Decompression in endocrine orbitopathy with a navigated piezosurgical bone grinder.

In severe cases of endocrine orbitopathy (Graves disease), decompression of the orbital contents has been shown to improve potentially disfiguring conditions, such as exophthalmos, and to prevent functional impairments that range from chronic inflammation and a burning sensation, to impairment of vision and blindness. It can be done on the lateral, caudal, or medial walls, or all three, depending on the desired effect. 1 Eckstein A. Schittkowski M. Esser J. Surgical treatment of Graves’ ophthalmopathy. Best Pract Res Clin Endocrinol Metab. 2012; 26: 339-358 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar Traditional high-speed burs and rongeurs have been used to remove bone but, to decrease lacerations of the soft tissues, piezosurgical instruments have been suggested. 2 Sivak-Callcott J.A. Linberg J.V. Patel S. Ultrasonic bone removal with the Sonopet Omni: a new instrument for orbital and lacrimal surgery. Arch Ophthalmol. 2005; 123: 1595-1597 Crossref PubMed Scopus (49) Google Scholar , 3 Cho R.I. Choe C.H. Elner V.M. Ultrasonic bone removal versus high-speed burring for lateral orbital decompression: comparison of surgical outcomes for the treatment of thyroid eye disease. Ophthal Plast Reconstr Surg. 2010; 26: 83-87 Crossref PubMed Scopus (32) Google Scholar , 4 Ponto K.A. Zwiener I. Al-Nawas B. et al. Piezosurgery for orbital decompression surgery in thyroid associated orbitopathy. J Craniomaxillofac Surg. 2014; 42: 1813-1820 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Navigated operations using burs or tracked burs have been introduced by Tavassol et al to improve intraoperative precision. 5 Tavassol F. Kokemüller H. Müller-Tavassol C. et al. A quantitative approach to orbital decompression in Graves’ disease using computer-assisted surgery: a compilation of different techniques and introduction of the “temporal cage”. J Oral Maxillofac Surg. 2012; 70: 1152-1160 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar