Maxillary midline diastema is a common esthetic concern with a multifactorial etiology that includes aberrant maxillary labial frenum attachment. A papillary penetrating labial frenum may contribute to the persistence of a maxillary midline diastema and may warrant consideration during treatment planning. We report a 19-year-old woman with a maxillary midline diastema associated with a papillary penetrating labial frenum. Comprehensive fixed orthodontic treatment was completed over 16 months, achieving closure of the diastema. Because the aberrant frenum persisted after space closure, a 980 nm diode laser-assisted frenectomy was performed under local anesthesia (pulsed mode, 3 W). The procedure was completed with minimal intraoperative bleeding, good hemostasis, and without sutures, and postoperative healing was uneventful, with satisfactory soft tissue maturation at the one- and three-month follow-up visits, after which a bonded lingual retainer was placed. The patient reported minimal postoperative discomfort and was satisfied with the overall esthetic result; no standardized pain or satisfaction scale was used. This case illustrates the clinical value of interdisciplinary sequencing, with orthodontic approximation first, followed by frenectomy before definitive retention, in a patient with a persistent papillary penetrating frenum. Within the limits of a single case with short follow-up, diode laser-assisted frenectomy may serve as a useful minimally invasive adjunct to orthodontic treatment in appropriately selected patients.

Diabetic patients are highly susceptible to surgical site infections, with Staphylococcus aureus being a major nosocomial causative agent. Dehiscence, inflammation, and scarring can complicate outcomes with conventional wound approximation and closure devices. To overcome these challenges, we leveraged the antibacterial properties of silver ion-exchanged nanostructured zeolites (AgNZeo) embedded within silk fibroin-based laser-activated sealant (LASE) films containing silver nanoprisms (AgNPr). AgNPr enabled efficient absorption of near-infrared (NIR) light, resulting in photothermal conversion of this energy and sealing of full-thickness incisional wounds in mice. AgNZeo-LASE films showed excellent antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) bacteria in in vitro antimicrobial susceptibility assays. AgNZeo-LASE films, upon laser irradiation, were able to seal incisional wounds in diabetic and obese mice, and protected against surgical site MRSA infections, demonstrating performance comparable to commercial antibacterial sutures. Immunohistochemical analyses indicated similar neutrophil recruitment and macrophage polarization with AgNZeo-LASE compared to suture controls. Our results support the use of silver ion-loaded nanozeolites as effective antibacterial agents and suggest that AgNZeo-LASE films may be useful for topical infection control.

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We report the use of bronchoscopy-guided intratracheal suturing in a refractory case. Case Presentation: A 17-year-old male with a history of congenital TEF experienced multiple recurrences despite two thoracotomies and one endoscopic clipping attempt. The procedure was performed under general anesthesia without endotracheal intubation, and superimposed high-frequency jet ventilation was used for airway management. Following electrocautery treatment of the visible tracheal-side margins, four interrupted absorbable sutures were placed through tissues adjacent to the fistula opening under bronchoscopic guidance. Tightening of the sutures approximated the visible fistula margins. The procedure lasted 62 min with no complications. Follow-up bronchoscopy, methylene blue testing, and esophagography at 2 weeks showed no evidence of fistula leakage, indicating early technical closure. At the 3-month telephone follow-up, the patient remained asymptomatic and reported normal oral intake and physical activity. These findings suggest early technical success; longer objective follow-up is required to assess durability. Conclusions: In this highly selected adolescent, bronchoscopy-guided intratracheal suturing was technically feasible and achieved early fistula closure without a perioperative complication. Longer objective follow-up after loss of suture tensile strength is required to determine whether closure can be maintained without mechanical suture support.