Piezoosteotomy in orthognathic surgery versus conventional saw and chisel osteotomy

Abstract

Piezoosteotomy was assessed as alternative osteotomy method in orthognathic surgery regarding handling, time requirement, nerve and vessel impairment. In this comparative clinical experience, 90 patient's orthognathic surgery procedures were performed in typical distribution prospectively by piezoosteotomy: 34 (38%) monosegment, 47 (52%) segmented LeFortI osteotomies, 94 (52%) sagittal split osteotomies, 11 (12%) symphyseal, and 4 (2%) mandibular body osteotomies. As controls served 90 retrospective patients with conventional saw and chisel osteotomy: 58 (64%) monosegment, 27 (30%) segmented LeFortI osteotomies, 130 (72%) sagittal split, and 4 (4%) symphyseal osteotomies. Piezoosteotomies were individually designed to interdigitate the jaw segments after repositioning. The pterygomaxillary suture weakened angulated tools; auxiliary chisels were required in 100% of cases for the nasal septum and lateral nasal walls, in 33% for pterygoid processes. The dorsal maxilla as the pterygoid process were easily reduced; 15% mandibular osteotomies required sawing, while the lingual dorsal osteotomy was performed by manual feedback due to limited visibility. Bloodloss decreased from average 537 +/- 208 ml vs. 772 +/- 338 ml (p = 0.0001). Operation time remained unchanged: 223 +/- 70 min vs. 238 +/- 60 min (p = 0.2) for a conventional bimaxillary procedure. Clinical courses and reossification were unobtrusive. Alveolar inferior nerve sensitivity was retained in 98% of the piezoosteotomy collective versus 84% of controls (p = 0.0001) at 3 months postoperative testing. Piezoelectric osteotomy did not prolong the operation and reduced blood loss as alveolar nerve impairment. A few patients required additional sawing or chisel. Piezoelectric screw insertion as complex osteotomies may be initiated to simplify the procedure and increase segment interdigitation after repositioning as to minimize the osteofixation time and dimensions.