Piezoelectric surgery versus mechanical drilling for orbital floor decompression: effect on infraorbital hypoaesthesia

ABSTRACT

Purpose: To compare efficacy and safety of mechanical drill and piezoelectric technology in the prevention of infraorbital nerve hypoaesthesia during orbital floor decompression.

Methods: Single-centre, non-randomized prospective, interventional case series. We enrolled 24 patients who underwent 3-wall orbital decompression. A total of 13 patients underwent floor decompression using 5-mm diamond dusted Piezoelectric tip (Synthes GmbH, Oberdorf, Germany), whereas 11 patients underwent conventional mechanical decompression of the floor using Stryker Core handpiece with 5-mm diamond dusted tip (Stryker, USA) and a Kerrison’s bone ronguer. All surgeries were performed by a single surgeon (MNN) using standard surgical technique. The infraorbital nerve hypoesthesia was measured pre-operatively, and post-operatively on day 1, at 1 week, 6 weeks, 3 months, and final follow-up by an independent observer. Hypoaesthesia was graded on a simple numerical scale: 0 defined as “normal”, 1 defined as “minimally reduced”, 2 defined as “grossly reduced but perceptible”, and 3 defined as “total loss”.

Results: The average follow-up after surgery was 16 months (range 13–48 months). The average score in the mechanical drilling group at day 1, week 6, week 12 and final follow-up was 1.9, 1.2, 0.7, and 0.6, respectively (p < 0.001). For the Piezo group, the average scores were 0.3, 0.2, 0.1, and 0.1, respectively. No procedure related complications were noted, and the average surgical time for floor decompression was comparable (p > 0.5).

Conclusions: Piezoelectric technology is effective in orbital floor removal by minimizing infraorbital nerve hypoaesthesia.

KEYWORDS:

• Orbital decompression
• piezoelectric surgery
• infraorbital anaesthesia
• thyroid eye disease
• Graves’ disease

Award

This study was awarded the Best Poster Award at the 36^th ESOPRS Meeting in Stockholm, Sweden in Sept 2017.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.