Endoscopic monobloc advancement with ultrasonic osteotomy: a feasibility study

Area of Science:

• Neurosurgery
• Craniofacial Surgery
• Surgical Innovation

Background:

• Traditional monobloc procedures carry risks like cerebrospinal fluid leaks, infection, and incomplete ossification.
• Distraction osteogenesis has reduced these risks but further improvements are sought.
• This study addresses the need for safer, more effective monobloc osteotomy techniques.

Purpose of the Study:

• To develop and evaluate an endoscopic, ultrasonic monobloc osteotomy technique.
• To minimize risks associated with conventional monobloc procedures.
• To assess the feasibility and safety of the novel technique in a cadaver model.

Main Methods:

• Utilized three fresh adult human cadavers for the study.
• Performed endoscopic ultrasonic monobloc osteotomy through three concealed scalp incisions.
• Employed an ultrasonic scalpel and endoscope for extradural osteotomy of craniofacial bones.

Main Results:

• Successfully completed the endoscopic ultrasonic monobloc osteotomy as a single fragment in all cadavers.
• Osteotomy completion time was under 2.5 hours.
• Confirmed intact dura and periosteum, with no injury to adjacent soft tissues.

Conclusions:

• Demonstrated the feasibility of an endoscopic ultrasonic monobloc advancement technique in a cadaver model.
• The technique avoids a bicoronal incision and protects vital structures.
• Preservation of vascularity and periosteum may lead to improved outcomes and fewer complications.