A novel, tissue-selective burr for temporal bone drilling

TL;DR

A new drilling tool called the Safety Burr was tested for safer and more precise drilling of the temporal bone in otologic procedures.

Contribution

The Safety Burr introduces a tissue-selective design with a self-centering ring to reduce soft tissue injuries during temporal bone drilling.

Findings

The Safety Burr showed no tearing or perforation of soft tissues in cadaveric heads during drilling.

Otosurgeons rated the Safety Burr superior in soft tissue protection, precision, and absence of jumping compared to conventional burrs.

Procedure times were similar between the Safety Burr and conventional cutting burrs.

Abstract

Temporal bone (TB) drilling is one of the most frequently performed otologic procedures. It carries the potential risk of damage to the facial nerve, sigmoid sinus, and dura. Conventional cutting burrs (CCBs) are effective at cutting bone but may easily cause soft tissue damage. A novel 5.4-mm cutting burr, the Safety Burr (SB), with a moving, self-centering ring placed around the cutting tip, was developed as a safety mechanism to prevent soft tissue injuries.

The SB was compared to the 5.0 mm CCB in 20 cadaveric fresh-frozen TBs. The contact time and number of inadvertent errors were recorded. The assessments of the three otosurgeons on burr characteristics were graded on a scale of 1 (poor) to 5 (superior). Soft-tissue protection was further evaluated in three cadaveric heads.

No differences were observed in the mean procedure time between the SB and the CCB. The SB was perceived to be superior to the CCB in terms of soft tissue protection, absence of jumping, and precision. In the cadaveric heads, drilling on the exposed middle fossa dura or sigmoid sinus resulted in no tearing or perforation.

The SB is a feasible alternative for TB drilling and provides soft-tissue protection. The absence of jumping contributed to superior handling and controllability of the burr. Further clinical studies are needed to comprehensively assess the tissue selectivity and its limitations in otological TB drilling.

The online version contains supplementary material available at 10.1007/s00405-025-09805-y.

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