Measurement of osteotomy force during endoscopic sinus surgery

Area of Science:

• Otolaryngology
• Surgical Engineering
• Anatomical Research

Background:

• Improving surgical technique and training effectiveness in endoscopic sinus surgery (ESS) requires a better understanding of surgeon's tasks and skills.
• Objective measurement of osteotomy forces during ESS and the validity of cadaver materials for such measurements are not well-documented.
• Cadaver models are frequently used in surgical training and research, but their biomechanical properties may not accurately reflect live tissue.

Purpose of the Study:

• To objectively measure peak axial osteotomy forces during ESS in live patients.
• To compare these forces with previously published cadaver data to validate the biomechanical properties of cadaver models for ESS research.
• To identify factors influencing osteotomy forces, including osteotomy site, patient demographics, and cadaver characteristics.

Main Methods:

• A prospective study measured peak axial osteotomy force using a modified Storz sinus curette in 25 live patients undergoing ESS.
• Osteotomy forces were measured at the uncinate, bulla ethmoidalis, and ground lamella.
• Data were compared with published results from 15 cadaver heads, analyzing independent variables such as osteotomy site, gender, and side.

Main Results:

• Mean osteotomy force in live patients was 9.6 N, significantly higher than the 6.4 N measured in cadaver heads (p < 0.0001).
• Ethmoid osteotomy in live patients required 3.2 N more force than in cadavers, a statistically significant difference at the bulla ethmoidalis and ground lamella.
• Osteotomy in female live subjects required more force (1.6 N) than in male live subjects (p = 0.03).

Conclusions:

• Cadaver tissue may underestimate the mean osteotomy force required in live ethmoid sinus surgery by approximately 1.5 times.
• Findings suggest caution is needed when extrapolating force estimates from cadaver studies to live patient scenarios.
• Objective force measurements in live patients are essential for accurate surgical training and biomechanical research in ESS.