Can piezoelectric ultrasound be used for percutaneous osteotomy to correct stairstep deformity?

Piezoelectric Ultrasound for Percutaneous Osteotomy in Stairstep Deformity Correction

Piezoelectric ultrasound can be effectively used for percutaneous osteotomy to correct stairstep deformity, offering superior precision and safety compared to conventional techniques by selectively cutting mineralized tissue while preserving surrounding soft tissues. 1

Advantages of Piezoelectric Ultrasound for Stairstep Deformity Correction

• High precision cutting with micrometric control (60-200 μm amplitude) 2
• Selective cutting of mineralized tissue while sparing soft tissue structures 1
• Reduced risk of damage to adjacent neurovascular structures 3
• Minimal bleeding due to cavitation effect 3
• Better visibility during the procedure with integrated irrigation and LED lighting 1
• Improved healing outcomes with less thermal damage to bone 1

Surgical Technique for Stairstep Deformity Correction

Preoperative Planning

• Identify the exact location of the stairstep deformity
• Determine optimal osteotomy sites to achieve proper correction
• Consider the patient's nasal anatomy and skin thickness 4

Procedural Steps

1. Make small skin punctures for percutaneous access
2. Use piezoelectric device with settings of 25-30 kHz frequency 3
3. Follow specific osteotomy path:
   • Start at the piriform aperture, just above turbinate attachment
   • Slide low over the nasofacial groove to prevent additional step-off deformities
   • End high on the nasal bone at the level of the medial canthus 5, 4
4. Preserve periosteal and mucosal attachments when possible 5
5. Use the smallest possible osteotomies to achieve desired mobilization 5
6. Apply light pressure with constant motion of the tip (different from rotary instruments) 1

Clinical Considerations

Patient Selection

• Most appropriate for cases where precise bone cuts are essential
• Particularly valuable when working near important neurovascular structures 1
• Beneficial for thin and fragile bones prone to fracture with conventional instruments 3

Technical Considerations

• Avoid intermediate osteotomies halfway up the nasal bone to prevent visible irregularities 4
• Consider combining with autogenous cartilage grafts to fill depressions and improve asymmetries 4
• Procedure may be more time-consuming than conventional techniques 3

Potential Complications

• Learning curve required to master the technique 1, 2
• Procedure duration may be longer than with conventional instruments 3

Post-Procedure Management

• Regular clinical and functional assessments
• Radiographic evaluation at 12 months post-surgery 5
• Earlier assessment if bone deformity worsens or clinical concerns arise 5

Pitfalls and Caveats

• Requires different surgical skills compared to conventional techniques 2
• Training is necessary to master the technique - light pressure with constant motion is required 1
• Not a substitute for proper surgical planning and anatomical understanding
• May not be suitable for all types of stairstep deformities, particularly those requiring extensive bone removal

Piezoelectric ultrasound represents an innovative and effective approach for percutaneous osteotomy in stairstep deformity correction, offering significant advantages in precision and safety compared to traditional methods.