Piezoelectric or Conventional Osteotomy in Rhinoplasty? A Clinical and Radiological Review of Fracture Lines Outcomes

Abstract Background Osteotomy of the nasal bones is the most challenging and critical step in rhinoplasty. The shaping of the nasal bony structures is the key for a successful operation. Mobilization of nasal bones along with minimizing the damage of supporting tissue and avoiding the excessive narrowing are the main goals of lateral osteotomy. Various techniques for lateral osteotomies have been described in order to reach the desired aesthetic and functional results, with reduction of soft tissue damage during rhinoplasty as the major goal. Piezoelectric surgery has been presented as a new method to be used during osteotomies, which takes advantage of ultrasonic piezoelectric vibrations in order to decrease the severity of morbidities. Its ability to minimize tissue trauma and its associated morbidity, along with its cutting effectiveness, has rendered piezosurgery popular for several clinical applications in various surgical fields during the last decades. Aim of the Study The basic aim of our study is planned to compare the postoperative fracture line criteria of the conventional and piezoelectric osteotomy in rhinoplasty and clinical examination to assess pain, edema and ecchymosis at day 1, 3, and day 7 and will be compared between left and right side in the same case. Patients and Methods Interventional clinical trial study for twenty patients eligible for rhinoplasty surgery subsequently undergo median, lateral osteotomy by a conventional osteotomes on right side and with an piezoelectric device for the left side, post-operative: Axial, coronal, sagittal and 3D reformat ct scan images 0.625mm thickness was done in on nasal bone to asses fracture line, in addition: postoperative pain assessed by a ten- point scale was applied, and edema with ecchymosis was assessed by visual analogue scale. Results Piezoelectric device in osteotomy step was associated with less pain, edema, ecchymosis and finer fracture lines outcome in comparison to traditional technique osteotomies in rhinoplasty. Conclusion Traditional osteotomies cause more tissues damages as a result more pain, more edema, and ecchymosis. The fracture line in piezoelectric side was accurate and more precise with regular and finer borders.