[What is Piezosurgery? Two-years experience in craniomaxillofacial surgery].
BACKGROUND
Piezosurgery is a new surgical technique used in dentistry to section hard tissues without damaging adjacent soft tissues. We hypothesized that such a device could also be useful in craniofacial and orthognathic surgery.


METHODS
An ultrasonic device (Mectron) was employed in different craniofacial surgical procedures: a) to perform 144 Le Fort I osteotomies, 140 palatal expansions after Le Fort I osteotomies, and 134 bilateral sagittal osteotomies; b) to perform a Le Fort III osteotomy for treatment of Crouzon syndrome in 2 patients; c) to perform 5 segmental osteotomies and 3 osteotomies of the inferior edge of the mandible for facial asymmetry; d) to perform 12 cases of unicortical calvarial bone grafting; e) to remove the superior orbital roof in 20 cases of craniofaciostenosis and the frontal bone in 5 cases; f) to remove the external wall of the orbit or the anterior and posterior wall of the frontal sinuses in 10 cases of orbital cavity tumors; g) to approach the skull base through the frontal sinuses in 4 cases. Integrity of soft tissues and surgical time were evaluated.


RESULTS
Analysis of the results showed that Piezosurgery: a) allows very precise cutting; b) avoids bone cutting using an osteotome; c) spares soft tissue such as brain, dura-mater, palatal mucosa, and the inferior alveolar nerve; d) increases the time of bone cutting but not the overall operative time because of the absence of soft tissue protection.


CONCLUSIONS
Piezosurgery is a new technical procedure, which can be advantageous for bone cutting in many situations, sparing adjacent soft tissues such as brain, palatal mucosa, and the inferior alveolar nerve from any damage. The device's lack of power appears to be a minor problem compared with the advantages.
Beziat
J-L
JL
Service de chirurgie maxillofaciale, groupement hospitalier Nord, 103, Grande-Rue de la Croix-Rousse, 39317 Lyon cedex 01, France. jean-luc.beziat@chu-lyon.fr
Vercellotti
T
T
Gleizal
A
A
D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D004598:Electrosurgery / Q000295:instrumentation; D006801:Humans; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D019647:Oral Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods; D021362:Palate, Hard / Q000601:surgery; D011312:Pressure; D014464:Ultrasonic Therapy / Q000295:instrumentation*