title: Piezosurgery for orbital decompression surgery in thyroid associated orbitopathy.
abstract: The purpose of this study was to assess a piezosurgical device as a novel tool for bony orbital decompression surgery. At a multidisciplinary orbital center, 62 surgeries were performed in 40 patients with thyroid associated orbitopathy (TAO). Within this retrospective case-series, we analyzed the medical records of these consecutive unselected patients. The reduction of proptosis was the main outcome measure. Indications for a two (n = 27, 44%) or three wall (35, 56%) decompression surgery were proptosis (n = 50 orbits, 81%) and optic neuropathy (n = 12, 19%). Piezosurgery enabled precise bone cuts without intraoperative complications. Proptosis decreased from 23.6 ± 2.8 mm (SD) by 3 mm (95% CI: -3.6 to -2.5 mm) after surgery and stayed stable at 3 months (-3 mm, 95% CI: -3.61 to -2.5 mm, p < 0.001, respectively). The effect was higher in those with preoperatively higher values (>24 mm versus ≤ 24 mm: -3.4 mm versus -2.81 mm before discharge from hospital and -4.1 mm versus -2.1 mm at 3 months: p < 0.001, respectively). After a mean long-term follow-up period of 14.6 ± 10.4 months proptosis decreased by further -0.7 ± 2.0 mm (p < 0.001). Signs of optic nerve compression improved after surgery. Infraorbital hypesthesia was present in 11 of 21 (52%) orbits 3 months after surgery. The piezosurgical device is a useful tool for orbital decompression surgery in TAO. By cutting bone selectively, it is precise and reduces the invasiveness of surgery. Nevertheless, no improvement in outcome or reduction in morbidity over conventional techniques has been shown so far.
authors: Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany; Center of Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany. Electronic address: katharina.ponto@unimedizin-mainz.de.
authors: Katharina A
authors: KA
authors: Ponto
authors: Dept. of Biostatistics, University Medical Center Mainz, Germany; Center of Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany.
authors: Isabella
authors: I
authors: Zwiener
authors: Dept. of Maxillofacial Surgery, University Medical Center Mainz, Germany.
authors: Bilal
authors: B
authors: Al-Nawas
authors: Medicine I, University Medical Center Mainz, Germany.
authors: George J
authors: GJ
authors: Kahaly
authors: Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany.
authors: Anna F
authors: AF
authors: Otto
authors: Dept. of Maxillofacial Surgery, University Medical Center Mainz, Germany.
authors: Julia
authors: J
authors: Karbach
authors: Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany.
authors: Norbert
authors: N
authors: Pfeiffer
authors: Dept. of Ophthalmology (Head: Prof. Dr. N. Pfeiffer), University Medical Center Mainz, Germany.
authors: Susanne
authors: S
authors: Pitz
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005094:Exophthalmos / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D007431:Intraoperative Complications / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery; D009901:Optic Nerve Diseases / Q000601:surgery; D009915:Orbit / Q000601:surgery*; D059745:Piezosurgery / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Decompression; Orbital surgery; Piezosurgery; Proptosis; Thyroid associated orbitopathy