title: Comparison between piezosurgery and conventional osteotomy in cranioplasty with fronto-orbital advancement.
abstract: BACKGROUND
  Cranioplasty of patients with craniosynostosis requires rapid, precise and gentle osteotomy of the skull to avoid complications and benefit the healing process. The aim of this prospective clinical study was to compare two different methods of osteotomy. Piezosurgery and conventional osteotomy were compared using an oscillating saw and high speed drill while performing cranioplasties with fronto-orbital advancement.
  
  
  METHODS
  Thirty-four children who required cranioplasty with fronto-orbital advancement were recruited consecutively. The operations were conducted using piezosurgery or a conventional surgical technique, alternately. Operative time, blood count, CRP and transfusion rate, as well as soft tissue injuries, postoperative edema, pain development and secondary bone healing were investigated.
  
  
  RESULTS
  The average age of patients was 9.7 months. The following indications for craniosynostosis were surgically corrected: trigonocephaly (23), anterior plagiocephaly (8), brachycephaly (1), and syndromic craniosynostosis (2). Piezosurgery was utilized in 18 cases. There were no group differences with regard to the incidence of soft tissue injuries (dura, periorbita), pain, swelling, blood loss or bony integration. The duration of osteotomy was significantly longer in the piezosurgery group, leading to slightly increased blood loss, while the postoperative CRP increase was higher using the conventional method.
  
  
  CONCLUSIONS
  The piezosurgery method is a comparatively safe surgical method for conducting osteotomy during cranioplasty. With regard to soft tissue protection and postoperative clinical course, the same procedural precautions and controls are necessary as those needed for conventional methods. The osteotomy duration is considerably longer using piezosurgery, although it is accompanied by lower initial postoperative CRP values.
authors.affiliation: Department of Oral, Maxillofacial and Plastic Surgery (Head: Univ. Prof. Dr. Dr. R.H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: markus.martini@ukb.uni-bonn.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Martini
authors.affiliation: Department of Neurosurgery (Head: PD Dr. med. M. Messing-Jünger), Asklepios Children's Hospital, Arnold-Janssen-Str. 29, 53757 Sankt Augustin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Röhrig
authors.affiliation: Department of Oral, Maxillofacial and Plastic Surgery (Head: Univ. Prof. Dr. Dr. R.H. Reich), University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Rudolf Hermann
authors.initials: RH
authors.lastname: Reich
authors.affiliation: Department of Neurosurgery (Head: PD Dr. med. M. Messing-Jünger), Asklepios Children's Hospital, Arnold-Janssen-Str. 29, 53757 Sankt Augustin, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Messing-Jünger
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D007223:Infant; D061646:Operative Time; D010027:Osteotomy / Q000009:adverse effects; D010149:Postoperative Pain / Q000209:etiology; D059745:Piezosurgery / Q000009:adverse effects; D011446:Prospective Studies
keywords: Brachycephaly; Cranioplasty; Craniosynostosis; Piezosurgery; Plagiocephaly; Trigonocephaly