Piezoelectric bone surgery in otologic surgery.

The aim of this work has been to evaluate the use of Piezosurgery in the different otological surgical techniques. Piezoelectric bone surgery, also known simply as Piezosurgery, is a new technique for osteotomy and osteoplasty. The equipment consists of two piezoelectric handpieces and two inserts that are connected to a main unit. This unit supplies power and has holders for the handpiece and irrigation fluids. It contains two peristaltic pumps for cooling during surgery with a jet of physiological solution that discharges from the inserts (Fig 1). The piezoelectric device uses low-frequency ultrasonic waves (25-30 kHz) that are created by the piezoelectric effect. (certain ceramics and crystals are modified when an electric current is passed across them, which causes an oscillation that has an ultrasonic frequency). The instrument’s power can be modulated between 2.8 and 16 W, in accordance to the density of the bone. The microvibrations that are created in the piezoelectric handpiece cause the inserts to vibrate linearly between 60 and 210 m. Appropriate handpieces and inserts (Fig 2) have been created for platinotomy, antroatticotomy, mastoidectomy, and endoauricular osteotomy, with the width, thickness, and angle of the inserts depending on the applied power, bone density, and surgical technique. In general anesthesia with orotracheal intubation, we have performed Piezosurgery in: stapedotomy and replacement of the chain using a prosthetic implant in the hole of the stapes footplate (9 patients), atticoantrotomy (8 patients), classical intact canal wall mastoidectomy (12 patients), posterior tympanotomy (3 patients), facial nerve decompression (2 patients), and exeresis of glomus tumor of the middle ear (2 patients). All the patients underwent the following tests before surgery, as well as 1 month and 6 months after surgery: otomicroscopic evaluation of the tympanic membrane and