Quantifying Osteotome Sharpness: Comparing the Major Manufacturers

Objective: 1) Develop a method for quantification of osteotome sharpness in a rhinoplasty model, using artificial bone; 2) demonstrate changes in osteotome sharpness over multiple uses; and, 3) compare sharpness of osteotomes from different manufacturers at baseline and after multiple uses. Method: Osteotomes were passed through synthetic bone blocks. Sharpness was measured using the Instron Universal Tester (force required to cut #2 Prolene suture) at baseline and after 1, 4, 7, and 10 osteotomies. Changes in sharpness over time were assessed using within-sample t tests. Comparison of manufacturers was performed with multiway ANOVA. Results: A novel, prospective surgical model was developed. Osteotomes from 5 manufacturers were tested (Nextedge, Black & Black, Storz, Miltex, and Biomet). Baseline measurements showed that the Storz osteotome was sharpest (1.74 lbs, P < .001), followed by Miltex and Biomet (2.50 lbs, 2.68 lbs), and Nextedge and Black & Black (3.48 lbs, 3.40 lbs). All osteotomes except Nextedge (P = .098) demonstrated a significant decrease in sharpness over time (P = .02 to P < .001), though relative changes and absolute sharpness varied widely between instruments. ANOVA showed the Storz osteotome was significantly sharper across all uses and timepoints (P < .001). The greatest decrease in sharpness over time was seen with Black & Black (-1.28 lbs). Conclusion: Otolaryngologists use osteotomes in cosmetic and functional rhinoplasty. Millimeter-level accuracy in these procedures is essential to maximize outcome and minimize complications. Multiple similar-appearing instruments are available, but their relative efficacy is infrequently tested. We have demonstrated that, at least in the case of osteotomes, not all instruments are created equally.