Is Conventional Osteotomy Still a Winning Technique in Rhinoplasty? Our Personal Experience

Precise osteotomy of nasal bones is a critical component in rhinoplasty, enabling correction of deformities and enhancement of both functional and aesthetic outcomes. Piezoelectric instruments are renowned for their atraumatic bone-cutting abilities; however, traditional osteotomes remain in use. This study aims to assess the safety and efficacy of conventional osteotome techniques in rhinoplasty and compare postoperative outcomes with those documented for piezosurgery. This retrospective cohort study conducted at Verona University Hospital included 24 patients who underwent primary or revision septorhinoplasty between June 2021 and October 2024. A senior surgeon performed all osteotomies using an endonasal approach with a conventional osteotome and standardized technique. Postoperative eyelid edema and ecchymosis were evaluated on postoperative days 1, 3, and 7 utilizing the Kara-Gokalan scoring system. Complication rates, surgical duration, and length of hospital stay were also recorded. The mean scores for edema and ecchymosis were comparable to those associated with piezoelectric techniques, suggesting that precise use of conventional osteotomes, including subperiosteal tunnelling, can achieve similarly favorable outcomes. Additionally, operative time was reduced. Comparative literature indicates that periosteal elevation and soft tissue management may be more influential on outcomes than the choice of instrument. The positive results observed may be attributed to the use of the endonasal approach for osteotomies combined with subperiosteal tunneling. Traditional osteotomes present a safe, reliable, and cost-effective alternative to powered devices, achieving postoperative outcomes comparable to piezosurgery when employed with standardized surgical protocols and careful handling. Surgical expertise and standardization of techniques remain vital.