Spinelli Giuseppe, Valente Domenico, Mannelli Giuditta, Raffaini Mirco, Arcuri Francesco
Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
First Clinic of Otorhinolaryngology Head and Neck Surgery, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
J Craniomaxillofac Surg. 2017 Apr;45(4):441-448. doi: 10.1016/j.jcms.2016.12.004. Epub 2016 Dec 18.
Piezosurgery is commonly used in different field of craniomaxillofacial surgery; since its introduction it has become one of the widely adopted technique for performing osteotomies in orthognathic surgery, distraction osteogenesis and dentoalveolar surgery. Little has been written regarding ultrasonic system for temporomandibular joint surgery (TMJ). In this prospective study we describe the use of piezoelectric device for ankylosis of the TMJ.
We enrolled in this study 19 patients, 10 males and 9 females, mean (SD) age 24.6 (7.6) years, affected by unilateral ankylosis of TMJ who were surgically managed between January 2009 and December 2014 by interpositional arthroplasty with temporomyofascial muscle flap. We adopted in all cases a preauricular approach with temporal extension. The ankylotic block was removed with piezoelectric device in 9 patients and using traditional rotary bur in 10 cases. We investigated and compared the following parameters as surgical outcomes: intraoperative bleeding, duration of operation, incidence of infection, postoperative swelling and hematoma, mouth opening, nerve impairment and rate of recurrence.
We noticed a substantial reduction in bleeding with the piezoelectric bone cutter when compared to traditional mechanical surgery (103 ml versus 117 ml; p < 0.05); however, we did not report any severe bleeding from the pterygoid plexus or maxillary artery. Operating time was longer in the piezo group (101 min versus 88 min; p < 0.05). There was a lower incidence of postoperative hematoma and swelling following piezoosteotomy. However, regarding postoperative nerve impairment and infection we did not observe any differences between the two groups. At one year follow-up mean (SD) mouth opening was 34 (4.3) mm. We did not report recurrence of the disease.
Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding and few postoperative complications. We believe that piezosurgery allows surgeons to achieve better results compared to a traditional surgery. It is a possible alternative due to the clinical benefits demonstrated.
压电手术常用于颅颌面外科的不同领域；自引入以来，它已成为正颌外科、牵张成骨术和牙槽外科中广泛采用的截骨技术之一。关于颞下颌关节手术（TMJ）的超声系统，相关文献较少。在这项前瞻性研究中，我们描述了压电装置在颞下颌关节强直中的应用。
我们纳入了19例患者，其中男性10例，女性9例，平均（标准差）年龄24.6（7.6）岁，均为单侧颞下颌关节强直患者，于2009年1月至2014年12月期间接受了颞肌筋膜瓣间置关节成形术的手术治疗。所有病例均采用耳前入路并向颞部延伸。9例患者使用压电装置去除强直骨块，10例患者使用传统旋转钻。我们调查并比较了以下手术结果参数：术中出血、手术时间、感染发生率、术后肿胀和血肿、开口度、神经损伤和复发率。
与传统机械手术相比，我们发现使用压电骨切割器时出血明显减少（103毫升对117毫升；p<0.05）；然而，我们未报告翼静脉丛或上颌动脉有任何严重出血。压电组的手术时间较长（101分钟对88分钟；p<0.05）。压电截骨术后血肿和肿胀的发生率较低。然而，关于术后神经损伤和感染，我们未观察到两组之间有任何差异。在一年的随访中，平均（标准差）开口度为34（4.3）毫米。我们未报告疾病复发情况。
用于松解颞下颌关节强直的压电骨切除术出血极少，术后并发症也很少。我们认为，与传统手术相比，压电手术能使外科医生获得更好的效果。鉴于已证明的临床益处，它是一种可行的替代方法。
