Comparison of piezosurgery and traditional saw in bimaxillary orthognathic surgery

Abstract

a b s t r a c tPurpose: Investigators have hypothesised that piezoelectric surgical device could permanently replace traditional saws in conventional orthognathic surgery. Methods: Twelve consecutive patients who underwent bimaxillary procedures were involved in the study. In six patients the right maxillary and mandible osteotomies were performed using traditional saw, whilst the left osteotomies by piezoosteotomy; in the remaining six patients, the surgical procedures were reversed. Intraoperative blood loss, procedure duration time, incision precision, postoperative swelling and haematoma, and nerve impairment were evaluated to compare the outcomes and costs of these two procedures. Results: Compare to traditional mechanical surgery, piezoosteotomy showed a significant intraoperative blood loss reduction of 25% (p ¼ 0.0367), but the mean surgical procedure duration was longer by 35% (p ¼ 0.0018). Moreover, the use of piezoosteotomy for mandible procedure required more time than for the maxillary surgery (p ¼ 0.0003). There was a lower incidence of postoperative haematoma and swelling following piezoosteotomy, and a statistically significant reduction in postoperative nerve impairment (p ¼ 0.003). Conclusions: We believe that piezoelectric device allows surgeons to achieve better results compared to a traditional surgical saw, especially in terms of intraoperative blood loss, postoperative swelling and nerve impairment. This device represents a less aggressive and safer method to perform invasive surgical procedures such as a Le Fort I osteotomy. However, we recommend the use of traditional saw in mandible surgery because it provides more foreseeable outcomes and well-controlled osteotomy. Further studies are needed to analyse whether piezoosteotomy could prevent relapse and promote bony union in larger advancements. Ó

Piezoelectric surgery—primary bone grafting in craniofacial trauma revisited

“…It is necessary to maintain a stock of tips and the system is more expensive than traditional osteotomy kits. 9 The authors feel that the accuracy of the bone fit, together with the operative logistics and safety to the surgeon, commend the use of piezoelectric surgery in this application.…”

Complex craniofacial advancement in paediatric patients: Piezoelectric and traditional technique evaluation

“…9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Piezoelectric surgery has been presented as a novel technique for osteotomy, and it is supposed to protect soft tissues, allowing bone cutting by creating an electric field that changes polarity periodically, thus causing piezoelectric substances to start vibrating (Vercellotti et al, 2001). Ultrasonic surgery is a well-known technical procedure that has been used in dental practice since the 1940s (Lynn et al, 1942); thereafter, it has been applied to other oral surgical procedures (Gonzalez-Garcia et al, 2009;Gilles et al, 2013;Rullo et al, 2013), becoming competitive with traditional instruments in orthognathic surgery (Beziat et al, 2009;Hoffmann et al, 2013;Landes et al, 2014;Spinelli et al, 2014). In fact, piezoelectric devices have been shown to allow minimal soft-tissue injury and to increase the precision of osteotomy, thus ensuring better intraoperative and clinical results, such as: 1) reduction in intraoperative blood loss, 2) better cutting precision, 3) lower incidences of postoperative swelling and haematoma, and 4) a lower incidence of nerve damage together with a faster nerve recovery when impaired (Beziat et al, 2007a;Gilles et al, 2013;Spinelli et al, 2014).…”

“…Ultrasonic surgery is a well-known technical procedure that has been used in dental practice since the 1940s (Lynn et al, 1942); thereafter, it has been applied to other oral surgical procedures (Gonzalez-Garcia et al, 2009;Gilles et al, 2013;Rullo et al, 2013), becoming competitive with traditional instruments in orthognathic surgery (Beziat et al, 2009;Hoffmann et al, 2013;Landes et al, 2014;Spinelli et al, 2014). In fact, piezoelectric devices have been shown to allow minimal soft-tissue injury and to increase the precision of osteotomy, thus ensuring better intraoperative and clinical results, such as: 1) reduction in intraoperative blood loss, 2) better cutting precision, 3) lower incidences of postoperative swelling and haematoma, and 4) a lower incidence of nerve damage together with a faster nerve recovery when impaired (Beziat et al, 2007a;Gilles et al, 2013;Spinelli et al, 2014). Therefore, based on the objective advantages ensured by this surgical device (Spinelli et al, 2014), its use has spread to other surgical specialties, such as neurosurgery and major maxillofacial surgical procedures (Kramer et al, 2006;Gleizal et al, 2007).…”

“…In fact, piezoelectric devices have been shown to allow minimal soft-tissue injury and to increase the precision of osteotomy, thus ensuring better intraoperative and clinical results, such as: 1) reduction in intraoperative blood loss, 2) better cutting precision, 3) lower incidences of postoperative swelling and haematoma, and 4) a lower incidence of nerve damage together with a faster nerve recovery when impaired (Beziat et al, 2007a;Gilles et al, 2013;Spinelli et al, 2014). Therefore, based on the objective advantages ensured by this surgical device (Spinelli et al, 2014), its use has spread to other surgical specialties, such as neurosurgery and major maxillofacial surgical procedures (Kramer et al, 2006;Gleizal et al, 2007). Accordingly, this paper is an extension of the authors' previous investigation on the comparison of ultrasonic surgical devices with a traditional saw in maxillofacial surgery (Spinelli et al, 2014).…”

“…Therefore, based on the objective advantages ensured by this surgical device (Spinelli et al, 2014), its use has spread to other surgical specialties, such as neurosurgery and major maxillofacial surgical procedures (Kramer et al, 2006;Gleizal et al, 2007). Accordingly, this paper is an extension of the authors' previous investigation on the comparison of ultrasonic surgical devices with a traditional saw in maxillofacial surgery (Spinelli et al, 2014). The clinical application was introduced and the safety of the ultrasonic device as an alternative tool in paediatric craniofacial surgery was evaluated.…”