Applications of Piezoelectric Device in Endoscopic Sinus and Skull Base Surgery

Abstract

Endoscopic sinus and skull base surgery has evolved significantly with advances in visualization and powered instrumentation, aiming to improve surgical precision while minimizing complications. Among these innovations, piezoelectric devices represent a valuable addition to modern rhinologic and skull base surgery. This review highlights the principles, mechanisms, and clinical applications of piezoelectric technology in endoscopic sinus and skull base procedures. Piezoelectric devices operate through ultrasonic microvibrations that selectively cut mineralized tissue while preserving adjacent soft tissues such as dura, nerves, blood vessels, and the Schneiderian membrane. This selective action enhances surgical safety, particularly when operating near critical structures including the orbit, optic nerve, internal carotid artery, and anterior skull base. Compared with conventional drills and curettes, piezosurgery provides improved surgical control, reduced bleeding, enhanced visibility, and lower risk of thermal and mechanical injury. Clinical applications include removal of thick bony partitions, skull base osteotomies, optic nerve decompression, management of fibro-osseous lesions, and assistance in endoscopic tumor surgery. Histological and experimental studies suggest improved bone healing and preservation of osteocyte viability following piezoelectric osteotomy. Despite its advantages, piezosurgery is associated with higher cost, longer operative time, and a learning curve that may limit widespread adoption. In conclusion, piezoelectric technology offers a safe and precise alternative to conventional bone-cutting instruments in endoscopic sinus and skull base surgery, particularly in anatomically high-risk areas. Further clinical studies are warranted to better define its cost-effectiveness and long-term outcomes.