Piezosurgery to Perform Hyoid Bone Osteotomies in Thyroglossal Duct Cyst Surgery Attilio Carlo Salgarelli, MD, DDS,* Massimo Robiony, MD,Þ Ugo Consolo, MD, DDS,* Marco Collini, MD, DDS,þ and Pierantonio Bellini, MD* Abstract: Ultrasonic bone-cutting surgery has been introduced as a feasible alternative to the conventional sharp instruments used in craniomaxillofacial surgery because of its precision and safety. The device used is unique in that the cutting action occurs when the tool is used on mineralized tissues and stops on soft tissues. This work describes the use of piezosurgery for hyoid bone resection in thyro- glossal duct cyst surgery, briefly reviews the literature on the surgical technique, and reports our experience with 12 cases. Key Words: Piezosurgery, thyroglossal duct cyst, osteotomy (J Craniofac Surg 2011;22: 2272Y2274) T hyroglossal duct cysts (TGDCs) are the most common malfor- mations found in the neck and account for 70% of congenital cervical abnormalities. 1 In 1920, Sistrunk 2 first described the procedure that is com- monly performed today to excise TGDCs. Although rare, major com- plications can be ascribed to surgical mishaps. Inadvertent entry into the airway, intraoperative hemorrhage, hypoglossal nerve injury, or incomplete resection of the hyoid bone could be avoided by a skilled surgeon, if the osteotomy was to be performed with a minimally traumatic device. 1 The Piezosurgery medical device (Mectron Medical Tech- nology, Carasco, Italy) is an ultrasonic bone-cutting surgical in- strument designed to perform sharp osteotomies. Its micrometric, selective action allows the efficient cutting of mineralized tissues, with minimal trauma to soft tissues. 3 This report presents the use of a surgical device for minimally invasive surgery as an alternative to a bone cutter during hyoid bone resection, to facilitate segmental osteotomies. 3,4 The technical characteristics, indications, advantages, and limitations of the method are discussed. PATIENTS AND METHODS Patients A retrospective study analyzed the clinical results in 12 patients with TGDC who underwent surgical treatment and hyoid bone sec- tioning with the Piezosurgery device between September 2009 and October 2010 at the Department of Head and Neck Surgery, Uni- versity Hospital of Modena, Modena; Department of Maxillo-Facial Surgery, Carlo Poma Hospital, Mantova; or Maxillo-Facial Surgery Department, University Hospital of Udine, Udine, Italy. The diag- noses were based on a clinical history and physical examination and were confirmed with ultrasound and computed tomography. The follow-up period was 6 to 18 months, with checkups every 6 months in the first year and annually thereafter. Surgery A 5-cm-long horizontal incision is made in a skin crease in- ferior to the lesion and carried through the subcutaneous tissue and platysma. Superior and inferior myocutaneous flaps are developed (Fig. 1). Superiorly, the flap is elevated to expose the hyoid bone and the inferior portion of the submental triangle of the neck. Inferi- orly, the flap is extended to expose the thyroid cartilage. The strap muscles are divided along their median raphe, and the dissection is extended to the level of the thyroid cartilage. The alae of the thyroid cartilage are exposed, and the notch of the thyroid cartilage is iden- tified. Based on Maddalozzo et al, 5 the thyrohyoid membrane is used as a conduit to identify the posterior aspect of the hyoid bone and the space between the bone and membrane. After performing the aforementioned steps, the height of the hyoid can be seen. It can be grasped with a tenaculum or elevated with a tracheal hook, and the hyoid can then be transected medial to the tendon of the digastric muscle. The osteotomy is carried out solely with a piezoelectric scalpel (Fig. 2), without using a sharp bone cutter. The dissection continues superiorly to include the cyst tract and a core of lingual musculature to the approximate level of the lingual mucosa, where the specimen is transected (Figs. 3 and 4). The tongue defect is sewn over, and the wound is drained before closure. Mectron Piezosurgery Technical Characteristics The Piezosurgery medical device (Mectron Medical Tech- nology) applied in this study is a multipurpose device that uses micrometric ultrasonic piezoelectric vibrations of variable frequency and cutting energy (Fig. 5). The device consists of a platform with a powerful piezoelectric handpiece and uses a functional frequency between 25 and 29 kHz, with the possibility of digital modulation up to 30 kHz. The device is fitted with a cooling irrigation system with variable sterile solution flow between 0 and 60 mL/min. Spe- cific inserts and scalpels, which vibrate in a linear pattern with a spatial range of 60 to 210 mm, are moved by an ultrasonic power that exceeds 5 W and reaches 16 W. Piezoelectricity has 3 times the TECHNICAL STRATEGY 2272 The Journal of Craniofacial Surgery & Volume 22, Number 6, November 2011 From the *Unit of Maxillofacial Surgery, Head and Neck Department, Modena and Reggio Emilia University, Modena; †Department of Maxillo- Facial Surgery, Udine University, Udine; and ‡Unit of Maxillofacial sur- gery, Head and Neck Department, Carlo Poma Hospital, Mantova, Italy. Received May 20, 2011. Accepted for publication July 7, 2011. Address correspondence and reprint requests to Attilio Carlo Salgarelli, MD, DDS, Unit of Maxillofacial Surgery, Head and Neck Department, Modena and Reggio Emilia University, Via del Pozzo 71, 41100 Modena, Italy; E-mail: attiliocarlo.salgarelli@unimore.it The authors report no conflicts of interest. Copyright * 2011 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e318232788e Copyright © 2011 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.