Purpose: Piezoelectric osteotomies have been limited in the field of orthognathics due to unfavorable tip angulations and insufficient cutting power for mandibular cuts. By adapting its ultrasonic blades and protective elements we have hence modified a more powerful ultrasonic device (BoneScalpel™, Misonix, Inc., Farmingdale, NY, USA).

Patients and methods: 75 patients underwent orthognathic surgery with the ultrasonic BoneScalpel. All osteotomies in the group were solely being performed with the ultrasonic straight blade without use of saw or burr at any time. Effects on peri-operative bleeding, post-operative edema, operative time and osseous consolidation were assessed.

Results and conclusion: An absence of nerve lesions was observed as well as significant reductions in swelling, hematoma, operative time and hospital stay. A delay in osseous consolidation was non-evident. The absence of bleeding facilitates osteotomy of the posterior wall of the maxilla and the pterygo-maxilla junction. Improved safety in the pterygomaxillary zone facilitates the down-fracture. Sagittal split is eased which is attributed to the propagation of the ultrasonic wave into the cancellous layer. Moreover, the osseous cutting is more precise and allows for an improved adaption to the anatomy e.g. in older patients (SAOS) or in cases of asymmetry. We noted an increase in referrals and submissions since we started using this less traumatic technique. We conclude the ultrasonic straight blade facilitates the procedures of orthognathic surgery.

Conflict of interest: None declared.