Dear Sir,
Lateral orbital decompression is a key component in the treatment of Thyroid Eye Disease (TED), either alone or in combination with additional surgical procedures. For surgeons who prefer advancement of the lateral orbital rim, a high-speed oscillating saw is often used for removal of this bony area. Operation of the oscillating saw poses direct surgical risk, namely thermal injury to the surrounding bone and tissues. Other risks include mechanical damage to surrounding soft tissues, especially those composing the neurovaculature supply. Recently, piezoelectric ultrasound technology has been used to remove bone with precision and a decreased risk of soft tissue injury as reported in the neurosurgical, otologic, maxillofacial, orthopedic and oculoplastic literature.
Other surgeons have described the use of piezoelectric instruments to burr the internal orbital wall structures. We have recently incorporated this technology to safely remove the lateral orbital rim using the Mectron Piezosurgery system (Mectron Technology, Carasco, Genova, Italy) with a saw attachment (MT1s-10). Constant sterile, aerosolized irrigation at the tip of the handpiece functions to cool the blade and thus reduces thermal injury to surrounding bone. Cavitation of the fluid provides for blood-free incisions while the operating frequency of 25–29 kHz ensures that only mineralized structures are cut while soft tissues are spared even upon direct contact with these delicate structures. This is a useful adjunct for efficacious and safe lateral orbital rim advancement in lateral orbital decompression surgery.