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Orbital rim repositioning is a pivotal step in lateral orbitotomy. This study aims to introduce a novel mortise-tenon joint fixation (MTF) technique inspired by traditional Chinese woodcraft for lateral orbital rim reconstruction. This retrospective case series analyzed outcomes in patients with thyroid eye disease (TED) undergoing balanced orbital decompression surgery using MTF. The clinical outcomes, the number of surgical implants used, and hospitalization costs were analyzed. Additionally, an orbital model of the same laterality, derived from another patient treated with titanium plate-and-screw fixation (PSF), was selected as the comparator for the three-dimensional finite element analysis. Analysis was conducted with masseter muscle fixation and the application of occlusal force on the masseter muscle. Nine TED patients (12 orbits) undergoing MTF reconstruction were enrolled. A mean proptosis reduction of 5.3 ± 0.9 mm was achieved. No complications such as severe hemorrhage, vision loss, or orbital rim displacement were observed. Finite element analysis showed that maximum stress was lower with MTF than with PSF: 8.59 MPa vs. 91.33 MPa (masseter muscle fixation) and 16.33 MPa vs. 91.20 MPa (force applied). Maximum displacement was also lower for MTF: 0.010 mm vs. 0.014 mm (masseter muscle fixation) and 0.026 mm vs. 0.033 mm (force applied). Implant material expenses in hospitalization costs decreased by $288.43-$412.00, representing an approximate 84.3% reduction compared to PSF. In summary, the MTF technique demonstrates safety, effectiveness, and biomechanical advantages for orbital rim repositioning during lateral orbitotomy. It also reduces patient costs, offering a promising alternative to traditional fixation methods.

The study investigated vertical orbital dystopia in patients with dentofacial deformities and its impact on coronal plane orientation. This retrospective analysis included 79 patients (52 females, 27 males, mean age 27.64 years) with dentofacial deformity who underwent orthognathic surgery from 2019 to 2022 with preoperative cone-beam computed tomography. Bilateral hard tissue measurements were performed using virtual orthognathic planning software (NemoFAB, Nemotec, Spain). Two anatomical landmarks were measured vertically to assess the severity and direction of orbital asymmetry. Of the 79 patients, 56 had class III and 23 had class II skeletal deformity. There were no significant differences between patients based on gender or Angle classification. Orbital dystopia was statistically significant (73.4%) among the study population (P = 0.05). The severity and the direction were analysed, respectively; no correlation was found between the orbitalis inferior (r = 0.052, P = 0.73) and the orbitalis superior (r = -0.060, P = 0.67). The study suggests that focusing solely on the orbital region in orthognathic surgery planning may lead to inaccuracies due to the prevalence of orbital dystopia in dentofacial deformity patients.

Endoscopic orbital surgery is likely a reasonable option for patients with orbital cavernous hemangiomas (OCH) medial to the optic nerve (ON). The endoscopic resection of OCH lateral to the ON is extremely challenging. Zhou et al. first described the endoscopic prelacrimal recess approach (PLRA) for the management of the maxillary sinus and skull base. However, the application of PLRA for endoscopic resection of OCH has not been reported. Here, we report a novel modification of the PLRA termed the prelacrimal transmaxillary-orbital approach (PLTMOA) for endoscopic resection of extraconal OCH lateral to the ON. A 58-year-old female presented with a 4-year history of left extraconal OCH causing left proptosis and diplopia. The imaging revealed the tumor to be localized inferolateral to the ON within the extraconal space. The tumor was resected entirely without complications via PLTMOA, and no recurrence was observed during 26 months of follow-up. The PLTMOA technique comprises four key steps: (1) creation of a prelacrimal recess window, (2) entry into the maxillary sinus, (3) exposure of the orbital floor and osteotomy of the orbital floor (orbital window), and (4) dissection to achieve complete tumor excision. This approach represents the first reported application of a PLTMOA for extraconal OCHs inferolateral to the ON, providing direct access to the orbit while preserving the integrity of the nasolacrimal duct.

Rhino-orbital mucormycosis is a rare, life-threatening opportunistic fungal infection, typically affecting immunocompromised patients. During the COVID-19 pandemic, increased cases were mainly linked to SARS-CoV-2 infection, diabetes, and corticosteroid exposure. We report a severe case in a previously healthy 44-year-old immunocompetent man who developed acute left-sided exophthalmos, ophthalmoplegia, severe visual loss, and systemic deterioration 10 days after AZD1222 COVID-19 vaccination. Clinical and radiologic findings suggested invasive rhino-orbital fungal disease, prompting immediate liposomal amphotericin B, broad-spectrum antibiotics, urgent endoscopic sinus surgery, and repeated orbital-sinonasal debridements with amphotericin B irrigation. Histopathological examination demonstrated broad aseptate hyphae with tissue necrosis, consistent with mucormycosis, while fungal culture and ITS sequencing identified Rhizopus arrhizus as the causative species. Therapy was later adjusted to include isavuconazole and antibacterial coverage for persistent inflammation and secondary colonization. Orbital and systemic improvement occurred within the first week, with globe preservation and marked proptosis reduction at 6 months, despite persistent ophthalmoplegia and residual light perception. Isavuconazole was continued for 2 years, with no recurrence during 3 years of follow-up. Although causality with vaccination cannot be established, the temporal association and biological plausibility warrant further investigation. Early suspicion and prompt combined medical-surgical management are essential in rapidly progressive orbital cellulitis.

Meningo-ophthalmic and orbitomeningeal arterial communications comprise route-specific relationships between the middle meningeal artery (MMA) and the ophthalmic or orbital arterial system. Their recognition is relevant to middle meningeal artery embolization because orbital or ophthalmic collateral pathways may create routes for non-target embolization. This systematic review aimed to synthesize the prevalence and anatomical patterns of these communications, using quantitative pooling only where the anatomical definition and denominator were sufficiently coherent. This systematic review and meta-analysis were conducted according to PRISMA 2020 principles and registered in PROSPERO (CRD420261361050). Eligible studies were original human cadaveric anatomical, angiographic, or radiological investigations reporting MMA-ophthalmic or MMA-orbital arterial relationships. After the closure of the full-text retrieval audit, studies and extracted rows were audited by anatomical family, unit of analysis, numerator, denominator, and independence. No global pooled prevalence was calculated across anatomical families. When family-specific pooling was methodologically defensible, proportions were synthesized using logit transformation, restricted maximum likelihood random-effects models, and Hartung-Knapp confidence intervals. Database searches identified 558 records. After removal of 228 duplicates, 330 records were screened, and 285 were excluded by title and abstract. Forty-five reports were sought for retrieval; 10 were not retrieved or were not available as assessable full-text reports after retrieval auditing. Thirty-five full-text reports were assessed; thirteen were excluded for reasons, and three were duplicate reports at the full-text stage. Nineteen studies were included in the qualitative synthesis, and 12 contributed independent data to the final R-ready matrix. MMA arising from the ophthalmic artery was uncommon, with a pooled prevalence of 0.03 (95% CI 0.01 to 0.13; I2 = 75.9%). After excluding the clinically selected chronic subdural hematoma subgroup, the estimate was 0.02 (95% CI 0.01 to 0.06; I2 = 7.7%). The meningolacrimal/lacrimal-MMA route yielded an exploratory pooled proportion of 0.45 (95% CI 0.09 to 0.86; I2 = 95.9%), with substantial anatomical and methodological heterogeneity. The available evidence supports route-specific synthesis rather than a single global prevalence estimate. MMA arising from the ophthalmic artery appears uncommon but procedurally important; however, this estimate should be interpreted as a route-specific estimate across eligible angiographic/anatomical series rather than as a universal anatomical prevalence. Meningolacrimal and lacrimal-MMA routes are frequently described, but their prevalence remains difficult to generalize because detection methods, populations, and denominators differ across studies. Future anatomical and angiographic reports should standardize route definitions, laterality, unit of analysis, and denominator reporting to improve prevalence estimation and procedural safety interpretation.

We report a diagnostically challenging case of polymicrobial orbital apex syndrome in an immunocompromised patient, emphasizing the importance of early multidisciplinary intervention and consideration of fungal aetiologies in high-risk individuals. A 70-year-old woman with multiple comorbidities presented with subacute left orbital pain and frontotemporal headache, with early signs of cranial nerve VI palsy. Despite initial stability, the patient deteriorated over 2 weeks, developing complete left ophthalmoplegia, proptosis, and vision loss. Further investigation demonstrated a polymicrobial skull base osteomyelitis with orbital apex and cavernous sinus involvement. Histopathology revealed necrotic material with chronic inflammation, and cultures identified Aspergillus flavus, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida parapsilosis. The patient was treated with intravenous vancomycin, oral ciprofloxacin, and voriconazole for 6-8 weeks. Diagnosing orbital apex syndrome in immunocompromised individuals is complex and early imaging is critical. A high clinical suspicion for fungal infection should be maintained, with a strong role for timely tissue diagnosis. Coordinated multidisciplinary care and targeted antimicrobial therapy can prevent further morbidity from intracranial extension.

Sinonasal mucoceles are benign cystic lesions caused by obstruction of sinus drainage; however, they may progressively expand and erode surrounding bone, leading to orbital complications. We report two cases of sinonasal mucoceles with orbital extension presenting as proptosis. The first case involved a 34-year-old man presenting with acute proptosis, diplopia, and decreased visual acuity, with imaging revealing a frontoethmoidal lesion extending into the orbit. The second case involved a 43-year-old woman with progressive proptosis without visual impairment, also related to a frontoethmoidal mucocele. Management differed between the two cases, with spontaneous regression in the first and surgical treatment in the second, both resulting in favorable outcomes. These cases illustrate the variable clinical presentation of sinonasal mucoceles and highlight the importance of imaging in diagnosis and management. Early recognition and appropriate treatment are essential to prevent visual complications.

Engineering proximity effects in twisted van der Waals heterostructures offers a powerful platform for designing electronic properties. While theoretical predictions of quantum interference in transition metal dichalcogenide-encapsulated graphene can selectively control the spin-orbit coupling component, experimental realizations have remained elusive. Here, we report pure valley-Zeeman spin-orbit coupling in monolayer graphene achieved by encapsulation between two parallel twisted WSe_{2} monolayers. We observed a symmetry-enforced reordering of Landau levels, which is driven by the competition between the fixed valley-Zeeman energy and the magnetic-field-dependent cyclotron energy. This reordering is characterized by a transition from symmetry-broken states in the quantum Hall effect to a restored fourfold degeneracy with integer or half-integer quantum Hall sequences. We also demonstrate the ability to completely quench the proximity spin-orbit coupling by tuning the encapsulated geometry.

In thyroid eye disease (TED), the connective tissue behind the eye becomes inflamed and expands, partly due to excessive deposition of hyaluronan (HA), which absorbs water, leading to osmotic swelling. Orbital fibroblasts (OFs) from patients with TED overexpress insulin-like growth factor 1 receptor (IGF-1R), a receptor that promotes cell survival, proliferation, and HA production. These processes contribute to orbital tissue remodeling and expansion, as well as to the inflammation and fibrosis characteristic of TED. Therapeutic options remain limited, highlighting the need for additional targeted therapies. Lonigutamab is a next-generation anti-IGF-1R monoclonal antibody that binds to a distinct epitope on IGF-1R with high affinity, eliciting a novel mechanism of action. To evaluate whether lonigutamab inhibits HA production and characterize its mechanism of action using TED OFs. TED OFs were treated with lonigutamab in the presence or absence of IGF-1. HA was measured by ELISA and agarose gel electrophoresis. IGF-1R levels were assessed by flow cytometry and Western blot. The proteasome inhibitor MG132 and the lysosome/autophagy inhibitor bafilomycin were used to probe lonigutamab-mediated degradation pathways. Lonigutamab significantly reduced basal and IGF-1-induced HA production across all evaluated TED OF strains. Lonigutamab also decreased mature IGF-1R protein levels in a time- and dose-dependent manner by promoting IGF-1R internalization and subsequent degradation through proteasomal and lysosomal pathways. These findings suggest that lonigutamab suppresses HA production in TED OFs via efficient IGF-1R internalization and degradation, supporting its unique mechanism of action and potential as a therapeutic option for TED.

Electrocatalytic reduction of CO2 to high-value chemicals and fuels, such as formate, offers a promising route to achieve carbon neutrality and climate change mitigation. In this work, we report a counterion-induced amorphization strategy applied to anionic indium metal-organic frameworks (In-MOFs) aimed at strengthening the binding of desired intermediates for efficient CO2 electroreduction. In-TDC containing the small counterion Me2NH2+ undergoes facile cation exchange, triggering framework reconstruction into an amorphous phase (A-In(OH)x(CO3)y). The A-In(OH)x(CO3)y catalyst achieves a FEformate of 97.2% at -1.4 V vs. RHE and maintains ∼90% selectivity for 36 h, far surpassing the other anionic crystalline analogue In-TEA with the bulky counterion TEA+ as a structural "anchor" for resisting collapse. Experimental and theoretical studies indicated that the better performance of A-In(OH)x(CO3)y results from the strong orbital coupling between In p and O p of *OCHO, which not only lowers the free energy barrier for the conversion of *CO2 to *OCHO but also enhances the *OCHO binding. This work highlights counterion exchangeability as a powerful tool to unlock p-orbital activity for efficient CO2 electroreduction.

Selective electrooxidation of ethylene glycol to glycolic acid offers a green route for value-added transformation and coupled hydrogen production. However, the long-term stability of the active sites and precise transformation toward C2 products still remain challenges. Herein, a BiPd electrocatalyst with d-f orbital hybridization is reported, which induces electron transfer from Bi to Pd, optimizes the adsorption capability of OH- and other key intermediates, and increases the proportion and stability of active Pd0 species. Thus, the catalyst requires a potential of 0.614 V vs RHE to achieve 100 mA·cm-2, and the coupled EGOR||HER system remains stable over 20 h of continuous operation under 200 mA·cm-2.

Recently, constrained nuclear-electronic orbital (CNEO) theory has been developed to incorporate nuclear quantum delocalization and zero-point effects into quantum chemistry calculations and ab initio molecular simulations. Motivated by discussions with John Stanton, we apply CNEO methods to protonated methane, CH5+, as a stringent test case for the quantum-corrected effective-potential framework. CH5+ is a prototypical penta-coordinated nonclassical carbonium ion with a highly anharmonic potential energy surface, many low-lying geometries connected by low barriers, and extensive fluxional motion. Using CNEO, we examine the effective structural features, hydrogen rearrangement dynamics, and simulated IR spectra of CH5+. The CNEO effective potential energy surface exhibits a minimum with C2v symmetry, which is more symmetric than the minimum-energy eclipsed-Cs structure on the conventional potential energy surface. CNEO molecular dynamics predicts more frequent hydrogen rearrangement than conventional ab initio molecular dynamics, with pronounced rearrangement observed starting from 50 K. A Fourier-filtered analysis of C-H bond-length distributions along the trajectories, combined with a Gaussian mixture model, reveals three structural and dynamical motifs: equilibrium-like, fluxional, and transition-state hovering configurations. The simulated IR spectra, which are obtained from either harmonic analysis or classical dynamics on the CNEO surface, are compared qualitatively with experimentally observed spectral features. Overall, this work assesses how the computationally efficient CNEO framework captures qualitative structural, dynamical, and spectroscopic trends in the highly fluxional CH5+, while also highlighting the challenges and shortcomings of this classical-trajectory-based method in a system where fully quantum nuclear effects beyond zero-point effects are important.

Flexoelectricity, defined as polarization induced by strain gradients, is especially pronounced in two-dimensional (2D) materials due to their mechanical flexibility and sensitivity to deformation. In nanostructures with nanometer-scale curvature, bending can perturb out-of-plane π orbitals and generate quantum-mechanical polarization and electrostatic modulation beyond classical lattice distortion alone. Here, we combine scanning probe measurements and first-principles calculations to provide experimental and theoretical evidence for large intrinsic quantum orbital flexoelectricity in graphene nanowrinkles (GNWrs) with estimated polarization densities of Pth ∼ 4 C m-2 and Pexp ∼ 1 C m-2, exceeding those of mesoscale systems by 5 to 7 orders of magnitude. These GNWrs exhibit high apex curvature, undergo atomic-level buckling, and produce localized strain fields, as supported by atomic force microscopy analysis and Raman spectroscopy. Kelvin probe force microscopy reveals curvature-dependent work-function shifts, while conductive atomic force microscopy detects reproducible GNWr-associated currents with a threshold voltage (Φth ∼ 1 V) comparable to the band offset predicted by ab initio calculations (∼ 1.2 V). These results support an interpretation in which curvature-induced flexoelectric dipoles reshape the local electronic potential. GNWrs therefore provide a structurally simple carbon-based platform for probing quantum-mechanical flexoelectricity.

The orbital angular momentum (OAM) of light provides an unbounded set of orthogonal modes for ultrahigh-capacity optical information processing. However, current OAM detection schemes typically rely on light interference or diffraction, which require bulky optical components and pose a major obstacle to on-chip integration. Here, we demonstrate an integrated silicon-based photodetector that enables direct electrical detection of light OAM. This photodetector can resolve vortex beams with topological charges from m = ±1 to ±9. With a single measurement, the OAM classification accuracy of the best-performing device can reach up to 99.92%. By integrating plasmonic gratings onto the device electrodes, incident vortex beams can be converted into surface plasmon polaritons with OAM-dependent splitting angles, which in turn produce photocurrents that vary monotonically with the OAM order. Further incorporation of a surface dielectric lens can enhance mode resolution, and a split-electrode architecture enables OAM chirality discrimination. Owing to its CMOS-compatibility and spectral scalability, this device provides a compact and robust solution for integrated OAM detection in structured-light-based optical communication and computing systems.

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