Piezosurgery in Oral Cancer and Osteonecrosis Treatment – Kate Scheer W&H UK

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  Posted by: The Probe      3rd March 2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Piezosurgery is a relatively recent advance in osteotomy, one that presents significant advantages over traditional cutting tools. One area that particularly benefits from this technology is craniofacial surgery.

Key Benefits of Piezosurgery

Piezoelectric vibrations can be used to cut through, or reshape, bone tissue with great ease and accuracy. The level of precision is similar to that of a laser, but without the lack of depth-control and excess heat.[i]The ultrasonic frequency can be adjusted to cut only the hard tissues, leaving the soft tissue safely unaffected. This makes the technology particularly advantageous when the bone needing to be cut is adjacent to delicate and important soft tissues, such as nerves. This method also produces significantly less heat than conventional osteotomy, even more so with increased irrigation.[ii]Again this is helpful in avoiding damage to surrounding tissue and for preventing bone necrosis.

As bleeding is kept to a minimum, piezoelectric surgery is also beneficial to the hygiene and visibility of the surgical site. Nearby blood vessels should be unaffected, while cutting with an ultrasound device prevents the bone tissue itself from bleeding. This is due to the cavitation effect, which creates bubbles in the physiological salt solution that implode to produce shockwaves that result in microcoagulation.[iii]

Another benefit is that piezoelectric devices produce less noise than a conventional motor, which helps reduce fear and stress on the part of the patient if they are conscious during the surgery.

Application in Oral Cancer Treatment

The key function of piezosurgical implements in oral cancer treatment is in the complete excision of tumours while leaving margins free of the disease. When lesions occur in close proximity to bone structures, removal of cortical bone becomes necessary in order to secure a healthy tissue margin. The oral cavity contains numerous important and delicate structures, which are at some risk when osteotomies are executed with traditional tools, such as burs and cutters. Avoiding damage to soft-tissue during this type of procedure requires great care, with manipulation of the surgical implements that may be difficult to execute.[iv]

Piezosurgery offers some distinct advantages over traditional implements in this area:

  • Surrounding soft tissues will not be damaged.
  • Greater freedom of movement. Corticotomies can be carried out in areas that would be difficult or impossible to attempt otherwise. This can also serve to reduce the required dimensions of the dissection.
  • Lower levels of excess heat, reducing the risk of bone damage.

Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw (MRONJ – previously known as bisphosphonate-associated osteonecrosis of the jaw) is a serious potential complication of dental treatments impacting the bone while on certain medications. This commonly occurs when the patient has cancer. MRONJ proceeds to expose necrotic bone tissue, resulting in pain and susceptibility to infection. Bisphosphonates are anti-resorptive drugs, commonly employed in the treatment of osteoporosis and bone cancer. This is due to their ability to strengthen and harden bone, reduce pain and blood calcium levels, and possibly slow the spread of cancer through bone tissue, thereby increasing quality of life of the patient.

While MRONJ is a risk, these drugs are currently too useful to be phased out for the general population. The precise mechanism is not fully understood, but the risk is much greater for those being given bisphosphonates intravenously than orally. Preventive measures against MRONJ include maintaining a high level of oral hygiene before and after surgery. Piezosurgery has been associated with helping to prevent this complication, due to the minimal surgical trauma it causes.[v]

Furthermore, it has been suggested that biofilm may be involved in causing MRONJ, and if this is the case, the ability of ultrasonics to disrupt biofilm may serve as an additional preventative factor.[vi]Initial treatment of MRONJ employs oral antibiotics and rinses; for more advanced cases, when these fail, surgical debridement or resection can relieve symptoms. Piezosurgery has been successfully employed in the treatment of the disease, with symptoms not reoccurring within one year of treatment.[vii]

A High Quality System

Piezosurgical tools are not created equal. While all feature the benefits outlined above to some degree, there is variability among the machines currently on the market. The Piezomed from W&H is a high quality offering, featuring efficient cooling and an innovative LED ring that provides excellent viewing conditions over the operating area. The Piezomed is the first device in its category to provide automatic instrument detection.

Piezosurgical tools make operating on craniofacial structures considerably safer and easier than in the past. Being able to perform surgery in this region without risk to the many densely packed, delicate tissues found there not only reduces the chance of complications, but also proves a powerful tool in treating complications if and when they do occur.

 

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

 

 

References

[i]Troedhan A., Mahmoud Z., Wainwright M., Khamis M. Cutting bone with drills, burs, lasers and piezotomes: a comprehensive systematic review and recommendations for the clinician. International Journal of Oral and Craniofacial Science.2017; 3(2); 20-33. Available at http://doi.org/10.17352/2455-4634.000028Accessed June 21, 2018.

[ii]Rashad A., Sadr-Eshkevari P., Heiland M., Smeets R., Hanken H., Gröbe A., Assaf A., Köhnke R., Mehryar P., Riecke B., Wikner J. Intraosseous heat generation during sonic, ultrasonic and conventional osteotomy. Journal of Cranio-Maxillo-Facial Surgery. 2015; 43(7): 1072-1077. Available at https://www.jcmfs.com/article/S1010-5182(15)00161-4/fulltextAccessed June 21, 2018.

[iii]Rahnama M., Czupkałło Ł., Czajkowski L., Grasza J., Wallner J. The use of piezosurgery as an alternative method of minimally invasive surgery in the authors’ experience. Videosurgery and other Miniinvasive Techniques. 2013; 8(4): 321-326. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908639/Accessed June 21, 2018.

[iv]Rossi M., Ludovichetti F., Bacci C. Efficacy and safety of piezosurgery device in the surgical treatment of oral cancer. Avicenna Journal of Dental Research. 2017; 9(3): e31975. Available at http://avicennajdr.com/en/articles/56974.htmlAccessed June 21, 2018.

[v]Vandone A., Donadio M., Mozzati M., Ardine M., Polimeni M., Beatrice S., Ciuffreda L., Scoletta M., Impact of dental care in the prevention of bisphosphonate-associated osteonecrosis of the jaw: a single-center clinical experience. Annals of Oncology. 2012; 23(1): 193-200. Available at https://academic.oup.com/annonc/article/23/1/193/161632Accessed June 21, 2018.

[vi]Blus C., Szmukler-Moncler S., Giannelli G., Denotti G., Orrù G. Use of ultrasonic bone surgery (piezosurgery) to surgically treat bisphosphonate-related osteonecrosis of the jaws (BRONJ). A case series report with at least 1 year of follow-up. The Open Dentistry Journal. 2013; 7: 94-101. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772575/pdf/TODENTJ-7-94.pdfAccessed June 21, 2018.

[vii]Blus C., Szmukler-Moncler S., Giannelli G., Denotti G., Orrù G. Use of ultrasonic bone surgery (piezosurgery) to surgically treat bisphosphonate-related osteonecrosis of the jaws (BRONJ). A case series report with at least 1 year of follow-up. The Open Dentistry Journal. 2013; 7: 94-101. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772575/pdf/TODENTJ-7-94.pdfAccessed June 21, 2018.

 


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