title: Quantifying osteotome sharpness: comparing the major manufacturers.
abstract: OBJECTIVE
  (1) To develop a method for quantification of osteotome sharpness in a rhinoplasty model, using artificial bone; (2) to demonstrate changes in osteotome sharpness over multiple uses; and (3) to compare osteotomes from different manufacturers in terms of sharpness and cost.
  
  
  METHODS
  Prospective surgical model.
  
  
  METHODS
  Academic hospital and engineering research facility.
  
  
  METHODS
  Osteotomes were used to make 4-cm cuts through 4-mm wedges of artificial bone. Sharpness was assessed at baseline and following 1, 4, 7, and 10 uses by measuring the load required to cut a #2 Prolene suture. Changes in sharpness from baseline were measured over time, and comparison of manufacturers was performed using analysis of variance (ANOVA). Cost per use was computed for each osteotome.
  
  
  RESULTS
  Five osteotomes were tested (Biomet, Black & Black, Miltex, NexEdge, Storz). At baseline, the Storz osteotome was sharpest (1.74 lb, P < .001), followed by Miltex and Biomet (2.50 lb, 2.68 lb) and NexEdge and Black & Black (3.48 lb, 3.40 lb). All osteotomes except NexEdge (P = .098) demonstrated significant decreases in sharpness over time (P = .02 to P < .001), although relative changes and absolute sharpness varied greatly. ANOVA demonstrated Storz to be significantly sharper at all time points (P < .001). Storz and Miltex were superior in cost-per-use analysis.
  
  
  CONCLUSIONS
  Sharp osteotomes are important in cosmetic and functional rhinoplasty. Instruments may appear the same but can be quite dissimilar in efficacy and cost. Indeed, relative efficacy has not been previously tested. Quantitative analysis performance and cost-effectiveness analyses are reported here and can assist the surgeon in selection and maintenance of instruments.
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania, USA. evan.ransom@gmail.com
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: Marcelo B
authors.initials: MB
authors.lastname: Antunes
authors.forename: Jason D
authors.initials: JD
authors.lastname: Bloom
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Becker
mesh_terms: D000704:Analysis of Variance; D004867:Equipment Design; D006801:Humans; D010027:Osteotomy / Q000295:instrumentation*; D011446:Prospective Studies; D012225:Rhinoplasty / Q000295:instrumentation*