title: Complex craniofacial advancement in paediatric patients: Piezoelectric and traditional technique evaluation.
abstract: OBJECTIVE
  The piezoelectric device allows bone cutting without damaging the surrounding soft tissues. The purpose of this study was to assess the role of this surgical instrument in paediatric craniofacial surgery in terms of safety and surgical outcomes.
  
  
  METHODS
  Thirteen consecutive paediatric patients underwent craniofacial Le Fort osteotomies type III and IV. The saw was used on the right side in seven patients and on the left side in six patients; the piezoelectric instrument was used on the right side in six patients and on the left side in seven patients. Intraoperative blood loss, surgical procedure length, incision precision, postoperative haematoma and swelling, and nerve impairment were evaluated to compare the outcomes of both procedures.
  
  
  RESULTS
  A longer surgical procedure was observed in 28% of the patients when using the piezoelectric device (p = 0.032), with an intraoperative blood loss reduction of 18% (p = 0.156). Greater precision in bone cutting was reported, together with a reduction in the requirement to protect and incise adjacent soft tissues during piezoelectric osteotomies. There was a lower incidence of postoperative haematoma and swelling following piezo-osteotomy, and a significant reduction in postoperative nerve impairment (p = 0.002).
  
  
  CONCLUSIONS
  The ultrasonic surgical device guaranteed a clean bone cut, preserving the integrity of the adjacent soft tissues beneath the bone. Although the time required for a piezoelectric osteotomy was longer, the total operation time remained approximately the same. In conclusion, the device's lack of power appears to be a minor problem compared with the advantages, and an ultrasonic device could be considered a valuable instrument for paediatric craniofacial advancement.
authors: Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors: Giuseppe
authors: G
authors: Spinelli
authors: First Clinic of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. Electronic address: mannelli.giuditta@gmail.com.
authors: Giuditta
authors: G
authors: Mannelli
authors: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
authors: Yi Xin
authors: YX
authors: Zhang
authors: Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy.
authors: Davide
authors: D
authors: Lazzeri
authors: Department of Pediatric Neurosurgery, Anna Meyer Children's Hospital, Florence, Italy.
authors: Barbara
authors: B
authors: Spacca
authors: Department of Pediatric Neurosurgery, Anna Meyer Children's Hospital, Florence, Italy.
authors: Lorenzo
authors: L
authors: Genitori
authors: Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors: Mirco
authors: M
authors: Raffaini
authors: Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors: Tommaso
authors: T
authors: Agostini
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery; D000293:Adolescent; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003394:Craniofacial Dysostosis / Q000601:surgery; D004487:Edema / Q000209:etiology; D005094:Exophthalmos / Q000601:surgery; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D061646:Operative Time; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D059745:Piezosurgery / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012449:Safety; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D016896:Treatment Outcome
keywords: Craniofacial malformations; Craniofacial osteotomies; Facial appearance; Intracranial volume; Piezo-osteotomy