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1.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682473

RESUMEN

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Asunto(s)
Hueso Nasal/cirugía , Osteotomía/métodos , Piezocirugía/métodos , Rinoplastia/métodos , Humanos , Osteotomía/efectos adversos , Osteotomía/instrumentación , Evaluación de Resultado en la Atención de Salud , Piezocirugía/efectos adversos , Piezocirugía/instrumentación , Rinoplastia/efectos adversos , Rinoplastia/instrumentación
2.
Niger J Clin Pract ; 23(11): 1517-1522, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33221775

RESUMEN

Objective: To compare the use of a piezosurgery expander and conventional chisel/osteotome on primary implant stability. Materials and Methods: Twenty fresh ribs were divided into two main groups; group P and group C. In group P, bone expansion was performed using piezosurgery. In group C, bone expansion was performed using conventional chisel osteotomy. In both groups, the implants were inserted into the ribs after bone expansion. After implant placement, primary stability values were evaluated from the bucco-lingual (B-L) and mesio-distal (M-D) sides of the implant. Results: The primary stability values on the B-L side of both implants in group P were significantly higher than in group C (P < 0.05). Conclusion: The use of piezo-expanders in the alveolar split technique has better effects on primary implant stability compared with the conventional technique.


Asunto(s)
Implantes Dentales , Osteotomía/instrumentación , Piezocirugía/métodos , Implantación Dental Endoósea , Instrumentos Dentales , Humanos , Osteotomía/métodos , Piezocirugía/instrumentación , Factores de Tiempo
3.
Med. oral patol. oral cir. bucal (Internet) ; 25(4): e461-e467, jul. 2020. ilus, tab
Artículo en Inglés | IBECS | ID: ibc-196497

RESUMEN

BACKGROUND: As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain, edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions. MATERIAL AND METHODS: Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3, 7 and 14-days. The measured parameters were duration of surgery, pain, trismus and swelling. RESULTS: The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p > 0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p = 0.038; p < 0,05). However, for the remaining analyzed periods there was no difference (p > 0.05). CONCLUSIONS: Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Tercer Molar/cirugía , Ultrasonografía Intervencional/métodos , Colgajos Quirúrgicos/cirugía , Osteotomía/métodos , Extracción Dental/métodos , Piezocirugía/métodos , Resultado del Tratamiento , Tempo Operativo , Dolor Postoperatorio , Análisis de Varianza , Estadísticas no Paramétricas , Reproducibilidad de los Resultados , Escala Visual Analógica , Trismo/etiología
5.
Biomed Res Int ; 2019: 8483658, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31662998

RESUMEN

Purpose: Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. Methods: A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. Results: The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p < 0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. Conclusions: The evidence supports the application of the piezoelectric approach compared to the drill's osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923.


Asunto(s)
Osteotomía/métodos , Dolor Postoperatorio/fisiopatología , Piezocirugía/métodos , Anciano , Implantación Dental Endoósea , Implantes Dentales , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Tempo Operativo
6.
Int Orthod ; 17(3): 562-566, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31296488

RESUMEN

Orthodontic and surgical techniques are constantly evolving and practitioners are facing an increasing demand for shorter treatments, with an expectation of results equivalent to conventional treatments. Corticotomies have made it possible to partly meet this need by facilitating dental movement in adult orthodontic care. Many surgical corticotomy techniques were proposed in the past presenting advantages but also a certain number of disadvantages. After retracing the various surgical techniques proposed and explaining the biological principles, we will introduce a new minimally invasive technique, without mucoperiosteal flap and without piezosurgery. This technique can be performed in the dental chair under local anaesthesia or sedation. It is simple and reproducible. This type of treatment combines comfort, speed and periodontal protection. Our objective is to provide more patients and practitioners with corticotomies while controlling the benefit/risk ratio.


Asunto(s)
Proceso Alveolar/cirugía , Arco Dental/cirugía , Maloclusión/terapia , Ortodoncia/métodos , Adulto , Arco Dental/diagnóstico por imagen , Humanos , Incisivo , Osteotomía/métodos , Piezocirugía/métodos , Técnicas de Movimiento Dental/métodos
7.
HNO ; 67(11): 836-842, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31165198

RESUMEN

BACKGROUND: Facial plastic and reconstructive surgery requires delicate, atraumatic handling of cartilage, bone and the surrounding soft tissue. Piezoelectric instrumentation (PEI) has previously been shown to be a precise and safe surgical instrument in rhinoplasty. It offers good preservation of surrounding soft tissue and high cutting precision and thus a good surgical applicability in rhinoplasty. OBJECTIVE: This article presents experiences using PEI for cartilage preparation and modelling for various indications in facial plastic surgery. The use of PEI in rhinoplasty, its safety and preciseness were evaluated and postoperative results are discussed with respect to facial swelling and bruising. MATERIAL AND METHODS: This retrospective study included 35 patients undergoing rhinoplasty and follow-up. Surgery was conducted by two expert surgeons in rhinoplasty in the department of otorhinolaryngology at the University Clinic of LMU Munich. Surgical performance of PEI in comparison with conventional instruments was evaluated by a customized questionnaire. The postoperative assessment of pain, facial swelling and bruising was documented. RESULTS: This article presents the different options for the use of PEI in rhinoplasty. In bone modelling procedures, such as hump removal, osteotomy and bony fixations, PEI was evaluated as being superior to conventional instruments. Intraoperative bleeding was reduced, which led to reduced facial swelling and/or bruising. Postoperative pain assessment showed no or only mild pain in two thirds of the patients. CONCLUSION: The results show that PEI enables a safe and very precise operation. Further development of surgical inserts will enable new surgical steps and facilitate the handling.


Asunto(s)
Piezocirugía/métodos , Procedimientos Quirúrgicos Reconstructivos , Rinoplastia , Cartílago , Humanos , Hueso Nasal/cirugía , Nariz/cirugía , Osteotomía , Estudios Retrospectivos , Rinoplastia/métodos
8.
Rev. Asoc. Odontol. Argent ; 107(2): 54-62, abr.-jun. 2019. ilus
Artículo en Español | LILACS | ID: biblio-1015871

RESUMEN

Objetivo: Presentar una técnica quirúrgica de disyunción con bisturí piezoeléctrico y expansión de rebordes delgados en maxilar inferior que permita la colocación de implantes en la posición tridimensional correcta en el mismo acto quirúrgico. Casos clínicos: Se presenta la resolución de dos casos clínicos de pacientes que acudieron a la Cátedra de Odontología Integral Adultos de la Facultad de Odontología de la Universidad de Buenos Aires. Ambos requerían la colocación de implantes en sectores posteroinferiores. Las imágenes tomográficas mostraban adecuada altura del reborde alveolar pero deficiente espesor para la colocación de implantes en la posición tridimensional correcta. Se decidió realizar una técnica de disyunción horizontal del reborde alveolar con bisturí piezoeléctrico, expansión del reborde y colocación de implantes e injerto óseo particulado de forma simultánea. Luego de 3 meses, se efectuó la segunda cirugía para iniciar la rehabilitación protésica. Conclusión: La técnica de disyunción horizontal del reborde alveolar mediante el uso del bisturí piezoeléctrico permitió ubicar al implante en la posición tridimensional correcta dentro del tejido óseo nativo sin la necesidad de realizar regeneraciones complejas en rebordes alveolares delgados (AU)


Aim: Present the horizontal split crest technique with a piezoelectric scalpel and the immediate implant placement in the correct tridimensional position, in thin mandibular alveolar ridges. Cases report: The surgical resolutions of 2 clinical cases of patients who attended the Adult Integral Dentistry Chair of the Faculty of Dentistry of the UBA, are presented. Both patients required implant placement in posterior madibular residual ridge. The tomographic images showed adequate height of the alveolar ridge but poor thickness for implants placement in a correct three-dimensional position. It was decided to perform a horizontal split crest technique of the alveolar ridge with piezoelectric scalpel, ridge expansion, and immediate implant placement with xenograft. After 3 months, the second surgery was performed to start with the prosthetic rehabilitation. Conclusion: The horizontal split crest technique using a piezoelectric scalpel, allowed immediate implant placement in the correct tridimensional position within native bone tissue, avoiding a guided bone regeneration technique, in these cases with thin alveolar ridges (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Técnica de Expansión Palatina , Implantación Dental Endoósea , Piezocirugía/métodos , Argentina , Facultades de Odontología , Oseointegración , Trasplante Óseo/métodos , Proceso Alveolar/cirugía , Rehabilitación Bucal
9.
Oper Neurosurg (Hagerstown) ; 17(6): 580-587, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31089696

RESUMEN

BACKGROUND: Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE: To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS: A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS: The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION: The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.


Asunto(s)
Vértebras Cervicales/cirugía , Condrosarcoma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Piezocirugía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias de la Columna Vertebral/cirugía , Adulto , Angiografía , Femenino , Humanos , Laminectomía/métodos , Imagen por Resonancia Magnética , Impresión Tridimensional , Implantación de Prótesis , Titanio , Arteria Vertebral/diagnóstico por imagen
10.
Am J Orthod Dentofacial Orthop ; 155(5): 662-669, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31053282

RESUMEN

OBJECTIVES: The aim of this work was to compare the duration of treatment between orthodontic treatment combined with piezocorticision (OT-PC) and conventional orthodontic treatment (COT), as well as to evaluate the safety, inflammatory process, periodontal health, and soft tissue healing in the OT-PC group. METHODS: Twelve patients were included in each group, and their treatment times were compared for preliminary bracket alignment (PBA) and for overall treatment. In the OT-PC group, the inflammatory process was evaluated by quantifying cytokines in the gingival crevicular fluid. A calibrated examiner measured the probing depth (PD), the distance between the gingival margin and the cementoenamel junction (GM-CEJ), and the clinical attachment level (CAL), before and after OT-PC. The presence of gingival scars was evaluated. Bone and root injuries were assessed with the use of cone-beam computed tomography. RESULTS: The treatment time was significantly reduced in the OT-PC group for PBA in both maxilla (45%; P = 0.001) and mandible (31%; P = 0.023), as well as for overall treatment (52%; P < 0.0001). Although not statistically significant, several inflammatory mediators demonstrated peaks at 3-5 and 16 weeks. There were not significant changes in PD and GM-CEJ after OT-PC treatment, unlike CAL (0.09 ± 0.12 mm; P = 0.024); 47.5% of piezocorticisions caused gingival scars. Only one patient showed no scars. Four cortical bones did not heal completely, and 2 roots had piezoelectric injuries. CONCLUSION: OT-PC was effective at reducing the orthodontic treatment time.


Asunto(s)
Citocinas/metabolismo , Líquido del Surco Gingival/química , Maloclusión/terapia , Ortodoncia Correctiva/métodos , Piezocirugía/métodos , Adolescente , Adulto , Terapia Combinada , Diagnóstico por Imagen , Femenino , Encía/anatomía & histología , Humanos , Masculino , Satisfacción del Paciente , Pérdida de la Inserción Periodontal , Índice Periodontal , Factores de Tiempo , Cuello del Diente/anatomía & histología , Resultado del Tratamiento
11.
World Neurosurg ; 126: 541-546, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30928600

RESUMEN

OBJECTIVE: To evaluate safety and effectiveness of the application of piezosurgery in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum (MTOLF). METHODS: Forty-one cases who had MTOLF and underwent en bloc laminectomy from January 2012 to January 2017 were reviewed and divided into Group A (high-speed drill, n = 23) and Group B (piezosurgery, n = 18). Comparisons in clinical outcome and perioperative complications were carried out between the 2 groups. RESULTS: Mean follow-up period was comparable between Group A (12.6 months) and Group B (11.4 months). Both operation time and intraoperative blood loss in Group A were significantly more than those in Group B (P < 0). Although final Japanese Orthopaedic Association (JOA) score in both groups significantly increased, differences in preoperative JOA, final JOA, and neurologic recovery rate between the 2 groups weren't significant. Perioperative complications included early neurologic deterioration (1 in Group A), wound infection (2 in Group A and 1 in Group B), and leakage of cerebrospinal fluid (5 in Group A and 1 in Group B); incidences of these complications between the 2 groups weren't significant (P > 0.05). A relationship analysis showed that cases with preoperative tram track sign, tuberous OLF, or larger compression ratio were at greater risk of developing an intraoperative dura defect. CONCLUSIONS: The application of piezosurgery in en bloc laminectomy is a safe and effective method in the treatment of MTOLF, and it was advantageous for reducing both operation time and intraoperative blood loss compared with the high-speed drill.


Asunto(s)
Laminectomía/métodos , Ligamento Amarillo/cirugía , Osificación Heterotópica/cirugía , Piezocirugía/métodos , Pérdida de Sangre Quirúrgica , Duramadre/lesiones , Duramadre/cirugía , Adhesivo de Tejido de Fibrina , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/etiología , Laminectomía/efectos adversos , Ligamento Amarillo/patología , Neuroimagen , Tempo Operativo , Piezocirugía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Riesgo , Vértebras Torácicas
12.
Clin Oral Investig ; 23(12): 4355-4363, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30955096

RESUMEN

OBJECTIVE: To explore patient-related outcomes measures (PROMs) of piezocision-assisted orthodontic treatment compared to a conventional orthodontic treatment using customized appliance. MATERIALS AND METHODS: Twenty-four adult patients requiring orthodontic treatment for mild-to-moderate overcrowding in both jaws were randomly assigned to a test group, treated with a piezocision-assisted orthodontic treatment, or to a control group, where piezocision was not applied. The patient-related outcomes were recorded using a 0-10 visual analog scale (VAS). Daily analgesic consumption and pain level were also recorded following the placement of the orthodontic appliance in both groups and after the piezocision procedure in the test group. Moreover, levels of apprehension and satisfaction were also assessed in both groups. RESULTS: In the piezocision group, over the 7-day period, paracetamol consumption was comparable after the placement of the orthodontic appliance and after the piezocision surgery. Pain levels after the orthodontic and the surgical procedure decreased with time (p < 0.0001) but remained globally higher after piezocision (p = 0.0056). Significantly, more patients of the piezocision group reported that they would undergo the treatment again (p = 0.033) and that they greatly appreciated the duration of treatment (p = 0.0008). However, the level of apprehension was significantly higher in the piezocision group compared to the test group (p = 0.012). CONCLUSIONS: Although, the degree of apprehension before the surgery and higher pain level in the piezocision group, PROMs emphasized similar pain killer consumption in both group and revealed high acceptance and satisfaction with piezocision approach. CLINICAL RELEVANCE: The benefit of piezocision-assisted orthodontic treatment seems to be relevant from a patient perspective. TRIAL REGISTRATION: NCT03406130.


Asunto(s)
Soportes Ortodóncicos , Piezocirugía/métodos , Técnicas de Movimiento Dental/métodos , Adulto , Femenino , Humanos , Masculino , Aparatos Ortodóncicos , Dolor , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Resultado del Tratamiento , Escala Visual Analógica
13.
Am J Orthod Dentofacial Orthop ; 155(4): 584-591, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30935613

RESUMEN

Surgical interventions on the alveolar ridges aimed at facilitating orthodontic tooth movement have been extensively reported. However, unexpected events or complications still occur in daily practice. The purpose of this report was to present a novel 3-dimensional (3D) computer-assisted piezocision guide (CAPG) designed to be translucent for increased visibility, rigid for enhanced support during guidance, and porous for profuse irrigation during procedure. Such a design can function to minimize the risk of surgical complications. In this case, we present a novel 3D-printed CAPG to facilitate a minimally invasive periodontal accelerated osteogenic orthodontics (PAOO) procedure with a guide that provides accuracy, adequate visibility, and greater access for the coolant to reach the surgery site. By navigating the cone-beam computed tomography data, we precisely know the cortical bone thickness, root direction, and interrelations between anatomic structures in an individual situation, which allows us to design our cutting slot for the required length and depth according to the operator's knowledge. Finally, 3D printing was applied, transferring our surgical plan to fabricate the CAPG. Moreover, the well designed pores on the CAPG allow effective irrigation during the piezocision procedure. This minimally invasive procedure was uneventful, and no devitalized tooth or alveolar bone was found.


Asunto(s)
Procedimientos Quirúrgicos Ortognáticos/métodos , Piezocirugía/métodos , Impresión Tridimensional , Proceso Alveolar/cirugía , Femenino , Humanos , Maloclusión de Angle Clase I/cirugía , Persona de Mediana Edad , Ortodoncia Correctiva/métodos
14.
Orthod Fr ; 90(1): 5-12, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30994445

RESUMEN

INTRODUCTION: The duration of orthodontic treatment in adults remains a barrier for some patients. Some surgical techniques have been developed in order to accelerate orthodontic tooth movement. The technique of corticotomies is effective in decreasing the orthodontic treatment time but remains invasive, leading to significant postoperative consequences. MATERIALS AND METHODS: Minimally invasive techniques without muco-periosteal flap elevation have been developed: corticision, micro-osteoperforations, piezopuncture and piezocision. RESULTS: The piezocision procedure seems to be the best compromise to accelerate orthodontic tooth movement while respecting a specific surgical and orthodontic protocol. The piezocision surgery allows the addition of biomaterials in cases of dehiscence and/or fenestration on the alveolar bone associated with moderate to severe overcrowding. CONCLUSION: According to current publications, minimally invasive corticotomy techniques can be viewed as a new therapeutic tool in the acceleration of orthodontic tooth movement.


Asunto(s)
Proceso Alveolar/cirugía , Hueso Cortical/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Osteotomía/métodos , Técnicas de Movimiento Dental/métodos , Adulto , Hueso Cortical/trasplante , Humanos , Oseointegración/fisiología , Piezocirugía/métodos , Factores de Tiempo
15.
World Neurosurg ; 126: e625-e633, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30831297

RESUMEN

BACKGROUND: Piezosurgery (PS) has gained increasing dispersion in neurosurgery. In pediatric neurosurgery, the experience is limited to craniosynostosis surgery. The present study assesses PS in the pediatric population, also considering outcomes and complications in cranial and spinal procedures. METHODS: All consecutive craniotomies and laminotomies, performed with PS (group A) or conventional osteotomes (group B) in the 2014-2017 period were reviewed. The following variables were analyzed: dural tears, estimated blood loss and need of transfusion, cosmetic outcome (Sloan score), and operative times. A review of the pertinent literature is included. RESULTS: 172 children were enrolled, 90 in group A and 82 in group B. The mean follow-up time was 2.1 years. A statistically significant difference in favor of group A was found about EBL (105 vs. 113 ml) and late outcome (Sloan class A 98.5% vs. 91.5%). PS also reduced the risk of dural tears (1 vs. 7 cases in groups A and B, respectively) and blood transfusion (52% vs. 55.5%) but without statistical significance. The operative times were significantly shorter in group B (13 vs. 23 minutes), although the newer PS plus (PSP) was demonstrated to significantly shorten these times compared with the traditional PS (3.5 vs. 6.5 minutes for orbitotomy and 7.5 vs. 9.5 minutes for hemicraniotomy). CONCLUSIONS: PS is a safe and effective tool that can be specifically recommended for bone splitting and graft, laminotomy, and craniotomy in cosmetically eloquent areas. The limit of operation times can be overcome by a learning curve in neurosurgery and PSP.


Asunto(s)
Craneotomía/métodos , Laminectomía/métodos , Neurocirugia/métodos , Pediatría/métodos , Piezocirugía/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Procedimientos Neuroquirúrgicos/métodos , Estudios Retrospectivos
16.
Sci Rep ; 9(1): 3711, 2019 03 06.
Artículo en Inglés | MEDLINE | ID: mdl-30842456

RESUMEN

The ability to measure the voltage readout from a sensor implanted inside the living cochlea enables continuous monitoring of intracochlear acoustic pressure locally, which could improve cochlear implants. We developed a piezoelectric intracochlear acoustic transducer (PIAT) designed to sense the acoustic pressure while fully implanted inside a living guinea pig cochlea. The PIAT, fabricated using micro-electro-mechanical systems (MEMS) techniques, consisted of an array of four piezoelectric cantilevers with varying lengths to enhance sensitivity across a wide frequency bandwidth. Prior to implantation, benchtop tests were conducted to characterize the device performance in air and in water. When implanted in the cochlea of an anesthetized guinea pig, the in vivo voltage response from the PIAT was measured in response to 80-95 dB sound pressure level 1-14 kHz sinusoidal acoustic excitation at the entrance of the guinea pig's ear canal. All sensed signals were above the noise floor and unaffected by crosstalk from the cochlear microphonic or external electrical interference. These results demonstrate that external acoustic stimulus can be sensed via the piezoelectric voltage response of the implanted MEMS transducer inside the living cochlea, providing key steps towards developing intracochlear acoustic sensors to replace external or subcutaneous microphones for auditory prosthetics.


Asunto(s)
Estimulación Acústica/métodos , Implantación Coclear/métodos , Piezocirugía/métodos , Acústica/instrumentación , Animales , Cóclea/fisiología , Implantes Cocleares , Conducto Auditivo Externo/fisiología , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Cobayas/fisiología , Sonido , Transductores
17.
Implant Dent ; 28(1): 86-90, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30624393

RESUMEN

The aim of this case report was to describe the inferior alveolar nerve (IAN) lateralization technique using the piezoelectric device for the posterior rehabilitation of an atrophic mandible with implants. The patient presented the absence of elements 35 and 36 associated with a vertical defect impairing the adequate dental implant placement without IAN damage. A full-thickness mucoperiosteal flap was raised, and a bone window was made with a piezoelectric device centralized on the IAN canal position. After dissection, the IAN was moved buccally with a sterile elastic strip. Morse cone 4.0 × 1.5-mm implants were inserted while the IAN remained retracted. At the 4-month follow-up, the screw-retained prosthesis was installed guaranteeing the recovering masticatory function. In conclusion, the case report showed that the IAN lateralization performed with an adequate surgical technique can be successfully indicated for longer implant placement in edentulous atrophic posterior mandible with no permanent neural damage.


Asunto(s)
Implantación Dental Endoósea/métodos , Arcada Parcialmente Edéntula/cirugía , Mandíbula/cirugía , Nervio Mandibular/cirugía , Piezocirugía/métodos , Adulto , Tomografía Computarizada de Haz Cónico , Implantes Dentales , Diseño de Prótesis Dental , Femenino , Humanos , Mandíbula/diagnóstico por imagen , Mandíbula/inervación , Nervio Mandibular/fisiología , Colgajos Quirúrgicos
18.
J Plast Reconstr Aesthet Surg ; 72(1): 107-113, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30243555

RESUMEN

BACKGROUND: Osteotomy is a crucial step in rhinoplasty, which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and endonasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques. MATERIALS AND METHODS: This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals, namely, endonasal continuous, external perforating, and piezosurgery groups. All the groups were evaluated for bone gaps, comminuted fractures, and nasal mucosa damage. RESULTS: There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group than in the other groups. The time required for the osteotomy was shorter in the endonasal group, similar to that in the external and piezo groups. CONCLUSION: New techniques are constantly being developed to achieve better results in rhinoplasty. As a natural consequence to technological developments, new devices are being introduced to rhinoplasty practice. Piezo is one such device. We have found that piezo osteotomy has resulted in lower amounts of nasal mucosal damage and comminuted fractures. We believe that piezo can safely be used in rhinoplasty practice until newer and more reliable technologies are being developed.


Asunto(s)
Osteotomía/métodos , Piezocirugía/métodos , Rinoplastia/métodos , Animales , Modelos Animales de Enfermedad , Cabras , Fotograbar , Cráneo/diagnóstico por imagen , Cráneo/cirugía , Tomografía Computarizada por Rayos X
19.
Orbit ; 38(6): 433-439, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30513237

RESUMEN

Introduction: Different minimally invasive surgical approaches to the orbit allow individualized bone resection to reduce proptosis and decompress the optic nerve in patients with Graves' orbitopathy (GO). This study aims to compare piezosurgery to an oscillating saw used to resect bone from the lateral orbital wall. Methods: In a retrospective study, we analyzed balanced orbital decompressions performed on 174 patients (318 cases) with GO. An oscillating saw was used in 165 cases (saw group) and piezosurgery in 153 cases (piezo group). Peri- and postoperative complications, reduction of proptosis, new onset of diplopia and improvement of visual acuity in cases of pre-operative optic nerve compression were analyzed. Results: We observed no significant differences in the surgical outcome between the two groups. Proptosis reduction was 4.6 mm in the saw group (p < 0.01) and 5.3 mm in the piezo group (p < 0.01). Intraoperative handling of the piezosurgery device was judged superior to the oscillating saw, due to soft tissue conservation and favourable cutting properties. Duration of the surgery did not differ between the groups. No serious adverse events were recorded in both groups. Conclusion: The application of piezosurgery in orbital decompression is more suitable than an oscillation saw due to superior cutting properties such as less damage to surrounding soft tissue or a thinner cutting grove.


Asunto(s)
Descompresión Quirúrgica , Oftalmopatía de Graves/cirugía , Órbita/cirugía , Osteotomía/instrumentación , Piezocirugía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diplopía/fisiopatología , Exoftalmia/fisiopatología , Femenino , Oftalmopatía de Graves/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
20.
World Neurosurg ; 122: e1398-e1404, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30458322

RESUMEN

OBJECTIVE: Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies and is an alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated the safety and feasibility of craniotomies using an ultrasonic device that allows the selective cut of mineralized structures, avoiding damages to the vascular, dural, and parenchymal structures. METHODS: We analyzed a series of 300 patients (age range, 1-81 years; SD ± 15.2) who underwent elective cranial surgery for brain tumors, in which the craniotomy was performed using a piezoelectric device. Pre- and postoperative imaging, clinical notes, and intraoperative details were collected. RESULTS: There were 197 patients (66%) who underwent surgery for supratentorial tumors; the remaining 103 patients (34%) underwent surgery for infratentorial ones. Tumors involved the skull base in 125 cases. Meningiomas, gliomas, and schwannomas represented the most common histotypes. Duraplasty for dural damages was not necessary in all cases; no venous sinuses or parenchymal injuries were reported during bone work. We noted in 13 cases (4.3%) a minor dural tear, requiring only direct sutures. Bone flaps were always intact after craniotomy. No subgaleal cerebrospinal fluid (CSF) collection or CSF leak was recorded. Because of the minimal bone gap, we always achieved correct bone flap ossification. No reabsorption or mobilization of bone flap was noted. CONCLUSIONS: We illustrate the feasibility and safety of a piezosurgical cutter to perform craniotomies. This alternative technique appears to be safe, with excellent cosmetic effects, adding another tool to the neurosurgical armamentarium.


Asunto(s)
Craneotomía/métodos , Neoplasias Infratentoriales/cirugía , Piezocirugía/métodos , Neoplasias Supratentoriales/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Quiste Epidérmico/patología , Quiste Epidérmico/cirugía , Estudios de Factibilidad , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Lactante , Neoplasias Infratentoriales/patología , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Meningioma/patología , Meningioma/cirugía , Persona de Mediana Edad , Imagen Multimodal , Neurilemoma/patología , Neurilemoma/cirugía , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/cirugía , Neoplasias Supratentoriales/patología , Tomografía Computarizada por Rayos X , Adulto Joven
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