with evidence of graft incorporation.ConclusionThis case illustrates the potential for clinically occult progression from liner dissociation to catastrophic head-on-shell wear. Gross locking-tab damage did not establish the initiating failure mechanism. Component-preserving acetabular revision was associated with a favorable short-term clinical and radiographic outcome in this patient.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1954682</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1954682</link>
        <title><![CDATA[Comparison of short- to mid-term outcomes between DAA hemiarthroplasty and PFNA internal fixation in elderly patients with trochanteric fractures: a propensity score-matched retrospective study]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yanfeng Jia</author><author>Liqun Xu</author><author>Hongwei Bao</author><author>Jingzhao Hou</author><author>Zhao Wang</author>
        <description><![CDATA[BackgroundTrochanteric fractures (TF) are common in elderly patients. Although Proximal Femoral Nail Antirotation (PFNA) internal fixation is widely used, hemiarthroplasty via the direct anterior approach (DAA) has attracted increasing interest because of concerns regarding prolonged bed rest and associated complications. This study compares early outcomes of DAA hemiarthroplasty vs. PFNA internal fixation in elderly TF patients.MethodsPatients aged ≥75 years with TF treated between January 2018 and January 2024 were retrospectively reviewed. After application of the inclusion and exclusion criteria, 54 patients who underwent DAA hemiarthroplasty were identified. To minimize selection bias, 1:1 propensity score matching was performed based on age, sex, body mass index (BMI), fracture type, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) grade, yielding 54 matched patients who received PFNA. Outcomes included operative duration, blood loss, incision length, bedridden duration, Harris Hip Scores (HHS) at 1, 3, 6, 12, and 24 months, complications, and radiographic findings.ResultsAfter matching, baseline characteristics were well balanced between the two groups. The PFNA group had significantly less blood loss (220.3 vs. 349.6 mL, P < 0.001) and a shorter operative time (40.05 vs. 75.02 min, P < 0.001), but a longer total incision length (11.49 vs. 9.29 cm, P < 0.001). Bedridden duration was markedly shorter in the DAA group (0.99 vs. 52.86 days, P < 0.001). At all follow-up points, HHS was significantly higher in the DAA group (1 month: 78.85 vs. 63.89, P < 0.001; 24 months: 92.03 vs. 82.86, P < 0.001). Complication rates were lower in the DAA group, although the difference did not reach statistical significance. Mean prosthesis subsidence in the DAA group was 2.7 mm.ConclusionIn this propensity score-matched retrospective study, DAA hemiarthroplasty was associated with faster early functional recovery and a shorter bedridden duration than PFNA internal fixation in elderly patients with TF, but also with a longer operative time and greater blood loss. The substantial difference in postoperative rehabilitation protocols between the two groups may have contributed to the observed gap in functional outcomes.Study designLevel of evidence, 3.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1964665</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1964665</link>
        <title><![CDATA[Short-term clinical and radiographic outcomes of arthroscopic-assisted uni-portal spinal surgery discectomy with versus without ligamentum flavum preservation: a retrospective comparative cohort study]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yuan Jiang</author><author>Shijie Fan</author><author>Tianyu Qin</author><author>Haoxiang Chen</author><author>Bo Wang</author><author>Feng Hu</author><author>Jialin Chen</author><author>Yumeng Du</author><author>Jie He</author><author>Houqing Long</author><author>Wei Guo</author>
        <description><![CDATA[BackgroundTo compare ligamentum flavum preservation vs. resection during AUSS for single-level lumbar disc herniation and evaluate the clinical value of preservation in this setting.MethodsThis retrospective comparative cohort study included 65 patients (Sept 2024–Sept 2025): Group A (preservation, n = 30) and Group B (resection, n = 35). Both underwent AUSS-assisted nucleotomy. Outcomes included operative parameters, complications, VAS for low back and leg pain, ODI, modified MacNab criteria, and imaging parameters (spinal canal cross-sectional area and sagittal and transverse diameters). Assessments were VAS preoperatively and at day 2; ODI preoperatively and at day 2, 1 month, and 3 months; MacNab at 3 months; disc height preoperatively and at 3 months; and CT preoperatively and at 3 and 6 months (65/65/65).ResultsOperative time, blood loss, and hospital stay did not differ significantly (P > 0.05). Both groups showed significant postoperative improvements in VAS and ODI vs. baseline (P < 0.05), with no intergroup differences (P > 0.05). At 3 months, good/excellent MacNab rates were 96.7% in Group A vs. 88.6% in Group B (P = 0.396). Both groups had significant increases in all canal dimensions vs. preoperative values (P < 0.05). At 3 months, Group A had larger postoperative cross-sectional area and transverse diameter than Group B (P = 0.047 and P = 0.002); these represented between-group differences in postoperative values, not improvement magnitude. At 6 months, Group A had larger cross-sectional area (320.6 vs. 233.7; unadjusted P < 0.001, Holm-adjusted P = 0.002) and transverse diameter (22.7 vs. 17.3 mm, P < 0.001), whereas Group B's transverse diameter fell below preoperative level. Sagittal diameter showed no intergroup difference (all P > 0.05). Complications occurred in 1/30 (3.3%) and 2/35 (5.7%) patients (Fisher exact P = 1.000); revision surgery was a subsequent intervention in one of the two patients with complications.ConclusionIn this single-center retrospective cohort, both preservation and resection during AUSS were accompanied by postoperative improvement in clinical scores; short-term clinical outcomes were broadly similar, with differences only in CT-measured canal dimensions at some time points. The clinical relevance of these radiographic differences remains uncertain, and the study cannot establish equivalence, long-term efficacy, or a specific pathological mechanism.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1953154</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1953154</link>
        <title><![CDATA[Reconstruction of a fibrous pseudo-patella in total knee arthroplasty after patellectomy: a function-preserving strategy via intraoperative soft tissue balancing and postoperative rehabilitation– a case report]]></title>
        <pubdate>2026-10-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhibing Wang</author><author>Xingwang Cheng</author><author>Xia Zhang</author>
        <description><![CDATA[BackgroundTo report the clinical outcomes in a case of severe osteoarthritis secondary to patellectomy 40 years earlier and successfully treated with the function-preserving strategy via fibrous scar tissue extension in total knee arthroplasty (TKA) and postoperative rehabilitation program.MethodsA 59-year-old male patient presented with severe osteoarthritis secondary to the left patellectomy due to trauma 40 years earlier. Intraoperative exploration revealed dense fibrous scar tissues measuring approximately 4.0 cm × 3.0 cm × 1.5 cm at the original patellectomy site. The patient was treated with a function-preserving strategy involving preservation and reshaping of residual fibrous scar tissue into a fibrous pseudo-patella prior to TKA and postoperative rehabilitation, instead of traditional bony patella reconstruction. The fibrous scar tissues acted as a natural alternative to the patella (fibrous pseudo-patella) through extensive lateral retinaculum release and medial capsular tightening to balance soft tissues, and allowed the further TKA using a semi-constrained prosthesis. Postoperatively, the patient was managed by a rehabilitation program for strengthening the quadriceps femoris muscle. Follow-up visits were conducted at 6 weeks, 3 months, and 1 year.ResultsThe patient benefited from an immediate postoperative pain relief of the knee. Quadriceps strength increased markedly at 6 weeks postoperatively, indicating a full restoration of active knee extension. At the 3-month follow-up, the patient regained functional knee range of motion (ROM) of 0°−120°, and was able to independently squat and stand. The 1-year imaging assessment showed an optimal prosthesis positioning and a stable trajectory of the fibrous pseudo-patella. In addition, the patient presented normal gait patterns at 1 year postoperatively.ConclusionResidual fibrous scar tissues with sufficient volume and biomechanical strength could be shaped into a natural alternative to the patella through soft tissue balancing, and our function-preserving strategy combining semi-constrained TKA with postoperative rehabilitation might realize an effective and safe post-patellectomy recovery.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1970956</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1970956</link>
        <title><![CDATA[Hydrogel and scaffold strategies for talar osteochondral repair: biofabrication, ankle biomechanics, and clinical translation]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Qi Zhu</author><author>Zhengyu Liu</author><author>Beibei Chen</author><author>Jun Cui</author>
        <description><![CDATA[Osteochondral lesions of the talus combine focal cartilage injury with variable subchondral bone damage in a small, highly loaded joint, making successful biomaterial translation dependent on more than regenerative capacity alone. This review examines hydrogel, scaffold, and biofabrication strategies for talar osteochondral repair through the combined lenses of ankle biomechanics, spatial construct design, and clinical feasibility. Defect containment, shoulder involvement, cystic depth, instability, and alignment alter the requirements for conformal filling, wet-field retention, cyclic compression and shear tolerance, and cartilage-bone anchorage. Recent biofabrication approaches, including gradient and multilayer scaffolds, 3D-printed architectures, decellularized extracellular-matrix hydrogels, directional microchannels, and adhesive or bioactive systems, provide increasing control over spatial organization and mechanical transitions, but most remain preclinical. Human studies support the feasibility of matrix- and scaffold-assisted talar repair, including autologous matrix-induced chondrogenesis, collagen- and hyaluronic acid-based platforms, cell-supported constructs, and related one-step procedures; however, heterogeneous lesion selection, concomitant bone grafting, instability correction, rehabilitation, imaging, and follow-up limit direct material-level comparisons. The central translational question is whether a material architecture addresses the dominant mechanical and surgical requirements of a defined talar lesion. Evaluation should therefore integrate wet-field handling, edge and interface stability, cyclic loading, bone-side integration, degradation under load, manufacturing reproducibility, and lesion-stratified clinical outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1956628</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1956628</link>
        <title><![CDATA[Intranasal teeth: a narrative review of clinical features, diagnosis and management]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Sai Hu</author><author>Yatian Liu</author><author>Xiuli Gao</author><author>Haijiao Zhao</author><author>Guangtao Liu</author><author>Chunchun Chen</author><author>Xinyang Jin</author><author>Yuxuan Yang</author><author>Sicong Ren</author><author>Xv Huang</author>
        <description><![CDATA[BackgroundIntranasal teeth are rare ectopic teeth situated wholly or partly within the nasal cavity. Because the evidence is dominated by case reports and terminology and anatomical boundaries vary across reports, diagnostic assessment and management have not been standardised. This review characterises the clinical presentation and synthesises patient-level evidence relevant to imaging, operative planning and multidisciplinary management.MethodsWe conducted a structured narrative review of PubMed, Embase, Web of Science and Scopus, supplemented by citation searching. Reports were eligible when a tooth entered or projected into the nasal cavity; teeth confined to a paranasal sinus without nasal-cavity involvement were excluded from the dataset. The included reports were critically appraised using the appropriate JBI checklist for case reports or case series.ResultsThe dataset comprised 139 articles and 170 patient records. Age was reported for 169 patients (median 24.0 years, range 1.67–78), and sex for 169, of whom 107 (63.3%) were male. Supernumerary teeth were reported in 121 records (71.2%), and nasal-floor involvement in 135 (79.4%). The most frequently reported manifestations were nasal obstruction (n = 94), rhinorrhoea or purulent discharge (n = 73), mass or foreign-body sensation (n = 50), epistaxis (n = 46), and pain (n = 44). Any imaging was documented in 166 records (97.6%), including CT, CBCT or MSCT in 117 (68.8%). Removal or direct extraction was performed in 157 records (92.4%). Critical appraisal identified limitations in adverse-event reporting and post-treatment outcome reporting.ConclusionsCT or CBCT interpreted with nasal endoscopy and oral examination provides the basis for confirming tooth identity, defining three-dimensional anatomy and selecting operative access. Endoscopic transnasal removal is the predominant published approach, whereas deeply embedded nasal-floor or nasal-maxillary-junction teeth may require oral or combined access. Management should be individualised according to symptoms, anatomical depth, procedural risk and the feasibility of surveillance. The case-based evidence does not support comparative claims between approaches.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1965112</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1965112</link>
        <title><![CDATA[Intracranial pulsatile pressure gradient: a hypothesis and the potential role of dual intracranial pressure monitoring]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Hypothesis and Theory</category>
        <author>Georgios Tsermoulas</author>
        <description><![CDATA[Intracranial pressure (ICP) monitoring is widely used in neurosurgical practice and the two key ICP variables, mean pressure and pulse amplitude, provide important information about intracranial compliance and cerebrospinal fluid dynamics. Mean ICP is assumed to be uniformly distributed and monitoring at a single intracranial location is considered representative of global ICP, but whether pulse amplitude is spatially uniform within the intracranial cavity remains uncertain. This article proposes the hypothesis that ICP waves undergo spatial attenuation within the skull resulting in an intracranial pulsatile pressure gradient. The hypothesis is supported by physiological principles of wave propagation and by evidence demonstrating attenuation of pressure waves along the craniospinal axis, although intracranial attenuation has not yet been experimentally demonstrated. This manuscript proposes that this hypothesis could be investigated using synchronous ICP measurements at two intracranial sites separated by a defined distance. It also describes the concept of a dual-sensor intracranial catheter, incorporating deep and superficial pressure sensors, that could provide simultaneous measurements and quantify the hypothetical spatial attenuation. Demonstrating an intracranial pulsatile pressure gradient could provide new insights into intracranial hydrodynamics and the interpretation of ICP pulsatility, with potential implications for neurosurgical conditions including traumatic brain injury, normal pressure hydrocephalus, idiopathic intracranial hypertension, and Chiari malformation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.2004471</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.2004471</link>
        <title><![CDATA[Cauda equina cavernous malformation with nerve fascicle involvement and chronic bowel and urinary urgency: a case report]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Shumei Wang</author><author>Jifeng Shang</author>
        <description><![CDATA[BackgroundCavernous malformations of the cauda equina can resemble nerve sheath tumors. Their relationship to functioning nerve fibers complicates surgical decision-making, and preserved motor strength alone may not capture postoperative morbidity.Case descriptionA 51-year-old woman presented with four years of low back discomfort, numbness of the right fourth and fifth toes, with occasional later numbness of the left fourth and fifth toes, and progressive bowel and urinary urgency without incontinence or weakness. Preoperative MRI demonstrated an approximately 11 × 10 × 15 mm intradural extramedullary nodule at L2, with mildly increased T1 signal, heterogeneous low T2 signal, and heterogeneous enhancement. A cavernous malformation and a neurogenic tumor were considered. At surgery, a gray-purple vascular lesion displaced the cauda equina roots, with a substantial nerve bundle traversing the mass. Most fascicles were separated; a small inseparable portion was coagulated and divided to permit complete excision. Reported motor and somatosensory evoked potentials remained within normal limits; pathology was labeled “cavernous hemangioma.” Postoperatively, bilateral hip pain with intermittent leg radiation improved with treatment, although mildly effortful urination was documented on postoperative day 7. At discharge on day 10, strength was grade 5 and no superficial sensory deficit was recorded. Postoperative MRI was obtained approximately four months after surgery. Longer-term autonomic outcomes were not documented.ConclusionThis case highlights the need to consider a cavernous malformation in the differential diagnosis of an L2 intradural mass and to report autonomic and pain outcomes separately from motor preservation after resection involving adherent nerve fascicles.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1767111</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1767111</link>
        <title><![CDATA[Robot-assisted laparoscopic augmentation ileocystoplasty for neurogenic bladder: case report and structured literature review]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jia You</author><author>Cheng Lan</author><author>Xu-fei Duan</author><author>Hai-tao Chen</author>
        <description><![CDATA[BackgroundBladder augmentation is generally reserved for selected patients failing conservative management or with unsafe storage pressures/compliance for neurogenic bladder (NGB) patients. The robotic-assisted laparoscopic approach for urinary issues has gained attention. This study evaluates the feasibility and safety of robot-assisted laparoscopic augmentation ileocystoplasty (RALAI) in treating NGB.MethodsWe present a case study of an 8.7-year-old male patient diagnosed with NGB, characterized by a preoperative bladder capacity of 198 ml, compliance of 13.6 ml/cm H2O, maximum detrusor pressure of 24 cm H2O, and a post-void residual volume of 250 ml. The patient underwent RALAI with the creation of a Mitrofanoff conduit. Subsequently, we conducted a comprehensive literature review on RALAI for NGB patients, covering the period from January 1, 2004, to December 31, 2024, utilizing databases such as PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang. The search employed keywords including “neurogenic bladder,” “ileocystoplasty,” and “robot.”MeasurementsThe primary objective was to ascertain the surgical success rate of RALAI without conversion to open surgery. Secondary objectives included assessing complications within 90 days postoperatively, such as stomal complications, intestinal issues, and infections.ResultsThe RALAI procedure was completed without conversion to open surgery in 86/92 patients (93.5%, 95% CI 88.4–98.5%), with a conversion rate of 6.5% (95% CI 1.6–11.4%). No intraoperative complications (e.g., visceral injury, hemorrhage or anesthetic events) directly attributable to the surgical technique were recorded). In the pooled cohort of 92 patients, the RALAI procedure demonstrated favorable patient-centred outcomes: postoperative bladder capacity increased substantially in the majority of reported cases; the rate of early postoperative complications was 38.0% (95% CI 28.1–48.0%), with 13.0% (95% CI 6.2–19.9%) requiring secondary surgical revision. Urinary tract infections occurred in 14.1% of patients. In our own index case, the patient achieved bladder capacity of 380 ml and social continence, resumed intermittent catheterization and spontaneous voiding, and remained free of urinary tract infections (UTIs) and bladder stones at 3 years.ConclusionsOur findings indicate that RALAI is a feasible minimally invasive option for selected NGB patients, with a conversion rate of approximately 6.5%. However, the true value of the procedure should be assessed by patient-centred outcomes, which our pooled data suggest are promising.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1938654</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1938654</link>
        <title><![CDATA[Severe delayed gastric emptying combined with enteroparalysis after pancreaticoduodenectomy: a case report]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhili Wan</author><author>Dingquan Wu</author><author>Yuhang Yang</author><author>Guizhong Li</author><author>Bin Liu</author><author>Yongfan Chen</author><author>Liangbi Zhou</author>
        <description><![CDATA[BackgroundPancreaticoduodenectomy is an important surgical procedure for treating diseases of the pancreatic head, periampullary region, and related conditions. However, due to its extensive surgical scope, long duration, and involvement of complex digestive tract reconstruction, postoperative gastrointestinal dysfunction remains relatively common. Among these, delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy, while the occurrence of severe DGE combined with enteroparalysis is relatively rare, and its diagnosis and treatment remain challenging.Case presentationThis article reports the case of a 69-year-old female patient who developed severe DGE complicated by intestinal paralysis after pancreaticoduodenectomy. The patient persistently experienced nausea, vomiting, and the inability to tolerate oral intake postoperatively. Although imaging studies suggested restricted passage at the gastrointestinal anastomosis, raising suspicion of obstruction, further laparoscopic exploration and gastroscopy revealed no definite mechanical obstruction. The patient received gastrointestinal decompression, nutritional support, internal environment management, and rehabilitation therapy. Enteral nutritional support was established through a jejunal feeding tube. After long-term comprehensive treatment, the patient's gastrointestinal function gradually recovered and eventually returned to oral intake. However, long-term follow-up showed that despite the recovery of gastrointestinal function, the patient still had a certain degree of decline in physical function and limited ability in activities of daily living.ConclusionSevere delayed gastric emptying complicated by enteroparalysis after pancreaticoduodenectomy is a rare but clinically challenging gastrointestinal dysfunction. This case suggests that persistent postoperative gastrointestinal dysfunction may present with clinical features resembling mechanical obstruction, therefore requiring comprehensive assessment integrating imaging, endoscopy, and dynamic clinical changes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.2007970</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.2007970</link>
        <title><![CDATA[Editorial: Alloplastic materials and emerging technologies in reconstructive and plastic surgery: an evidence based state-of-the-art]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Giuseppe Cottone</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1944619</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1944619</link>
        <title><![CDATA[Adjunctive screw fixation and screw corridors for spiral tibial fractures involving the distal tibial articular surface: a retrospective case series]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xianjie Ai</author><author>Zhimeng Wang</author><author>Yuhang Liu</author><author>Chengcheng Zhang</author><author>Hongfei Qi</author><author>Shuai Ji</author><author>Bing Du</author><author>Zhong Li</author><author>Ming Li</author><author>Bo Wu</author>
        <description><![CDATA[ObjectiveBuilding on a CT-based regional evaluation framework developed in our previous morphological study, this study retrospectively summarized the adjunctive screw corridors actually used and their fixation targets in spiral tibial fractures involving the distal tibial articular surface that were treated with intramedullary nailing combined with adjunctive screw fixation, and used representative intraoperative and postoperative images to illustrate the relationship between the adjunctive screws and the intramedullary nail.MethodsThis was a single-center retrospective case series of patients with spiral tibial fractures involving the distal tibial articular surface who underwent tibial intramedullary nailing combined with adjunctive screw fixation at the Department of Lower Limb Trauma, Honghui Hospital, Xi'an Jiaotong University, between May 2020 and May 2025. During the study period, 110 patients were treated with this combined fixation; 98 patients with a follow-up duration of at least 12 months and complete clinical and imaging records were included in the analysis, and 12 patients were excluded because of insufficient follow-up or incomplete imaging records. Two observers independently assessed the involvement of the posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region on preoperative CT, and Cohen's kappa was calculated from the original independent assessments obtained before consensus discussion. The four types of adjunctive screw corridors actually used were retrospectively summarized from operative records and postoperative imaging. All patients underwent adjunctive screw fixation before reaming and intramedullary nail insertion. Corridor use was summarized using descriptive statistics, and perioperative variables, time to full weight bearing, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS) pain score, the difference in ankle dorsiflexion angle between the affected and contralateral sides, and related complications were recorded.ResultsA total of 98 patients were included, comprising 62 men and 36 women, with a mean age of 45.67 ± 13.61 years. The posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region were involved in 76 (77.6%), 40 (40.8%), and 23 (23.5%) patients, respectively; single-region, two-region, and three-region involvement was present in 64, 27, and 7 patients. Interobserver agreement for the individual regions and for their combinations ranged from 95.9% to 98.0%, with kappa values of 0.924–0.957. The tibiofibular incisura, anterior cortical, posterior cortical, and medial malleolar corridors were used in 93, 8, 7, and 6 patients, respectively; 87 patients received a single corridor and 11 received multiple corridors. The number of adjunctive screws ranged from 1 to 4, with a mean of 1.23 ± 0.62. Mean operative time was 73.45 ± 7.88 min, mean intraoperative blood loss was 67.56 ± 10.46 mL, and mean follow-up was 16.13 ± 2.20 months. Ninety-seven patients were included in the analyses of time to full weight bearing and final functional outcomes. Mean time to full weight bearing was 64.81 ± 16.91 days; at the final follow-up, the mean AOFAS ankle-hindfoot score was 91.67 ± 3.13, the mean VAS pain score was 1.36 ± 0.50, and the mean difference in ankle dorsiflexion angle between sides was 6.06 ± 3.27 degrees. Two patients developed delayed healing of the anterior ankle incision used for distal locking screws, which healed after dressing changes, and one patient developed an infection at the tibial shaft fracture site and was treated with implant removal and antibiotic-loaded bone cement. Among the 98 patients with complete follow-up, no obvious articular redisplacement or fixation failure was observed on the available follow-up radiographs.ConclusionThis retrospective case series summarized the four types of adjunctive screw corridors actually used when spiral tibial fractures involving the distal tibial articular surface were treated with intramedullary nailing combined with adjunctive screw fixation, and described the fixation target of each corridor. Representative images are used to illustrate, but do not systematically analyze, the relationship between the adjunctive screws and the intramedullary nail. These results provide descriptive information on the adjunctive fixation technique used in this cohort, and their value for guiding preoperative planning and surgical decision-making requires further validation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1898849</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1898849</link>
        <title><![CDATA[Case Report: Diagnostic and management challenges of necrotizing fasciitis in an immunocompromised child with acute lymphoblastic leukaemia]]></title>
        <pubdate>2026-10-22T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Meng Xian Chan</author><author>Nazurah Jaafar Sidek</author><author>Arief Sadiqin Azaharie Mohamed Zahari</author><author>Azrina Syarizad Kuthubul Zaman</author><author>Adzim Poh Yuen Wen</author><author>C-Khai Loh</author><author>Sie Chong Doris Lau</author><author>Marjmin Osman</author>
        <description><![CDATA[Necrotizing fasciitis (NF) is a rare, rapidly progressive soft-tissue infection that, when compounded by an immunocompromised state, increases susceptibility, severity, and diagnostic difficulty. Furthermore, reconstruction of the resulting defects is particularly challenging in neutropenic patients. Skin allograft offers a temporary biological cover that may be especially advantageous in this setting. We describe its use in a child with relapsed Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph + ALL) who presented with NF of the perineum while on chemotherapy. A 4-year-old boy with relapsed Ph + ALL on a high-risk chemotherapy protocol presented with neutropenic fever and decompensated septic shock. Despite resuscitation and broad-spectrum antibiotics, he deteriorated, requiring intensive care. A perianal swelling initially attributed to cellulitis progressed, and rapid clinical deterioration raised suspicion of perineal NF. He underwent emergency exploration, which revealed extensive non-viable tissue of the perineum, bilateral inguinal regions, and thigh; serial debridement and a diverting colostomy were performed, with tissue cultures yielding Proteus mirabilis sensitive to cefepime and meropenem. Reconstruction was staged with negative-pressure wound therapy and human skin allograft. Allograft was preferred over autograft because the child was physiologically unstable with an unhealthy wound bed, and because delayed allograft rejection in the immunosuppressed permits prolonged engraftment. The wound healed over 5 months, and the stoma was reversed at 5 months. Skin allograft served as an effective temporary biological dressing that prepared the wound bed and promoted healing while avoiding the donor-site morbidity of an autograft in a critically ill child, with immunosuppression likely favouring prolonged engraftment. This case adds to the limited evidence supporting allograft as a useful adjunct for staged wound closure in immunocompromised children with NF. NF in immunocompromised children is easily missed and demands a high index of suspicion and prompt surgical control. Skin allograft is a useful, well-tolerated adjunct for staged wound closure in this group, avoiding donor-site morbidity in a critically ill child; larger studies are needed to define its role.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1983298</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1983298</link>
        <title><![CDATA[Artificial intelligence in Saudi otolaryngology research: a scoping review of the current landscape, gaps, and future directions]]></title>
        <pubdate>2026-10-21T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Turki Aldrees</author><author>Abdullah Alabdulqader</author><author>Mohammed Al-Bar</author><author>Feras Alkholaiwi</author>
        <description><![CDATA[BackgroundArtificial intelligence (AI) is increasingly used in otolaryngology, but the extent and focus of AI research in Saudi Arabia remain unclear. This scoping review mapped the available evidence and identified key research themes and knowledge gaps.MethodsA scoping review was conducted following the PRISMA-ScR guidelines. PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Saudi Medical Journal archive were searched for studies published between January 2019 and April 2026. Eligible studies investigated AI applications or clinician perspectives within Saudi otolaryngology. The evidence was mapped across major otolaryngology domains, including cochlear implantation and hearing, rhinology and skull base surgery, facial plastic surgery, laryngology and voice, head and neck oncology, surgical and other ENT-related interventions for obstructive sleep apnoea, AI education and implementation, and AI-assisted patient education.ResultsThe searches identified 2,925 database records, four records from other sources and seven records from an updated search and expert suggestions; thirteen studies met the inclusion criteria. The evidence covered AI awareness and education, large language model (LLM)-based patient education, cochlear implantation, rhinology and skull base surgery, facial plastic surgery, laryngology and voice, and head and neck oncology; no eligible study addressed surgical or other ENT-related interventions for obstructive sleep apnoea. Clinicians were generally positive about AI, while clinical studies showed promising performance of AI models. LLM chatbots generally gave accurate postoperative advice, although, when validated tools were used, their responses were harder to read and less actionable than patient-education standards recommend. However, limited AI education, small or non-Saudi datasets, limited external validation, and implementation barriers remained important challenges.ConclusionAI research in Saudi otolaryngology remains limited but is expanding across several clinical domains. Future research should prioritise Saudi-specific datasets, multicentre clinical validation, structured AI education, rigorous bilingual (Arabic and English) evaluation of LLM-generated patient information, and safe integration of AI into clinical practice in line with Saudi Vision 2030.]]></description>
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