Power Assisted Osteotomies : A New Breakthrough in Rhinoplasty
Osteotomies are frequently performed during rhinoplasty to treat a wide or asymmetric bony vault, or to balance a reduced nose. Bony hump lowering is also very common in caucasian rhinoplasty. Even with very sharp osteotomes, the exact control of the fracture line may be difficult, especially on very thick bones, or on brittle bones, but also when a previous rhinoplasty with osteotomies has been performed.
A new power assisted technology has been applied to bone trimming, rasping and fracture since February 2013, and adapted inserts have been designed to ease the bony work in rhinoplasty. Our purpose is to share our early experience with this very new material.
Methods/Technique:
The material per se has changed during the study’s duration, as the inserts have been improved in their dimensions, ergonomics, water distribution pattern … We don’t report here a scientific study, but our experience with this evolving innovative material in 115 patients. A whole set of inserts has been developed during 2013-2014 to do all the bone surgery performed during a rhinoplasty. Photos and measurements have been taken at all the post-op follow up consultations.
Results/Complications:
This new type of assisted bone surgery has many advantages:
.The surgeon performs the bone job without the influence of the assistant. Trimming the bone becomes a continuous process and not an interrupted one depending on the strength and tempo of the mallet strokes
.The soft tissues are protected from any type of injury, allowing all the osteotomies to be done safely through a close or open approach. The lining under the bones isn’t undermined, which could improve bone stabilization after osteotomies.
.It allows an accurate bone incision with a very thin and controlled fracture line, and virtually no irradiated fractures, whatever the quality of the bone.
.Different saw patterns have been developed to do all the existing osteotomies. Moreover, transverse osteotomies are done internally. Lateral osteotomies can be done L-L or L-H guided by the protuberances located on the top of the saws.
.Intermediate osteotomy can be done safely before or after a lateral osteotomy
.The bone edge can be easily lowered with a burr or a saw, even after completion of the osteotomies, without risking displacing the bones.
.The bony septum can also be precisely trimmed without sweeping movements
The learning curve is very steep and for beginners, this material should ease the bone reshaping.
The only disadvantage is the need to buy a new motor, handpiece and inserts
Conclusion:
This new instrumentation has revolutionized our way of doing and controlling osteotomies. Compared to the existing motors used for osteotomies, this new one protects the soft tissues and cartilages that can’t be harmed, allowing medial, transverse and lateral osteotomies, but also bone reduction to be performed either through close or open rhinoplasty. Compared to the traditional osteotomes, this material allows a very accurate control of the fracture line and avoids irradiated fractures. It allows also horizontal osteotomies to be done internally and so to customize the intended fractures to reshape precisely the bones during rhinoplasty. Finally, osteotomies can be controlled in difficult cases: very asymmetric bones, previously traumatized or operated noses, mature noses…