The ultrasonic scalpel in head and neck surgery

The Cavitron ultrasonic surgical aspiration system (CUSA) is a new surgical tool that has received little attention in head and neck surgery. The device fragments and aspirates tissues with mechanical energy delivered by direct contact with the tip of a transducer vibrating at 23,000 Hz. The potential of the CUSA system was evaluated in several laboratory exercises: superficial parotidectomies on fresh cadavers, subtotal sialadenectomies on cats, and direct application to the brachial plexus in cats to assess effects on peripheral nerves. The CUSA quickly etched away salivary gland parenchyma while grossly preserving nerve, vessel, and fibrous elements, allowing virtually bloodless dissection. Small vessels could be cauterized directly. Direct application of CUSA to peripheral nerves for limited periods produced no significant clinical deficits, although worrisome histologic findings were noted.