Reshaping of different parts of the facial bones is often required to either reduce or smooth certain facial prominences to get a desired contour. This is traditionally done with a handpiece and burr with saline dripped over it to reduce heat build-up and prevent bone ‘burning’. Using a high speed rotary instrument inside small and restricted tunnels under and inside the face must be done with care and protection of surrounding tissues. It is very easy to have this fast turning burr inadvertently grab onto adjacent tissues (e.g., nerves) and create injury and bleeding.
One technologic improvement in craniofacial and maxillofacial bone contouring is the Sonopet Ultrasonic Aspirator. This system allows for fine bone dissection and contouring with prevention of damage to any adjacent soft tissues. This instrument removes bone through ultrasonic cavitation and not a rotary or spinning motion of a fluted burr. Thus the burr does not spin or rotate but rather vibrates by ultrasonic energy. This creates the cavitation process by which the bone is ‘fragmented’ off in small pieces under direct saline irrigation. The sharp points on the Sonopet burrs will engage the hard bone but not the soft tissues since it has no spinning or rotary motion. The visualization, manipulation, ease of use, and speed of bone removal with the Sonopet is definitely better than with traditional drills or rongeurs.
This is an excellent innovation in technology for bone removal in craniomaxillofacial surgery. Since much of facial surgery and some skull surgery is done through limited access incisions, it can be hard to precisely shape bone. The size of traditional handpieces and burrs and the need to irrigate while they are on puts adjacent tissues at some risk of injury. The Sonopet with its ultrasonic energy allows for better control and eliminates the concern about any collateral damage from the bone work.
Dr. Barry Eppley
Indianapolis, Indiana