Piezocirurgia aplicada à cirurgia ortognática - estudo retrospectivo com descrição de nova técnica de piezo-osteotomia sagital da mandíbula

A cirurgia piezoeletrica foi iniciada em 2000 com o classico artigo do Dr. Tomaso Vercellotti e a aplicacao na cirurgia ortognatica com publicacoes somente em 2004 e 2005. Este artigo descreve o uso racional das pontas ultrassonicas na cirurgia ortognatica, com especial enfase a descricao de uma nova piezo-osteotomia sagital de mandibula. Tambem relata a experiencia de cinco anos do autor com o uso da piezocirurgia nos procedimentos de cirurgia ortognatica. No periodo de maio de 2007 a maio de 2012, foram realizados quarenta e tres procedimentos maxilares: 36,5% Le Fort I multi-segmentadas, 26,8% Le Fort I para expansao rapida de maxila assistida cirurgicamente, 19,6% Le Fort I, 14,6% osteotomia subapical anterior de maxila e 2,5% Le Fort II modificada. Dos 36 procedimentos maxilares que envolveram disjuncao pterigomaxilar, 100% foram realizados com cinzel apos 30,5% de tentativas frustradas para piezo disjuncao. Das 61 mandibulas operadas, 88,3% osteotomia sagital de mandibula bilateral, 41,6% mentoplastia Tenon e Mortise, 5% expansao rapida de mandibula assistida cirurgicamente, 5% mentoplastia horizontal reta, 5% osteotomia subapical anterior de mandibula, 5% osteotomia subapical posterior de mandibula bilateral, 1,6% osteotomia subapical posterior de mandibula unilateral e 1,6% osteotomia sagital de mandibula unilateral. O tempo para a piezo-osteotomia aumentou de 10 a 20% nas osteotomias maxilares e de 20 a 30% nas osteotomias mandibulares (mentoplastias inclusas), quando comparado com as tecnicas tradicionais com brocas e serras. As maiores porcentagens do tempo gasto foram para os primeiros pacientes operados em 2007, ano do inicio da experiencia do autor com a piezocirurgia. Nenhuma intercorrencia transoperatoria ou complicacoes foram observadas no emprego da tecnica (AU) The piezoelectric surgery was initiated in the year 2000 with the classic Dr. Tomaso Vercellottiis article and, its application in maxillary and mandibular orthognathic surgery publications have occured only in 2004 and 2005. This article reports the rational for ultrasonic inserts application for osteotomy/osteoplasty in orthognathic surgery with special emphasis to a new sagittalpiezo-osteotomy. It also, reports the authoris five-year piezosurgery experience in orthognathic surgical procedures. Forty three maxillary procedures were performed: 36.5% multipieceLe Fort I, 26.8% Le Fort I for rapid maxillaryexpansion, 19.6% Le Fort I, 14.6% subapical anterior maxillary osteotomy, and 2.5% modified Le Fort II. Of the thirty six procedures involving maxillary pterygomaxillary disjunction, 100% were carried out with chisel after 30.5% ofthe attempts to usepiezo-disjunction failed. Of the sixty one operated mandibles, 88.3% bilateral sagittal split mandibular osteotomy, 41.6% genioplasty with Mortise e Tenon technique, 5% mandibular rapid expansion, 5% genioplasty with straight horizontal technique, 5% subapical anterior mandibular osteotomy, 5% bilateral subapical posterior mandibular osteotomy, 1.6% unilateral subapical posterior mandibular osteotomy, and 1.6% unilateral sagittal split mandibular osteotomy. The time for piezo-osteotomy has increased by about 10 to 20% for maxillary osteotomies, and about 20 to 30% for mandibular osteotomies (genioplasties included) as compared to traditional techniques using drills and reciprocating saws. The largest percentages of time were spent for the first patients operated in 2007, year of the beginning of the authorAEs experience with piezosurgery. None intraoperative complications were observed with the technique application (AU)