CHAPTER 25

Instruments

The most clever surgical procedure may be difficult and time-consuming if the proper instruments are not avail­able. As much as any operation technique will be altered and improved and modified through experience with it, the same is true for instruments which will undergo some changes and improvement, either by the origina­tor of the procedure or by others. That's how progress is made.

For the surgeon, it is easy to improve his surgical technique. But he can hardly make the necessary instru­ments himself, alter them or develop new ones. He may have an idea of what kind of instrument he wants. But he does not always receive from the instrument maker what he thought he had ordered. The instrument maker has to understand how the surgeon wants to use the in­strument. I have met only a very few really good ones who can grasp quickly the concept and details of what is requested and produce a usable product. Once the in­strument is made according to the surgeon's require­ments, he can evaluate whether or not that instrument is able to do what he expected. Very rarely is the very first the final one. That means that the instrument maker must be willing to work by trial and error.

The development of new instruments and their alter­ation is expensive for the instrument maker. Some man­ufacturers were not able to produce what I wanted and others very rarely produced it at the first attempt. When the person responsible for product merchandising in an instrument sales company feels confident to evaluate whether or not that instrument is going to sell, although having no conception regarding the use of the instru­ment and decides himself whether or not your request­ed instrument should be made, then every hour invest­ed in the instrument you want is often wasted.

Twice, I took an idea to two different instrument­making companies and was told there was no call for that idea of mine. So it would not be developed. Later I found that the companies had produced my idea as their own, resulting in good sales for the company.

If you want an instrument to be reproduced in the quality you desire, you must have a written agreement with that company that you have the right to check your instrument's quality and design, if it is to be sold with your name attached to it. It is almost unbelievable what alterations instruments undergo when they are copied

but not checked by the surgeon who had developed them originally.

This chapter is not meant to become a catalogue of all the instruments which I had specially made for my type of surgery. I want to mention just a few of them which have made my surgery so much easier.

A Special Surgical Handpiece for the Electro-motor. It was needed in order to be able to use any rotating bur­like instrument available on the market with a shaft di­ameter of 2.35 mm. It had to be slim and so long, that while working in the depths of the mouth, the surgeon still has good visibility. The W & H Company in Austria was willing to develop it for me. It is a wonderful hand­piece, which permits the use of burs with a very short as well as a normal or an extra long shaft. That means that any bur with an ordinary shaft diameter of 2.35 mm can still be used when its shaft is inserted only 10-12 mm into the handpiece. This is very advantageous for working in the depths. It also has the advantage that the holding system for the bur can be handled by the surgeon himself without his assistant's help. The W & H Company has supplied also the same type of bur-holding system to its already existing short surgical handpiece (Fig. 102a).

Indications for the use of the long surgical handpiece are any bone work in the depth such as removal of im­pacted wisdom teeth, osteotomies of the jaws, osteoto­mies of the orbits, any surgery on the cranio-facial skeleton, any reconstruction work as well as ENT preci­sion bone work.

The same company has produced a very efficient and strong electro-motor for dental and other surgical pur­poses. It is called Elcomed" and can run from 200 up to 50,000 revolutions per minute. With the company's speed reduction handpiece, the speed can be reduced to approximately 0.2 turns per second, very useful for den­tal implant work. The high speed permits a special hard steel bur to be used like a fine paint brush. The cable and motor is fully autoclavable. It also has an automatic ster­ile water delivery system, which can be attached to a small tube on the surgical handpiece for simultaneous rinsing and cooling of the bone and the instrument while working.

Indications for the use of the electro-motor: Its pow­er permits it to be used for working with any type of

H. L. Obwegeser, Mandibular Growth Anomalies© Springer-Verlag Berlin Heidelberg 2001

438 CHAPTER 25 Instruments

-a

b

c

d

saw, reciprocating as well as oscillating types, as long as the saw handpiece can be attached to an ordinary type of dental motor. The motor is so powerful that it can easily handle those power requirements. At my request, the company is arranging to produce handpieces for both oscillating and reciprocating saws. They should be available in the near future. I have also suggested the production of their own disposable saw blades for their new saw handpieces. They should be produced accord­ing to the requirements of the various specialties. In ad­dition I have asked the company to produce a mini-re­ciprocating saw ..

Address of the Company: W & H Dentalwerk Btirmoos GmbH, Austria, 5111 Btirmoos

The Gutter-shaped Soft Tissue Retractors. With an up­wardly or downwardly bent end are of real advantage for work in the mouth, compared with plane retractors. The gutter-shaped form does not cause damage to the lips as do the ordinary retractors. Its upwardly bent end is ideal for holding the cheek away without damaging its mucosal covering while those with the downwardly bent end are used for retracting soft tissues as normally done. There are several types, differing in length and width (Fig. 102b).

The Bone Separator (Fig. 102c). It is an instrument which makes the sagittal splitting of the mandibular ra­mi (see Fig. 87d) and also any required decortication so much easier. It is also used for the posterior and anteri­or downward fracture technique in the Le FortI-type osteotomy (see Fig. 96e). In addition is an excellent in­strument in cranio-facial surgery for mobilization of the middle third of the face after aLe Fort III-type oste­otomy and also for mobilizing the orbital cones.

With the Maxillary Advancer (Fig. 102d and see Fig. 96g). With it the often difficult problem of mobiliza­tion of the maxilla is finally solved. With this instru­ment, the surgeon no longer needs to fear that a half or the whole maxilla is pulled completely out of the mouth when he has difficulty in mobilizing it or has to accept insufficient mobilization. It is also a very useful instru­ment for advancing the middle third of the face. Once all necessary osteotomy cuts are completed, with that in­strument the surgeon can pull the piece of bone to be mobilized forward millimetre by millimetre.

Fig.102a-d. Important special instruments. a W+H surgical handpieces which can hold any length of bur with a 2.35 mm diameter shaft, even the very short ones. The long handpiece is very useful for wisdom teeth removal and bone work in the depth of the operating field. b Gutter-shaped soft t issues retrac­tors with upwardly curved ends. c Bone separator. It exists in two widths. It is very useful for several indications. It can be fixed in any opening positioJ1. d The maxillary advancer

e

25.1 Where to Obtain the Instruments in Checked Quality 439

Ill flo! If

"

'f h •i i!fti ;;,~ ··l·· I

~ ., Q -'•

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Fig. 1 02e-g. Important special instruments. e The nasal septum cutter. f The perforated nasal rasps. g The bone contouring forceps, round and flat

The Nasal Septum Cutter (Fig. 102e). With it it is in­tended to weaken the deviated septal cartilage without mutilating it badly by squeezing it as other instruments for the same purpose do. With it, many small cuts are produced in the area of the cartilage which eliminates the tendency to return to its original bent form. These little cuts will become fixed together by scars in their new position. It is, of course, necessary to have a tampon or soft rubber drains inserted in both nasal cavities to adapt the mucosa to the weakened septal cartilage to ensure its straight final shape.

The Perforated Nasal Rasps (Fig. 102f). They are not normal bone rasps which become clogged with bone mush after 2-3 pulls. They have sharp teeth to engage the bone surface and the mush is pushed through perforations which widen conically towards the back of the rasp. This prevents obstructing on the the

perforations and keeps the instrument working effec­tively.

The Bone Contouring Forceps. A flat and a round type exist. They are very useful for contouring a piece of soft bone to the shape the surgeon needs. Cortical bone can­not be bent. The instrument is ideal for contouring de­corticated halves of ribs (Fig. 102g).

25.1

Where to Obtain the Instruments in Checked Quality

In any instrument catalogue for maxillofacial surgery there are instruments advertised as Obwegeser instru­ments. Some of them are worse than poor copies of my original instruments. Even in the well-known instru­ment-producing companies the shape and quality of the

440 CHAPTER 25 Instruments

instruments change within a few years. This is my expe­rience. For that reason and for further improvement it is necessary that the surgeon checks, at intervals, all those newly produced instruments which are sold under his name. There are only two instrument-producing com­panies which want me to check their production of Ob­wegeser instruments. These two companies alone and their subsidiary companies hold the right to put my name on their products. They may distribute these in­struments directly or sell them to other distributing companies. So, in addition to my name, there must al­ways be the name of that manufacturing company on the instruments which I recommend.

In the USA and Canada my instruments were pri­marily distributed by the Walter Lorenz Company only. Walter Lorenz and I had a longstanding friendship which started in 1967. Literally overnight, he improved a few instruments for me so well that I could use them in a demonstration operation during a postgraduate course that was transmitted by TV into the lecture hall. I thanked him during the operation for his cooperation. All the attending surgeons wanted his address and he wanted me to check the quality of the instruments he was going to sell under my name. His name was a guar­antee of quality. Before he passed away he had sold his company. With the new director of the Walter Lorenz Company the philosophy changed. When I was there last, in 1995, I was surprised what change some of the Obwegeser instruments had undergone. Quite a num-

ber of them were almost not usable for the purpose for which I had originally designed them. The new director was also not interested in my newer improved and the newly developed instruments. It is for that reason that the Walter Lorenz Company is not permitted now to put my name on any instrument they sell.

KLS in jacksonville is now the only instrument dis­tributing company in the USA which sells my instru­ments checked by me for their quality. The company's instruments are made in Tuttlingen, Germany.

Address: KLS-Martin L.P., P.O. Box 50249, Jacksonville, FL 32250-0244, U.S.A.

Martin at Tuttlingen, Germany, a very large instru­ment distributing company, also distributes my instru­ments all over the world. It obtains the instruments from the same manufacturer as does KLS.

Address: Martin Medizin Technik, Ludwigsthaler Strasse 132, Postfach 60,78501 Tuttlingen, Germany

Medicon Company at Tuttlingen, is also producing my instruments, all of them. They want me to check what they sell as Original Obwegeser Instruments. That company has developed for me some of my newer in­struments.

Address: Medicon eG, Postfach 4455, 78509 Tuttlingen, Germany