Rasping in Rhinoplasty: Bone Healing Outcomes With Manual Versus Piezoelectric-Assisted Techniques

There has been an increasing trend in using piezoelectric devices in craniofacial surgery to selectively cut bone and reduce collateral soft tissue trauma. Although the benefits of piezosurgery have been well demonstrated for osteotomies, its impact on bone healing during rasping remains understudied. This study evaluated bone regeneration following medial maxillary rasping performed with a manual rasp (MR) compared with piezotome-assisted rasping (PR) in a skeletally mature sheep model. Bilateral defects (rasps: ∼2 cm x ∼2 cm) were created along the coronal plane on the anterodorsal aspect of the nasal bone, with PR used on the anatomic right side and MR on the anatomic left side. Nondecalcified histologic processing and analysis was performed on the nasomaxillary bone at 3 and 12 weeks postoperatively (n=6 sheep/timepoint). At 3 weeks, MR-treated defects showed smoother, intact bone defect margins with minimal bone deposition. PR-treated defects displayed more irregular margins with scattered bone fragments, consistent with ultrasonic microfracturing. By 12 weeks, both techniques demonstrated comparable healing patterns with a regenerating nasal bone contour, maturation of bone architecture, visible osteocytes, and no evidence of bone fragments or inflammatory infiltrates. Semiquantitative scoring of osteogenesis revealed statistically homogenous findings between MR and PR usage (p=0.63 at 3 weeks; p=1.00 at 12 weeks). Within the limits of this model, piezotome-assisted rasping altered early bone surface topography but did not impair long-term bone regeneration compared with manual rasping. This provides preclinical support for piezotome use as an alternative bone-modifying technique in rhinoplasty.