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Piezosurgery bone surgery in otology.

abstract

Piezoelectric bone surgery in otology. Piezosurgery® is a new instrument which can cut the bone without causing necrosis and non-mineralized tissues damage. The equipment consists of two hand-pieces, two inserts, two peristaltic pumps and one main unit. The piezoelectric device uses low freq...

uency ultrasonic waves (25-30 kHz) and therefore performs a selective cut where the insert works only on mineralized tissue whilst being ineffective on soft tissue (to cut soft tissue higher frequency waves are required). The applied power can be modulated between 2.8 and 16W, and the machine is programmed in accordance with the density of the bone to be cut. The microvibrations that are created in the piezoelectric hand-piece cause the inserts to vibrate linearly between 60 and 210 μm. The inter-operative irrigation is performed using a “cavitation effect� of physiological solution that is subject to ultrasonic vibrations, breaking up the liquid into very small particles that: cool down the bone surface, make the operating site blood free and offer maximum visibility. The advantages are: first, the cut is precise because it is produced by microvibrations from the cutting insert; second, the cut is safe (the ultrasonic frequency used does not affect soft tissues; the microvibration allows an easy intraoperative management); third, the less invasive cutting action produces minor tissue damage and consequently better healing. We have used Piezosurgery® in mastoidectomy, tympanoplasty, facial nerve decompression, excision of middle ear tumours, platinotomy and cochleostomy. Specific inserts have been created, particularly in platinotomy a specific operative program has been created to avoid involuntary error of power regulation: this program consents to perforate the footplate of stapes with a predetermined and not modifiable temporization. Single spot for platinotomy; this program generates low power microvibrations which last for 1/200 second. Our experiences highlight an easy intraoperative management, a precision of the cut, minimal surgical risk, high visibility during surgery, single spot for platinotomy, selective cut - no soft tissue damage, no risk of harming adjacent tissue and therapeutic success of the operation, especially in difficult anatomic situations.

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