Minimally invasive orthognathic surgery: a systematic review

Alasseri, Nasser; Swennen, G.

doi:10.1016/j.ijom.2018.04.017

Cited by 51 publications

(24 citation statements)

References 69 publications

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“…A technique for minimally invasive orthognathic surgery has been described, in which the maxillary bone is exposed by making a small mucosal incision from tooth 12 to tooth 22, osteotomized with an oscillating saw or piezoelectric osteotome, and downfractured by combining manual manipulation with using a chisel and hammer. This minimally invasive technique appears to reduce postoperative morbidity and the length of hospital stay [35][36][37]. Therefore, the applicability of the CARLO ® device as an alternative to conventional osteotomy in this minimally invasive technique should be assessed in a future cadaver study.…”

Section: Discussionmentioning

confidence: 99%

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside

Ureel

Augello

Holzinger

et al. 2021

JCM

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Background: In order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®). Methods: The CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images. Results: The CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications. Conclusion: The newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.

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Section: Discussionmentioning

confidence: 99%

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside

Ureel

Augello

Holzinger

et al. 2021

JCM

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“…In implantology, it is often necessary to perform procedures to restore bone volume sufficient for implant installation [4]. Several techniques of bone grafting with the use of autogenous block or particulate bone for the reconstruction of these defects can be performed with the use of PiZ [5].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…Thus, it is noted that the use of PiZ is in the performance of procedures close to noble structures, such as vessels and nerves, demonstrating excellent results, minimizing and, in some cases, avoiding injuries, even when direct contact of the device with these structures occurs [5]. Also, when used in maxillary sinus elevation procedures, where the preservation of the Schneider's membrane is necessary, better results have been observed, mainly due to the reduction of the risk of perforation of the sinus, besides providing a reduction of the postoperative edema by the minor surgical trauma [5].…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…The use of PiZCi has been associated with a characteristic called "selective cutting", in which the ultrasonic vibration of the tips would act specifically on mineralized tissues through the cavitation effect, performing precise cuts of bone, providing a better visualization of the operative field, with absence of soft tissue injuries (dura mater, mucous membranes and nervous tissue), as well as a reduction of transoperative bleeding, with lower vibration, thus reducing the patient's stress in procedures under local anesthesia when compared to the instruments conventional [5].…”

Section: Introductionmentioning

confidence: 99%

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Major Approaches on the Piezoelectric Device, Drills and Saws to Orthognathic Surgery: A Systematic Review

Marques¹,

Pinto²,

Vian³

et al. 2019

Health

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Introduction: The incidence of lesions of sensory and motor nerves associated with oral and maxillofacial surgery is often underestimated, representing around 32.0% of all lesions, and orthognathic surgery contributes 12.3% to these lesions. Thus, the use of piezosurgery (PiZCi) has been indicated in several procedures within oral and maxillofacial surgery due to a number of advantages over conventional drill and saw techniques. Objective: to analyze the main literature on the use of the piezoelectric device in relation to the use of drills and to orthognathic surgery in dentistry. Methods: A total of 41 articles were found involving Orthognathic Surgery, Piezoelectric Device, Drills Device, Saws Device, and Efficiency. Initially, it was held the exclusion existing title and duplications following the interest described this work. After this process, the summaries were evaluated, and a new exclusion was held. 29 articles were included and discussed in this study. Initially, the keywords were determined by searching the DeCS tool (Descriptors in Health Sciences, BIREME base) and later verified and validated by MeSh system (Medical Subject Headings, the US National Library of Medicine). Results and conclusion: It was concluded that the piezoelectric device has excelled with an effective surgical technique, being able to be indicated in the most diverse areas of the oral surgery, providing accurate, clean and minimally traumatic osteotomies for the soft tissues, intraoperative bleeding, when compared to conventional surgery using drills and/or saws.

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“…Entre las desventajas de la utilización de este tipo de instrumental se ha descrito un daño accidental a tejidos blandos aumentando la incidencia de complicaciones intra o postoperatorias tales como daño a tejido nervioso o vasos sanguíneos (1) . Desde el año 2005 en adelante, el uso de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos y garantizar un campo quirúrgico menos contaminado (2,3) . Este sistema se basa en microvibraciones ultrasónicas que son transferidas a una punta de vibración (inserto) capaz de producir un fenómeno de cavitación sobre tejido duro como el hueso (2) , y su frecuencia de vibración para la realización de osteotomías presenta un rango que fluctúa entre los 24 y 32 kHz (1,2) .…”

Section: Problemaunclassified

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática.

Vargas-Buratovic

López-Suárez

Rojas-Bascuñán

et al. 2021

Int. j interdiscip. dent.

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Introducción:La utilización de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos en comparación al uso de sierra convencional. Sin embargo, aún existe incertidumbre respecto a las complicaciones asociadas a cada instrumental. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con la sierra convencional podría disminuir el riesgo de daño nervioso grave y disminuir el sangrado grave (>500 mL), pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría presentar poca o nula diferencia en el dolor postoperatorio, pero la certeza de la evidencia es baja. Finalmente no es posible establecer con claridad si el uso de instrumental piezoeléctrico disminuye la pérdida de sangre intraoperatoria (variable continua), la inflamación postoperatoria o el tiempo operatorio, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

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Minimally invasive orthognathic surgery: a systematic review

Cited by 51 publications

References 69 publications

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside

Cold Ablation Robot-Guided Laser Osteotome (CARLO®): From Bench to Bedside

Major Approaches on the Piezoelectric Device, Drills and Saws to Orthognathic Surgery: A Systematic Review

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática.

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