The Effect of Piezoelectric (Piezo) Versus Classic Lateral Osteotomy on the Lacrimal Drainage System (LDS): A Retrospective, Single-Center, Controlled Study

<i>Background and Objectives:</i> Lateral osteotomies in rhinoplasty run adjacent to the lacrimal drainage system (LDS), risking postoperative tearing. Piezoelectric (piezo) devices enable precise bone cuts that may reduce LDS trauma. We compared the 1-month incidence of objective lacrimal dysfunction after piezo versus classic osteotomy. <i>Materials and Methods:</i> Retrospective, single-center controlled cohort (1 January 2024-1 January 2025) at a tertiary ENT clinic. Consecutive patients aged 19-45 with pre-operative paranasal sinus CT and no prior lacrimal disorder were grouped by osteotomy technique (piezo vs. classic; <i>n</i> = 65 per arm). Assessments were performed at postoperative day 7-10 and at 1, 3, and 6-12 months. The primary endpoint was 1-month objective lacrimal dysfunction, defined as fluorescein dye disappearance test (FDDT) grade ≥1 or reflux/resistance on irrigation plus symptoms (Munk ≥2). Pre-specified statistical tests were used. <i>Results:</i> Early tearing favored piezo. At week 1, epiphora occurred in 32.3% with piezo versus 46.1% with classic (<i>p</i> = 0.041); by month 6, rates were 4.6% versus 15.1% (<i>p</i> = 0.031). Differences at months 1 and 3 also favored piezo but were not statistically significant (<i>p</i> = 0.062 and <i>p</i> = 0.088). FDDT positivity was lower with piezo at week 1 (23.0% vs. 38.4%, <i>p</i> = 0.045) and month 6 (3.0% vs. 10.7%, <i>p</i> = 0.048). Irrigation obstruction was less frequent with piezo at week 1 (7.6% vs. 21.5%, <i>p</i> = 0.026), but groups converged by months 1 (15.4% vs. 12.3%, <i>p</i> = 0.80) and 3 (6.2% vs. 4.6%, <i>p</i> > 0.99). Punctum stenosis/occlusion remained uncommon in both groups without significant differences. <i>Conclusions:</i> Piezo-assisted lateral osteotomy is associated with less early lacrimal dysfunction and lower 6-month epiphora compared with the classic technique. Convergence of irrigation findings by 1-3 months suggests postoperative edema as the dominant transient mechanism. Given the retrospective, single-center design and low event rates, multicenter prospective studies powered for early LDS outcomes are warranted.