An osteotome is a specialized handheld instrument used in surgery to precisely cut, shape, or modify bone tissue. It provides a mechanical alternative to power tools, enabling delicate manipulation of bone in sensitive anatomical locations. The core purpose is to achieve accurate bone separation or reduction while minimizing trauma to surrounding tissues.
Defining the Instrument
The term “osteotome” is derived from Greek, combining osteo, meaning bone, and -tome, which signifies a cutting instrument. Physically, it consists of a handle, a neck, and a working end that acts as the blade or tip. These instruments are forged from medical-grade stainless steel, ensuring durability and a sharp edge.
A distinct feature of the osteotome is the configuration of its working end, which differentiates it from a standard surgical chisel. An osteotome is typically bibevelled, meaning the blade is tapered on both sides to form a symmetrical cutting edge. In contrast, a chisel is monobevelled, with a bevel on only one side.
This bibevelled design allows the osteotome to split or divide bone symmetrically for controlled separation. Osteotomes come in several variations to suit different surgical needs and bone types. Common types include straight blades for linear cuts, curved blades for angled access, and guarded osteotomes that prevent the blade from penetrating too deeply.
How Osteotomes Function
The mechanism of action for an osteotome is entirely manual, relying on controlled force applied by the surgeon. The osteotome is used in conjunction with a specialized surgical mallet or hammer. The surgeon positions the cutting edge against the bone and taps the handle with the mallet to drive the blade forward. This impact technique allows for a gradual and controlled progression through the dense outer layer (cortical bone) and the inner spongy bone (cancellous bone).
The process creates a clean line of separation, known as an osteotomy. This manual process is advantageous because it gives the surgeon immediate tactile feedback on the bone’s consistency and resistance. The controlled, non-rotary action minimizes the potential for thermal necrosis, or heat-induced bone death, which is a concern with power tools.
In certain dental applications, this mechanical action can compress the bone tissue. This compression may increase the density of the bone surrounding an implant site and improve stability.
Primary Surgical Applications
Osteotomes are used across several surgical disciplines where precise bone modification is required. In orthopedic surgery, they are frequently used for corrective osteotomies, procedures that involve cutting a bone to shorten, lengthen, or realign a limb. For example, they may be utilized to adjust the alignment of the knee or hip joint to shift a patient’s weight away from damaged cartilage.
Their precision is valued in oral and maxillofacial surgery, particularly in dental implantology. Osteotomes are used in techniques like ridge expansion, where a narrow jawbone ridge is gently split and widened to create space for an implant. They are also used in crestal approach sinus lifts, where the instrument is tapped to gently elevate the floor of the maxillary sinus to prepare for implant placement.
In plastic and reconstructive surgery, the osteotome is a standard instrument for procedures like rhinoplasty, or nose reshaping. Surgeons use small, specialized osteotomes to perform a lateral osteotomy, which involves making controlled cuts to fracture and reposition the nasal bones, allowing the surgeon to narrow the bony pyramid of the nose.