Ultrasonic orthognathic surgery: enhancements to established osteotomies

The use of a novel ultrasonic osteotome enabled the authors to modify well-established orthognathic osteotomies to more favourably address the anatomy. For this purpose, they utilized a powerful ultrasonic device with tissue-selective cutting characteristics that was originally developed for spinal osteotomies and nerve decompression (BoneScalpel™ by Misonix Inc., Farmingdale, NY, USA). Its straight ultrasonic blade was adapted for dual action, and a soft protective element was added. The product modifications and the related changes regarding maxillary and mandibular osteotomies are explained in detail. A series of 83 patients underwent orthognathic surgery with the BoneScalpel ultrasonic osteotome. All osteotomies within this study group were performed purely ultrasonically and without the auxiliary use of reciprocating saws or rotary burrs. The complications, alveolar nerve impairment and bad splits were assessed. To assess the quality of the lingual osteotomies and pterygomaxillary separation, three-dimensional scanning was performed on 30 patients. In conclusion, the BoneScalpel™ ultrasonic osteotome enabled improved control over orthognathic osteotomies and resulted in significant reductions in the occurrence of nerve impairment and bad splits.