Open Barrier Membrane Technique for the Treatment of Oroantral Communications: Two Case Reports.

Oroantral communications (OACs) are relatively common complications after extractions of maxillary posterior teeth. Some defects can heal spontaneously, while others require surgical treatment. The lack of an appropriate therapeutic approach can lead to the epithelialization of the OAC that causes a permanent connection between the two cavities, called an oroantral fistula (OAF), and subsequent chronic sinusitis. Various treatment modalities have been used in cases of OACs, including advancement flaps, bone grafts, synthetic materials, and barrier membranes. We present two cases of closure of OACs with dense polytetrafluoroethylene (d-PTFE) membranes (of FDI tooth #28 in the first case and #17 in the second case), which were left exposed to the oral cavity. In both cases, healing was uneventful.

Comprehensive fertility preservation can be offered in a timely manner around gonadotoxic therapy in children and adolescents.

BACKGROUND: Treatment for certain childhood cancers and nonmalignant conditions can lead to future infertility and gonadal failure. The risk of treatment delay must be considered when offering fertility preservation (FP) options. We examined the timeline from FP referral to return to treatment (RTT) in pediatric patients who underwent FP due to iatrogenic risk for infertility. METHODS: A retrospective review was performed of patients with FP consultation due to an increased risk of iatrogenic infertility at Ann & Robert H. Lurie Children's Hospital of Chicago from 2018 to 2022. Data on diagnosis, age, treatment characteristics, and procedure were collected. RESULTS: A total of 337 patients (n = 149 with ovaries, n = 188 with testes) had an FP consultation. Of patients with ovaries, 106 (71.1%) underwent ovarian tissue cryopreservation (OTC), 10 (6.7%) completed ovarian stimulation/egg retrieval (OSER), and 33 (22.1%) declined FP. Of the patients with testes, 98 (52.1%) underwent testicular tissue cryopreservation (TTC), 48 (25.5%) completed sperm banking (SB), and 42 (22.3%) declined FP. Median time from referral to FP consultation was short (ovaries: 2 days, range: 0-6; testes: 1 day, range: 0-5). OSER had a significantly longer RTT versus OTC and no FP (52.5 vs.19.5 vs. 12 days, p = .01). SB had a significantly quicker RTT compared to TTC or no FP (9.0 vs. 21.0 vs. 13.5 days; p = .008). For patients who underwent OTC/TTC and those who declined FP, there was no significant difference in time from consultation to treatment. CONCLUSIONS: It is feasible to promptly offer and complete FP with minimal delay to disease-directed treatment.

Does Robotic Assistance Help with Bone Preservation in Total Knee Replacement?

Introduction: This research paper investigates whether robotic total knee replacement (TKR) reduces bone resection compared to conventional TKR. While TKR is a successful procedure, revision surgery remains a challenge with up to 8.3% of all knee replacement procedures requiring revisions. Materials and methods: The study retrospectively analyzed the tibial polyethylene inserts used and bone cuts made in 157 primary TKRs performed by a single surgeon. The results show that 93.3% of robotic TKRs used the base size tibial polyethylene of 9 mm, and the average distal femoral cut was 7.4 mm and the average tibial cut was 6.4 mm, with the minimum being 3 mm. Conclusion: The study suggests that robotic TKR reduces bone resection compared to conventional TKR.

Factors associated with successful intraoperative oocyte retrieval for fertility preservation during open pelvic surgery for gynecologic indications.

OBJECTIVE: The study investigated factors associated with successful intra-operative oocyte retrieval for fertility preservation during transabdominal gynecologic surgery. STUDY DESIGN: A total of 29 patients who underwent intraoperative oocyte retrieval during staging surgery at a single academic hospital from May 2014 to August 2022 were enrolled in this study, and their outcomes were analyzed. RESULTS: Among 29 patients who underwent intra-operative oocyte retrieval during staging surgery, oocytes were obtained in 24 patients, representing 82.8 % of the retrieval rate (24/29), and two patients returned to use cryopreserved oocytes (6.9 %). Among 24 women who succeeded in obtaining oocytes, 20 patients succeeded in oocyte cryopreservation, and two patients proceeded to embryo cryopreservation. The cryopreservation rate was 91.7 % (22/24). All patients with failed oocyte retrieval (n = 5) and cryopreservation (n = 7) were diagnosed with malignancy. AMH of those with successful cryopreservation oocytes was higher than those without cryopreservation (4.10 ng/mL vs. 1.18 ng/mL, p = 0.003). A higher portion of the unstimulated cycle was observed in those with failed cryopreservation (8.3 % vs. 40.0 %, p = 0.01). No complications were noted. CONCLUSION: For women planning to undergo open pelvic surgery, intra-operative oocyte retrieval is a feasible option. High serum AMH and ovarian stimulation before surgery may predict successful oocyte cryopreservation.

No guarantees: planned oocyte cryopreservation, not quite an insurance policy.

Planned oocyte cryopreservation (OC) has the potential to address the burden of the biological clock, giving women and individuals with ovaries more autonomy in choosing when to have children and with whom. In the United States, the annual number of OC cycles has grown significantly, yet many questions remain regarding planned OC. The field is starting to gather data on the clinical practice and social perspectives around planned oocyte cryopreservation, including the optimal age range at which to offer planned OC, what factors are most predictive of a successful outcome, and the optimal number of oocytes and ovarian stimulation cycles to achieve a live birth. There is a clear need for setting realistic expectations about the chance of success with OC; however, most patients have yet to return to thaw their oocytes, and outcomes data are limited. Clinical models have been developed to predict OC success based on surrogate markers such as age, number of oocytes retrieved, and anti-Müllerian hormone level. Patient education should emphasize the age-related decline in fertility, that eggs do not equal embryos, and that more than one cycle may be needed to obtain sufficient oocytes to have a reasonable chance of future success. While planned OC is not quite an insurance policy against future reproductive challenges, it provides the best option to date for expanding the reproductive window and maximizing reproductive options while navigating individual life circumstances in the context of family building.

Zwitterionic-hydrogel-based Sensing System Enables Real-time ROS Monitoring for Ultra-long Hypothermic Cell Preservation.

Hypothermic preservation (HP) is highly desired for the maintenance of the viability of living cell specimens, e.g. rare cells in whole-blood samples or therapeutic cells, in an unfrozen state. However, the extension of the viable preservation time is a challenge because of the multiple injuries suffered by hypothermically preserved cells. Here, based on a dynamic bond crosslinked zwitterionic hydrogel, we established a sensing preservation system that could monitor the levels of reactive oxygen species (ROS) via real-time electronic signals and intelligent control of antioxidant addition, to completely prevent an excess of ROS in the whole-cell specimen. Furthermore, the hydrogel-based system can counter the extracellular-matrix-loss-induced anoikis of living cells. Based on the design aimed at affording protection against two primary HP injuries (i.e. ROS overproduction and anoikis) to cells, this system extended the preservation time of cell specimens under refrigerated conditions to 24 days. After preservation, the use of a mild cell retrieval process guaranteed the activity of the preserved living cells. This work not only possesses the potential to facilitate intelligent cell-based clinical applications, but also paves the way for the preparation of living materials that can host programmed cells with long-term survival. STATEMENT OF SIGNIFICANCE: An intelligent system based on a zwitterionic sensing hydrogel is established, which can afford ultra-long hypothermic cell-preservation times of up to 24 days. The system enables the real-time monitoring of ROS overproduction and intelligent antioxidant addition, because of the merging of the smart hydrogel with a computer intelligent detection and control system. Furthermore, the automatic addition of an antioxidant according to the ROS-signal changes produced by the ZBA hydrogel effectively prevented HP lesions, including ROS over-production and ECM loss, in the preserved living cells. Subsequently, the system could also be gently dissociated, to retrieve the preserved cells. This work provides a solution for the real-time monitoring and long-term HP of living specimens, which holds the promise of benefiting cell-based medicine and the development of genetically programmed cell-based living materials.

Application of nano-ZnO in the food preservation industry: antibacterial mechanisms, influencing factors, intelligent packaging, preservation film and safety.

In recent years, how to improve the functional performance of food packaging materials has received increasing attention. One common inorganic material, nanometer zinc oxide (ZnO-NPs), has garnered significant attention due to its excellent antibacterial properties and sensitivity. Consequently, ZnO-NP-based functional packaging materials are rapidly developing in the food industry. However, there is currently a lack of comprehensive and systematic reviews on the use of ZnO-NPs as functional fillers in food packaging. In this review, we introduced the characteristics and antibacterial mechanism of ZnO-NPs, and paid attention to the factors affecting the antibacterial activity of ZnO-NPs. Furthermore, we systematically analyzed the application of intelligent packaging and antibacterial packaging containing ZnO-NPs in the food industry. At the same time, this paper also thoroughly investigated the impact of ZnO-NPs on various properties including thickness, moisture resistance, water vapor barrier, mechanical properties, optical properties, thermal properties and microstructure of food packaging materials. Finally, we discussed the migration and safety of ZnO-NPs in packaging materials. ZnO-NPs are safe and have negligible migration rates, simultaneously their sensitivity and antibacterial properties can be used to detect the quality changes of food during storage and extend its shelf life.

[Gender medicine in peritoneal diseases]. / Gendermedizin bei peritonealen Erkrankungen.

Diseases of the peritoneum are divided into benign and malignant, whereby malignant diseases are more frequent. The incidence of peritoneal metastases is difficult to determine as they are frequently not listed separately in cancer databases and registries. Peritoneal metastases can be caused by many primary tumors but are particularly frequent in gastric, ovarian and colorectal carcinomas. Systemic chemotherapy shows gender-specific differences in the tolerability, especially gastrointestinal side effects and hematological toxicity occur more often in women. Surgical treatment options in selected patients include cytoreductive surgery with or without hyperthermic intraperitoneal chemoperfusion (HIPEC). The treatment recommendations depend on the primary tumor entity and the stage of the disease. Hysterectomy and/or salpingo-oophorectomy is often necessary during cytoreductive surgery. As the incidence of cancerous diseases is increasing in younger patients, the aspect of fertility is becoming increasingly more important. The iatrogenically induced menopause is another aspect that needs to be addressed after these types of procedures. Women with gastric and colorectal cancer tend to have a slightly better survival rate, especially in localized tumors; however, in advanced tumor stages the survival rates are comparable. Even if gender-specific differences in incidence, treatment response and adverse events are conspicuous, there is so far no exact explanation for these differences. More studies are needed in order to treat both genders as adequately as possible, with low adverse events and to achieve the best possible outcome.

Exploring the Potential of In vitro Maturation (IVM) of Oocytes: Indications, Applications, and Treatment Protocols.

This review addresses the current understanding of In Vitro Maturation (IVM) treatment, including indications and effective treatment protocols influencing oocyte developmental competence. A comprehensive literature search was performed to gather relevant studies, clinical trials, and reviews related to IVM. Databases such as PubMed, MEDLINE, and pertinent medical journals were searched. The selected literature was analyzed and synthesized to offer a comprehensive overview. IVM has emerged as a promising technique for inducing maturation in immature oocytes across various developmental stages. Its applications extend to areas utilizing In Vitro Fertilization (IVF), gaining traction as a treatment option for Polycystic Ovary Syndrome (PCOS) and fertility preservation in cancer patients. Recent advancements have led to improved global pregnancy rates, resulting in successful births. IVM also holds potential in reducing risks associated with conventional IVF, including ovarian hyperstimulation syndrome and multiple pregnancies. Despite these advantages, IVM adoption in clinical practice remains limited. Ongoing research aims to refine therapeutic protocols and expand clinical indications. IVM holds promise in assisted reproductive technology, spanning applications from cancer patient fertility preservation to addressing PCOS. Enhanced pregnancy rates highlight efficacy, while risk reduction compared to IVF underscores its importance. Further research is needed for optimal use across patient groups, emphasizing protocol refinement and expanded applications.

Sub-Zero Non-Freezing of Vascularized Composite Allografts in a Rodent Partial Hindlimb Model.

Ischemia is a major limiting factor in Vascularized Composite Allotransplantation (VCA) as irreversible muscular injury can occur after as early as 4-6 hours of static cold storage (SCS). Organ preservation technologies have led to the development of storage protocols extending rat liver ex vivo preservation up to 4 days. Development of such a protocol for VCAs has the added challenge of inherent ice nucleating factors of the graft, therefore, this study focused on developing a robust protocol for VCA supercooling. Rodent partial hindlimbs underwent subnormothermic machine perfusion (SNMP) with several loading solutions, followed by a storage solution with cryoprotective agents (CPA) developed for VCAs. Storage occurred in suspended animation for 24h and VCAs were recovered using SNMP with modified Steen. This study shows a robust VCA supercooling preservation protocol in a rodent model. Further optimization is expected to allow for its application in a transplantation model, which would be a breakthrough in the field of VCA preservation.

Mechanism of low-voltage electrostatic field on flavor retention in refrigerated sturgeon caviar: Insights from phospholipids.

This study investigated the effect of low-voltage electrostatic field on the flavor quality changes and generation pathways of refrigerated sturgeon caviar. Research has found that after storage for 3-6 weeks, the physicochemical properties of caviar in the LVEF treatment group are better than those in the control group. The results of two-dimensional gas chromatography-time-of-flight mass spectrometry showed that the contents of hexanal, nonanal, (E,Z)-2,6-nonadienal, (E)-2-octenal and 1-octene-3-one related to the characteristic flavor of caviar (sweet, fruity and green) increased significantly. The lipidomics results indicated that the effects of LVEF on caviar mainly involve glycerophospholipid metabolism, linoleic acid metabolism, and α-Linolenic acid metabolism. Methanophosphatidylcholine (15:0/18:1), phosphatidylcholine (18:0/20:5), and phosphatidylcholine (18,1e/22:6) were significantly correlated with odor formation. Therefore, low-voltage electrostatic field treatment preserved the quality and enhanced the flavor of sturgeon caviar. This study provided a new theoretical basis for the preservation of sturgeon caviar.

Bilateral Inguinal Hernias Masking Cryptorchidism: A Case Report.

This case report discusses the uncommon occurrence of bilateral inguinal hernias masking cryptorchidism in a 47-year-old male, emphasizing the complexities and nuances of diagnosing and managing undescended testes in adults. Cryptorchidism is most often identified and treated during infancy; however, its rare adult manifestation presents significant diagnostic challenges and is fraught with serious implications for fertility and malignancy if left untreated. The subject presented with long-standing bilateral groin discomfort and was initially evaluated using clinical examination and CT imaging, which diagnosed bilateral inguinal hernias but did not initially detect cryptorchidism. During the staged surgical repairs, the testes were unexpectedly discovered within the hernia sacs, significantly altering the surgical approach and postoperative management. This necessitated an intraoperative consultation and collaboration between general surgery and urology, highlighting the critical role of multidisciplinary teamwork in managing complex surgical cases. The report underscores the importance of meticulous preoperative assessment and raises awareness about the potential for unusual findings in adult inguinal hernia repairs. This case report stresses the need for careful postoperative follow-up and regular urological surveillance to monitor for potential complications, including the development of testicular cancer. This case contributes valuable insights into the management strategies and long-term considerations for adult cryptorchidism, reinforcing the need for heightened clinical suspicion in similar presentations to ensure optimal patient outcomes.

Use of innovative sample dryer for effective sample drying in forensic investigations: An experimental study.

BACK GROUND: The sample collection and preservation before transportation to a Forensic Science Laboratory in a medicolegal case in India is a crucial step in establishing a link between accused, victim, crime scene and the weapon. This paper discusses pioneering advancement in health technology-a state-of-the-art sample dryer developed to preserve biological samples during Forensic investigations. This unique design has been officially registered with the design office in India as a copy right. AIMS AND OBJECTIVES: The primary goal of the sample dryer is to augment the preservation of biological evidence by removing moisture content through air drying before packaging, sealing and its transportation to a Forensic Science Laboratory. MATERIAL AND METHODS: The process of air drying of biological samples by variety of experiments conducted in sample's dryer designed for the purpose which employs a range of air movement techniques including horizontal, vertical, and circular laminar flows to swiftly extract moisture from the samples. The drying duration for each experimental sample was documented upon manual confirmation of complete drying. RESULTS: The results were extraordinary, showcasing that the sample's dryer reduced the drying time drastically by up to 27 times lesser in comparison to conventional methods for identical samples. The diverse airflow patterns generated by the sample dryer unequivocally demonstrated it's utility in achieving superior sample preservation through efficient air drying. CONCLUSION: Given the exceptional outcomes observed in the experimental phase, the authors strongly advocate for the widespread adoption of this innovative sample's dryer equipment to ensure effective air drying of biological samples and their efficient sample preservation to enable successful forensic analysis as expected.

A ratiometric fluorescent probe for selective detection of hypochlorite (ClO-) and gallium (III) (Ga3+) ions in environmental and food samples.

Hypochlorite (ClO-) and gallium (Ⅲ) ions (Ga3+) have extensive applications in various human industries and daily activities. However, their inherent toxicity poses significant risks to environmental preservation and human well-being. Hence, the development of reliable and handy detection tools for ClO- and Ga3+ in the environment and food is crucial. In this study, a ratiometric fluorescent probe was prepared based on benzothiazolaldehyde and pyridine-2-carboxylic acid hydrazide, which exhibited exceptional performance characteristics for the selective detection of ClO- and Ga3+. These features include high specificity, low detection limits (0.28 µM for ClO-, 0.13 µM for Ga3+), mild pH conditions (pH 4-11 for ClO-, pH 6-11 for Ga3+), fast response time (within 30 s), as well as versatile applicability across different matrices such as water, soil, food, and plant samples. Additionally, this probe can be used with a smartphone color recognition app. The probe offers a convenient and effective tool for the detection of ClO- and Ga3+, demonstrating its potential application value in environmental monitoring and food safety.

Advances in biomaterials based food packaging systems: Current status and the way forward.

World hunger is getting worse, while one-third of food produced around the globe is wasted and never consumed. It is vital to reduce food waste to promote the sustainability of food systems, and improved food packaging solutions can augment this effort. The utilization of biomaterials in smart food packaging not only enhances food preservation and safety but also aligns with current demands for eco-friendly technologies to mitigate the impacts of climate change. This review provides a comprehensive overview of the developments in the field of food packaging based on the innovative use of biomaterials. It emphasizes the potential use of biomaterials derived from nature including cellulose, chitosan, keratin, etc. for this purpose. Various smart food packaging technologies such as active and intelligent packaging are discussed in detail including scavenging additives, colour-changing environment indicators, sensors, RFID tags, etc. The article also delves into the utilization of edible films and coatings, nanoparticle fillers and 2D materials in food packaging systems. Furthermore, it outlines the challenges and opportunities in this dynamic domain, emphasizing the ongoing need for research and innovation to shape the future of sustainable and smart food packaging solutions to enhance and monitor the shelf-life of food products.

Feasibility of interdisciplinary evaluation in non-arthritic hip pain: A randomized trial.

BACKGROUND: Physical therapy and orthopaedic surgery are two common treatments for non-arthritic hip pain. Interdisciplinary evaluation across these disciplines may produce a more supportive treatment-planning process; however, the feasibility of such an evaluation remains unknown. HYPOTHESIS OBJECTIVE: To assess the feasibility of an interdisciplinary evaluation with an orthopaedic surgeon and physical therapist for non-arthritic hip pain. STUDY DESIGN: Observational feasibility study of a randomized controlled trial. METHODS: Participants were randomized to an interdisciplinary (surgeon + physical therapist) or standard (surgeon) evaluation in a hip preservation clinic. Recruitment rate was recorded. Retention rate was calculated for all variables of interest. Enrollment and refusal reasons were recorded as patient quotes and categorized by a single grader. Time spent in clinic was compared across groups using Mann Whitney U tests (P ≤ 0.05). Study clinicians were interviewed, and responses were categorized based on pre-determined themes. RESULTS: Eighty-one percent of eligible patients enrolled over a 15-month recruitment period. Willingness(n = 16), urgency to resolve pain(n = 10), financial compensation(n = 1), interest in research(n = 42), physical therapy(n = 6), or multiple-provider care(n = 15) were participants' enrollment reasons; reason was not recorded for 22 participants. Time(n = 11), preference for single-provider care(n = 6), current physical therapy treatment(n = 1), and disinterest in physical therapy(n = 7) or research(n = 2) were refusal reasons of patients who did not enroll. Retention for primary variables of interest was 100% in both groups. Participants spent, on average, 23.5 min more time in clinic for the interdisciplinary evaluation compared to the standard (P < 0.001). CONCLUSIONS: An interdisciplinary evaluation for patients with non-arthritic hip pain that included a physical therapist and orthopaedic surgeon in a hip preservation clinic was feasible and may better inform the treatment planning process.

Green fabrication of modified lignin/zeolite/chitosan-based composite membranes for preservation of perishable foods.

Chitosan, as a kind of naturally occurring green and degradable material for the preservation of perishable foods, was investigated in this study with the objective of enhancing its preservation performances. Herein, lignin was modified using the solvent fractionation method (modified lignin, ML, including ML1-ML3), while natural clinoptilolite zeolite was modified using the alkali modification method (modified clinoptilolite zeolite, MCZ, including MCZ1-MCZ5). After optimizing the conditions, it was discovered that incorporating both ML3 and MCZ3 into pure chitosan-based membranes might be conducive to fabricate chitosan-based composite membranes for the preservation of perishable foods. As-prepared composite membranes possessed better visible light transmittance, antioxidant activity, and carbon dioxide/oxygen selectivity, resulting in improved preservation effects on the model perishable foods such as bananas, cherry tomatoes, and cheeses. These findings might indicate promising applications for chitosan-based composite membranes with modified lignin and zeolite in the field of eco-friendly degradable materials for the preservation of perishable foods.

Fabrication of Abelmoschus manihot gum/pullulan/magnesium L-ascorbate green composite packaging film and its excellent performance in preserving fresh-cut carrots.

Pullulan-based composite film can be a potential alternative packing material to non-environmentally friendly plastic wrap (PE) to preserve fresh-cut carrots. However, many developed pullulan-based composites either have high water vapor permeability (WVP) and high mechanical strength or vice versa, which limits the practicality of the developed packaging materials for potential commercialization. Herein, Abelmoschus manihot gum (AMG)/pullulan/magnesium L-ascorbate (MLA) was created as a green composite film (APL) to preserve fresh-cut carrots. The optimal amount of MLA was found to be 10 % (APL10), demonstrating a balance of lower WVP and greater mechanical strength and antioxidant performance than many pullulan-based films. This effectively solved many problems faced by other pullulan-based packaging films. After the fresh-cut carrots were packed with the composite film for 4 days, it was found that APL10 was effective in preserving the quality of carrots, in terms of freshness, weight loss rate, Vitamin C (VC), and malondialdehyde (MDA) content after 4 days of storage, much better than non-biodegradable PE. Thus, based on these findings, it is concluded that APL films have huge potential as a green packaging material for food to replace PE in the future.

Is Routine Pathology Evaluation of Tissue Removed for Fertility Preservation Necessary?

BACKGROUND: For all fertility preservation (FP) cases at our institution, a biopsy is performed for routine pathology from all gonadal tissue removed. This is not standard at all centers. We reviewed our experience with biopsy for pathological evaluation of ovarian and testicular specimens in FP cases to determine clinical utility. METHODS: The medical records of individuals who underwent ovarian tissue cryopreservation (OTC) or testicular tissue cryopreservation (TTC) between 2011 and 2023 were retrospectively reviewed under an IRB-approved study at a free-standing tertiary care children's hospital. Patient demographics, diagnosis, operative characteristics, and pathology results were collected. RESULTS: One-hundred and eighty-three patients underwent OTC, and 134 patients underwent TTC. All patients had their gonadal tissue biopsied for routine pathology. Malignancy was identified in the biopsies of 4 OTC patients (2.2%) and 2 TTC patients (1.5%). Two OTC patients (1.1%) and 2 TTC patients (1.5%) did not have germ cells identified in their biopsy. All OTC and TTC patients and families elected to continue storing tissue for FP after discussion of pathology findings. CONCLUSIONS: Pathology results provide another data point to help inform patients and their families when making decisions on ovarian or testicular tissue storage and on how tissue may be utilized in the future to restore fertility and/or hormones. There is a low rate of identifying malignancy in gonadal tissue biopsies taken from FP specimens even in patients with known malignancy. However, when malignancy was identified, it could be unexpected and alter the diagnosis and treatment plan significantly for patients. LEVEL OF EVIDENCE: IV.

Combining Piezo and Power Tools for a Better Outcome in Hybrid Structural-Preservation Rhinoplasty.

INTRODUCTION: Over the past decade, rhinoplasty has seen an unprecedented evolution in concepts, techniques and tools. New concepts have led to new techniques, prevalently but not exclusively related to preservation rhinoplasty, and the use of new tools has made such techniques easier, more precise and thus better reproducible. Power tools can presently be considered only relatively new, while Piezo has gained great popularity over the last years. MATERIALS AND METHOD: This article is focused on how power tools (diverse burrs with specific spherical, cylindrical, conical, discoid tips) can be integrated efficiently together with the use of Piezo and its different inserts in a logical and effective manner. DISCUSSION: This combination should be implemented in a progressive fashion into specific steps of surgery, although, in general, burrs should be used for reshaping and piezo for cutting bone. Specific and notable exceptions to this rule will be mentioned in the paper. Obviously, cost should be considered, but the benefits are evident: heightened control, reduced asymmetries, smoother bony and middle vault contour, and a more precise management of septum and turbinates. We have come to this conclusion following the combined experience of the two centers participating in the study, with over 350 patients over the last three years. CONCLUSIONS: The article focuses on the modified dorsal split preservation hybrid rhinoplasty favored by the senior author, but its principles will easily apply to any structural, preservation, or hybrid rhinoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .