The Use of an Ultrasonic Serrated Knife in Transcanal Excision of Exostoses

Abstract

Objective To describe a novel approach for excision of exostoses and evaluate the outcomes of transcanal excision of exostoses using ultrasonic serrated knife-assistance vs. micro-osteotomes only. Study Design Retrospective analysis Setting Academic Tertiary Care Center Patients/Interventions Patients receiving a transcanal excision of exostoses between 2007 and 2016. Main outcome measures The outcomes and post-operative complications of 138 patients who received transcanal micro-osteotome only technique were compared to 10 patients who received transcanal excision of exostoses using ultrasonic serrated knife-assistance (Stryker Corporation, Kalamazoo, MI). Results A total of 175 ears in 128 patients underwent a transcanal micro-osteotome only technique. Of these, 11 (6.3%) developed an intra-operative tympanic membrane perforation. One developed anterior canal mobilization requiring prolonged (3 weeks) packing. One hundred and thirty five ears (77%) were well healed by the three week post-operative visit. All but one ear was well healed by the six week visit. In comparison, 11 ears in 10 patients were treated for exostoses using a transcanal approach with the use of ultrasonic serrated knife and micro-osteotomes. One ear canal (the first in the series) was not well healed by the three week post-operative visit due to suspected thermal injury. All patients had well healed ear canals by six weeks, and there were no complications. Conclusions This is the first series to report the use of an ultrasonic serrated knife in the transcanal excision of exostoses. When compared to a transcanal micro-osteotome only excision of exostoses, the addition of the Sonopet appears to result in a similarly low complication rate. Sonopet can allow for more controlled transcanal excision of broad based exostoses in patients with severe obstruction.

Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods

“…Haidar et al found favorable healing rates when utilizing a piezoelectric cutting device; however, they did not report rates of otorrhea findings nor the incidence of subjective pain at 3 weeks postoperation. They also noted 1 incidence of thermal injury out of 11 ears, which may have implications for our current findings 7 . Conversely, the OP group was the soonest on average to return to the water, but not significantly compared to OA, suggesting that most patients were subjectively and objectively well enough to return to previous activities (Table 4).…”

“…4 Furthermore, the piezoelectric knife has been suggested to emit vibrations that are outside the range of frequencies that would have negative implications on the cochlea; however, the referenced study only contained eleven total ears operated upon by the piezoelectric. 7 In a similar study by Salami et al, no inner ear issues were found after the removal of symptomatic external ear canal osteomas with a piezoelectric device, but this study also only had 10 subjects. 8 Similarly to the previous studies, it is important to note the substantially fewer number of ears operated on in the OP group when evaluating these current findings.…”

“…They also noted 1 incidence of thermal injury out of 11 ears, which may have implications for our current findings. 7 Conversely, the OP group was the soonest on average to return to the water, but not significantly compared to OA, suggesting that most patients were subjectively and objectively well enough to return to previous activities (Table 4).…”

“…Tinnitus is often utilized as a proxy for inner ear disturbance, and it has been an often‐cited concern for utilization of the drill due to the proximity to the cochlea and vibrations emitted with use 4 . Furthermore, the piezoelectric knife has been suggested to emit vibrations that are outside the range of frequencies that would have negative implications on the cochlea; however, the referenced study only contained eleven total ears operated upon by the piezoelectric 7 . In a similar study by Salami et al, no inner ear issues were found after the removal of symptomatic external ear canal osteomas with a piezoelectric device, but this study also only had 10 subjects 8 .…”

External ear canal exostectomy: influence of surgeon’s experience on 3-years recurrence and occurrence of complications

“…7 In a series of 10 exostoses, Haidar et al did not find any complication. 6 This surgical technique would be interesting to evaluate over a larger series with long-term follow-up.…”