Minimally invasive genioplasty: an observational study

PURPOSE

This study aimed to determine the feasibility of a minimal invasive genioplasty (MIG) technique combining a limited vertical incision, endoscopy, and a piezotome.

METHODS

A total of thirteen patients who underwent primary genioplasty procedures under general anesthesia were evaluated. The feasibility of the method was reported in terms of total surgery time, the total amount of intra-operative blood loss, neurosensory dysfunction, pain sensation, infection, and patient satisfaction using the FACE-Q Chin scale.

RESULTS

We observed the mean surgery time of 46.08 ± 5.33 min with a statistically significant p-value of 0.157. The ANOVA test value for mean neurosensory testing score (NST) was calculated as 5.95 (p = 0.006) for the right side and 7.64 (p = 0.017) for the left side. The paired t-test value of the mean pain score was 117.98 (p < 0.001) and showed no significant pain after 1 week. The quality of the osteotomy was deemed good in 12 patients with less intra-operative blood (ranged from 7.7 to 46.2%).

CONCLUSION

Based on these results, this minimally invasive technique for genioplasty is a promising approach to perform a chin osteotomy and should be an alternative to the conventional genioplasty technique.

Assessing outcomes from rhinoplasty using clinical and patient reported measures (FACE-Q™)

AIM

To assess the effect of cosmetic rhinoplasty on PROMS using the FACE-Q™ tool.

METHODS

Between July 2020 and February 2022 all patients undergoing rhinoplasty by a single surgeon were approached pre-operatively and 6 months post-operatively to complete the Face-Q™ "Satisfaction with Nose" module. Post-operative patients were asked to complete the FACE-Q™ "Satisfaction with Outcome" module.

RESULTS

One hundred and sixty-five patients underwent rhinoplasty (147 primary, 18 revisions). Eighty two percent (n = 135) completed a pre-operative "Satisfaction with Nose" module. Thirty three percent (n = 54) completed the full pre and post- operative dataset. The mean pre-operative "Satisfaction with Nose" score was 32.88 (± 8.40). The mean post-operative "Satisfaction with Nose" score was 77.45 (SD17.26) and "Satisfaction with Outcome" score was 75.27(SD 21.88). The mean change in score 133% (SD 63%). Seventy-seven percent of patients were "very satisfied" or "somewhat satisfied" across all 10 aspects of the nose. The tip had the lowest post-operative satisfaction with 19% of patients somewhat or very dissatisfied.

CONCLUSION

Rhinoplasty generates significant improvements in PROMS and satisfaction is high, an important positive finding for patients considering surgery. Routine collection of PROMS for rhinoplasty can inform practice and guide expectations as to its psychological impact.

Periotome versus piezotome as an aid for atraumatic extraction: a randomized controlled trial

Objectives

A single-blinded randomized controlled trial was designed to compare and evaluate the effectiveness of the periotome and piezotome as aids for atraumatic extraction and its sequalae.

Materials and Methods

The study sample comprised 48 teeth, equally allotted to the piezotome or periotome groups by random allocation, in participants aged 19-62 years. All samples in both groups had either complete tooth structure or intact roots without crowns and had mobility ≤grade II. Clinical parameters of operative duration, presence or absence of gingival laceration, reported operative and postoperative pain, and intake of analgesics following extraction were recorded. IBM SPSS software package version 22 was used for data entry and analysis.

Results

The mean operation time was significantly (P≤0.05) longer in the piezotome group than in the periotome group. However, fewer gingival lacerations were observed with use of a piezotome than with a periotome, although no significant difference was observed. The piezotome group reported significantly (P≤0.05) higher visual analog scale (VAS) pain scores during the procedure and non-significantly higher scores thereafter until the third postoperative day. In the piezotome group, the dosage of analgesic was higher, although the periotome group had a higher percentage of participants who used analgesics postoperatively; however, these differences were not statistically significant.

Conclusion

The present clinical trial favors the use of periotome over piezotome for atraumatic extraction due to shorter operating time, lower postoperative VAS pain scores, and lower dosage of analgesics despite the superior ability of the piezotome to prevent gingival laceration.

Piezoelectric Osteotomies in Dorsal Preservation Rhinoplasty

Dorsal preservation rhinoplasty requires precise management of the osseocartilaginous vault. Ultrasonic piezo instruments offer several advantages compared with traditional tools such as hand saws, rasps, and osteotomes. As always, an understanding of the dynamics of manipulation of the vault, anatomy, and proper technique are paramount and are reviewed herein.

Ultrasonic Wave Bone Cutting Technique (Piezotome) in Cochlear Implant Surgery by Veria Technique

To study use of ultrasonic wave bone cutting technique (piezotome) in cochlear implant surgery by veria technique. The Piezoelectric device is a bone cutting tool that transmits ultrasonic high frequency vibrations through a metallic tip to selectively cut bone while sparing the surrounding soft tissues. We have used the piezo tools instead of the perforator in over 50 cases of Cochlear Implant by the non mastoidectomy Veria technique [which uses a specially designed hand piece perforator with a guide (Kiratzidisa et al. in ORL J Otorhinolaryngol Relat Spec 64:413-416, 2002)]. These tools are helpful in: straightening the posterior bony canal wall, making the well for Implant bed, making space for excess electrodes and removing bone tissue close to dura without risk of injury to dura. Though use of Piezo tools in various otologic surgeries has been described but we feel the piezo tools will be an important tool in a CI surgeon's armament.

Minimally invasive orthognathic surgery: a systematic review

Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n=44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n=4), endoscopically assisted orthognathic procedures (n=17), or the use of a piezoelectric device in orthognathic surgery (n=25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.

Narrow ridge management with ridge splitting with piezotome for implant placement: report of 2 cases

Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker method wherein an atrophic ridge can be predictably expanded and grafted with bone allograft or allograft, eliminating the need for second surgical site. Traditionally, osseous surgery has been performed by either manual or motor-driven instruments. Piezosurgery is a relatively new technique for osteotomy and osteoplasty that utilizes ultrasonic vibration which allows clean cutting with precise incisions. This case series describes reports of 2 such cases in which narrow mandibular ridge splitting was carried by mean of piezotome with immediate placement of implants in the osteotomy site. Five months later, the implants were uncovered followed by impression and restored with impant- supported porcelain-fused-to-metal crowns.

In vivo assessment of bone healing following Piezotome® ultrasonic instrumentation

PURPOSE

This pilot study evaluated the molecular, histologic, and radiographic healing of bone to instrumentation with piezoelectric or high speed rotary (R) devices over a 3-week healing period.

MATERIAL AND METHODS

Fourteen Sprague-Dawley rats (Charles River Laboratories International, Inc., Wilmington, MA, USA) underwent bilateral tibial osteotomies prepared in a randomized split-leg design using Piezotome® (P1) (Satelec Acteon, Merignac, France), Piezotome 2® (P2) (Satelec Acteon), High-speed R instrumentation, or sham surgery (S). At 1 week, an osteogenesis array was used to evaluate differences in gene expression while quantitative analysis assessed percentage bone fill (PBF) and bone mineral density (BMD) in the defect, peripheral, and distant regions at 3 weeks. Qualitative histologic evaluation of healing osteotomies was also performed at 3 weeks.

RESULTS

At 1 week, expression of 11 and 18 genes involved in bone healing was significantly (p < .05) lower following P1 and P2 instrumentation, respectively, relative to S whereas 16 and 4 genes were lower relative to R. No differences in PBF or BMD were detected between groups within the osteotomy defect. However, significant differences in PBF (p = .020) and BMD (p = .008) were noted along the peripheral region between P2 and R groups, being R the group with the lowest values. Histologically, smooth osteotomy margins were present following instrumentation using P1 or P2 relative to R.

CONCLUSIONS

Piezoelectric instrumentation favors preservation of bone adjacent to osteotomies while variations in gene expression suggest differences in healing rates due to surgical modality. Bone instrumented by piezoelectric surgery appears less detrimental to bone healing than high-speed R device.