Critical evaluation of piezoelectric osteotomy in orthognathic surgery: Operative technique, blood loss, time requirement, nerve and vessel integrity

Purpose: Piezo-osteotomy feasibility as a substitute for the conventional saw in orthognathic surgery was evaluated regarding operative technique, blood loss, time requirement, and nerve and vessel integrity. Patients and Methods: Fifty patients had orthognathic surgery procedures in typical distribution using piezosurgical osteotomy: 22 (44%) monosegment, 26 (52%) segmented Le Fort I osteotomies; 48 (48%) sagittal split osteotomies, 6 (12%) symphyseal, and 4 (4%) mandibular body osteotomies. Controls were 86 patients with conventional saw and chisel osteotomies: 57 (66%) monosegment, 25 (29%) segmented Le Fort I osteotomies, 126 (73%) sagittal split, and 4 (5%) symphyseal osteotomies. Results: Piezosurgical bone osteotomy permitted individualized cut designs, enabling segment interdigitation after repositioning. Angulated tools weakened the pterygomaxillary suture; auxiliary chisels were required in 100% of cases for the nasal septum, and lateral nasal walls as 46% pterygoid processes. After downfracture, the dorsal maxillary sinus wall and pterygoid processes were easily reduced. Hemorrhage was successfully avoided with average blood loss of 541 +/- 150 mL versus 773 +/- 344 ml, (P = .001) for a conventional bimaxillary procedure. Sagittal mandibular osteotomy required considerable time (auxiliary saw in 13%); the lingual dorsal osteotomy was mostly performed tactile. Time investment remained unchanged: 227 +/- 73 minutes per bimaxillary standard osteotomy versus 238 +/- 61 minutes (P = .5); clinical courses and reossification were unobtrusive. Alveolar inferior nerve sensitivity was retained in 95% of the study collective versus 85% in the controls (P = .0003) at 3 months postoperative testing. Conclusions: Piezoelectric osteotomy reduced blood loss and inferior alveolar nerve injury at no extra time investment. Single cases require auxiliary chiseling or sawing. Piezoelectric drilling for screw insertion and complex osteotomy designs may be developed to maintain bone contact or interdigitation after repositioning and minimize need for osteofixation. (C) 2008 American Association of Oral and Maxillofacial Surgeons.