title: Surgical management of ankyloses of the temporomandibular joint by a piezoelectric device.
abstract: BACKGROUND
  Piezosurgery is commonly used in different field of craniomaxillofacial surgery; since its introduction it has become one of the widely adopted technique for performing osteotomies in orthognathic surgery, distraction osteogenesis and dentoalveolar surgery. Little has been written regarding ultrasonic system for temporomandibular joint surgery (TMJ). In this prospective study we describe the use of piezoelectric device for ankylosis of the TMJ.
  
  
  METHODS
  We enrolled in this study 19 patients, 10 males and 9 females, mean (SD) age 24.6 (7.6) years, affected by unilateral ankylosis of TMJ who were surgically managed between January 2009 and December 2014 by interpositional arthroplasty with temporomyofascial muscle flap. We adopted in all cases a preauricular approach with temporal extension. The ankylotic block was removed with piezoelectric device in 9 patients and using traditional rotary bur in 10 cases. We investigated and compared the following parameters as surgical outcomes: intraoperative bleeding, duration of operation, incidence of infection, postoperative swelling and hematoma, mouth opening, nerve impairment and rate of recurrence.
  
  
  RESULTS
  We noticed a substantial reduction in bleeding with the piezoelectric bone cutter when compared to traditional mechanical surgery (103 ml versus 117 ml; p < 0.05); however, we did not report any severe bleeding from the pterygoid plexus or maxillary artery. Operating time was longer in the piezo group (101 min versus 88 min; p < 0.05). There was a lower incidence of postoperative hematoma and swelling following piezoosteotomy. However, regarding postoperative nerve impairment and infection we did not observe any differences between the two groups. At one year follow-up mean (SD) mouth opening was 34 (4.3) mm. We did not report recurrence of the disease.
  
  
  CONCLUSIONS
  Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding and few postoperative complications. We believe that piezosurgery allows surgeons to achieve better results compared to a traditional surgery. It is a possible alternative due to the clinical benefits demonstrated.
authors.affiliation: Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinelli
authors.affiliation: Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Valente
authors.affiliation: First Clinic of Otorhinolaryngology Head and Neck Surgery, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Giuditta
authors.initials: G
authors.lastname: Mannelli
authors.affiliation: Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Raffaini
authors.affiliation: Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. Electronic address: fraarcuri@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Arcuri
mesh_terms: D000293:Adolescent; D000328:Adult; D000844:Ankylosis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D059745:Piezosurgery; D011446:Prospective Studies; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D055815:Young Adult
keywords: Interpositional arthroplasty; Piezosurgery; Temporomandibular joint ankylosis