Piezosurgery in External Dacryocystorhinostomy

Abstract

Piezourgery is a viable modality for performing external DCRs. The lack of surgical complications shows a potential for decreased soft tissues damage. The surgical success rate based on patient-reported epiphora is similar to those published for mechanical external DCRs. This modality may benefit the novice surgeon in the reduction of soft and mucosal tissue damage.

<p>External Dacryocystorhinostomy: A Comparison Of Ultrasonic Bone Aspiration To High-Speed Drilling</p>

“…This finding validates earlier research from Czyz et al, who suggested anecdotal improvements in operative time when using a piezosurgical device. 6 One key difference between our study and that of Czyz et al is our utilization of a single device and bone cutting tip with the UBA, which facilitates direct comparison of these tools. Although cross-study comparisons of operative time are challenging given wide variability in anesthesia protocols, surgical techniques, and individual surgeon preferences, the UBA objectively appears to shorten the surgical time when other variables are held constant.…”

“…The Sonopet ® UBA is a piezosurgical device that combines torsional and longitudinal oscillation to selectively cut bone and minimize collateral damage to soft tissue. 6,8 As the success of external DCR may correlate with soft tissue preservation and flap management, removing bone without injuring mucosa may potentially improve clinical outcomes (Figure 3). This hypothesis is supported by histopathologic studies in animal models, which have shown that piezoelectric devices result in less direct damage to bony structures and soft tissue compared to traditional drills and oscillating saws.…”

“…[5][6][7][8] Given its high success rate and low risk of problematic scarring, the external approach is preferred by many oculoplastic surgeons and can be performed in the outpatient setting under monitored sedation. 1,6 Historically, rongeurs, osteotomes, and electric drills have been used during DCR to create a bony ostium through the lacrimal sac fossa. 1 While these tools remain effective, they impart a risk of damaging underlying nasal mucosa during the osteotomy.…”

“…1 While these tools remain effective, they impart a risk of damaging underlying nasal mucosa during the osteotomy. 6 Piezosurgical devices utilize metal cutting tips oscillating at ultrasonic frequencies (25-30kHz) to selectively emulsify bone while displacing and preserving adjacent soft tissue. 7 Theoretically, these tools may preserve delicate nasal mucosa during DCR and facilitate the creation of lacrimal-nasal mucosal flaps.…”

“…Furthermore, the ability to simultaneously irrigate and aspirate the operative field through the tip of the device may improve the surgeon's visibility, control, and precision. [6][7][8] Given these potential advantages and the relative dearth of existing literature, we sought to investigate the value of piezosurgical devices in external DCR. The primary objective of this study is to compare surgical outcomes for external DCR using a single piezosurgical device (Sonopet Ultrasonic Aspirator ® , Stryker Medical, Kalamazoo, MI, USA) versus a high-speed drill with a diamond burr.…”