Comparison of Piezosurgery and Conventional Osteotomy Post Rhinoplasty Morbidities: A Double-Blind Randomized Controlled Trial

The Fish Bone Technique: An Innovative Approach for the Bony Nasal Pyramid

Among many contributions to the world of art and science, Renaissance artist Leonardo da Vinci created the technique known as sfumato. In this technique, da Vinci considered that the regions to be highlighted should be lit up, while the regions to be hidden should be darkened. Drawing parallel with the face, we can work on the anatomical structures underlying the skin and create a favorable surface anatomy for the entire face, including the nose. However, to achieve the ideal hourglass shape of the nose, the bones must be shaped, and a variety of osteotomies are described and used to achieve this. The new and innovative Fish Bone technique, described in this article, allows for the bony nasal pyramid to be shaped and adapted to the hourglass shape, resulting in a harmonious contour, with smooth transitions and preservation airway.

Comparing the piezoelectric and conventional osteotome in rhinoplasty

IMPORTANCE

Edema affects outcomes in Rhinoplasty. Edema and bruising influences patient satisfaction in the perioperative period.

OBJECTIVE

A qualitative analysis of edema comparing piezoelectric and conventional osteotome, and a qualitative comparison of bruising between these methods.

DESIGN

A prospective cohort study of 31 aesthetic Rhinoplasty cases. Participants act as their own control measure. An osteotome is used on one side of the nasal bone and a piezoelectric is used contralaterally.

MAIN OUTCOMES AND MEASURES

Edema is calculated by comparing a pre and post-operative 3-D image with volumetric analysis. Ecchymosis is scored and compared.

RESULTS

The mean volume of the piezoelectric was 1.37 cc (SD 0.87) and the mean volume of the osteotome was 1.17 cc (SD 0.70) (0.19 absolute difference [95 % CI 0.3 to 0.35], p = 0.02). Bruising scores were 0.35 points lower for the piezoelectric arm (-0.35 absolute difference [95%CI -0.7 to 0.06], p < 0.01). This corresponded to 26 % of lateral piezo osteotomies having significant bruising compared to 38 % of the lateral osteotomies using the conventional technique.

CONCLUSION

There is a difference in postoperative edema and bruising with the piezoelectric and conventional osteotome for lateral osteoetomy in Rhinoplasty. There is more edema with the piezoelectric and more ecchymosis with the conventional osteotome.

ASSESSMENT OF THE EFFICIENCY OF PIEZOELECTRIC AND CLASSIC OSTEOTOMY WHEN PERFORMING SEPTORHINOPLASTY

OBJECTIVE

The aim: Comparison and analysis of the main intraoperative and postoperative results of piezoelectric and traditional osteotomy in septorhinoplasty.

PATIENTS AND METHODS

Materials and methods: Examination and treatment were carried out in 40 patients who were divided into two groups. The first included patients who underwent septorhinoplasty using a traditional osteotomy - 20 people (control group). In the second group of patients, piezoelectric surgery was used for septorhinoplasty. This research group consisted of 20 people. All patients of both groups underwent only primary septorhinoplasty by closed and open methods. Piezoelectric surgery was performed using a Japanese VarioSurg3 NSK piezotome.

RESULTS

Results: The research was conducted on the first day after surgery, 3 days and a week after treatment. The following indicators were evaluated: intraoperative complications (mucosa damage), postoperative complications: (swelling of the eyelids,periorbital ecchymoses, nasal secretion activity, inflammatory reaction of the nasal cavity, postoperative pain). Significantly fewer cases of mucosal damage were detected in the second study group compared to the first. And the severity of postoperative complications in the second group of patients who underwent septorhinoplasty with the help of a piezotome was statistically significantly (p<0.05) lower than in patients of the control group.

CONCLUSION

Conclusions: Piezoelectric surgery has a number of advantages over traditional osteotomy techniques, such as selectivity of impact on soft tissues, accuracy of bone destruction. Piezoelectric osteotomy during septorhinoplasty can reduce intra- and postoperative complications with statistical reliability.

A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review

Piezosurgery use has become increasingly prevalent in osteotomies. Piezoelectric ultrasound waves can cut bone effectively, and some studies have shown reduced post-operative morbidities compared to conventional osteotomies. Oedema and ecchymosis are common complications of rhinoplasty and can impact patient satisfaction, wound healing, and recovery. We aim to provide an up-to-date comparison of post-operative oedema and ecchymosis in piezosurgery and conventional osteotomies. A literature search was conducted using the following online libraries; Pubmed, Cochrane, Science Direct, and ISRCTN (International Standard Randomised Controlled Trial Number). English publications between 2015 and 2020 were included. A systematic review was completed, and a comparison of oedema and ecchymosis in piezosurgery and conventional osteotomies was examined alongside other outcomes such as pain, mucosal injury, and surgery time. Eight randomised controlled trials (RCTs) met our criteria with a combined total of 440 patients: 191 male and 249 female. Piezosurgery had statistically significant (p < 0.05) reduction in short-term oedema compared to conventional osteotomies in 75% of the papers included, and in 50% this persisted across the whole follow-up period. Similarly, ecchymosis scoring was initially statistically lower (p < 0.05) in piezosurgery in 87.5% of the RCTs, and in 75% this persisted across the whole follow-up period. A reduction in pain (p < 0.05) and mucosal injury (p < 0.05) was also seen in piezoelectric osteotomies. The length of surgery time varied. Piezoelectric osteotomies reduce oedema and ecchymosis compared to conventional osteotomies, in addition to improving pain and mucosal injury. However, disadvantages such as length of surgery time and cost have been reported. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Piezosurgery versus Conventional Cutting Techniques in Craniofacial Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery.

METHODS

A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed.

RESULTS

Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, -0.86; 95 percent CI, -1.20 to -0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, -1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, -2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent).

CONCLUSIONS

Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.

A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures

ABSTRACT

In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV).

Modalities of Post-Rhinoplasty Edema and Ecchymosis Measurement: A Systematic Review

Background:

Post-rhinoplasty edema and ecchymosis can influence patient satisfaction with surgery as well as result in poor quality of life. Methods to quantify such edema and ecchymosis have been described in the literature. Despite this, there is currently no collective understanding of which methods are the most effective. Hence, this systematic review aims to describe and analyze the literature on post-rhinoplasty edema and ecchymosis measurement techniques.

Methods:

Standard bibliographic databases (OVID Medline, EMBASE, and PubMed) were searched from their inception to December 2019 for the terms: “rhinoplasty”, “postoperative”, “edema”, and “ecchymosis”. Descriptive analysis was completed.

Results:

The search revealed 1116 articles of which 33 met inclusion criteria and were included for qualitative synthesis. A total of 1801 patients from all studies were included. Of the 33 included studies, there were 57 unique ecchymosis/edema measurements. The majority of studies measured edema/ecchymosis on post-operative day 1, 2, 3 and 7. Ninety-three percent of measurements described were taken subjectively from a human rater. Other techniques described included magnetic resonance imaging, ultrasound, 3-dimensional imaging, and digital analysis. Less than half of the subjective ecchymosis/edema gradings were completed by a blinded rater.

Conclusion:

There are a wide variety of post-rhinoplasty edema and ecchymosis techniques being used by rhinoplasty surgeons. The majority of post-rhinoplasty edema and ecchymosis measurements are completed by unblinded subjective raters. It is important that facial plastic surgeons select an accurate measurement tool so they may be able to initiate precise patient-specific management of edema and ecchymosis.

Surgical Burr-Assisted Lateral Osteotomy Technique in Septorhinoplasty

ABSTRACT

Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Patients who underwent primary open septorhinoplasty were included in the study and were divided into 2 groups. The first group had lateral endonasal osteotomy with conventional guided osteotomes, and the second group had lateral osteotomy with surgical round burr. Edema and ecchymosis scoring systems were used on the postoperative first, third, and seventh day to evaluate postoperative edema and ecchymosis, and the visual analog scale was used to evaluate pain severity on the postoperative period. Out of 70 patients who had undergone septorhinoplasty, 36 received conventional osteotomy and 34 received surgical round burr osteotomy. Periorbital ecchymosis scores were significantly lower in the second group on the postoperative first, third, and seventh days. The periorbital edema scores were significantly lower in the second group on the first postoperative day but no difference was found between postoperative days 3 and 7. Also, the pain scores were significantly lower in the second group. Osteotomy with surgical round burr yields less ecchymosis, edema, and pain in the early postoperative period than conventional osteotomy in primary septorhinoplasty patients.

New Concepts in Dorsal Hump Reduction

Dorsal hump modification is a commonly performed procedure in most rhinoplasties. Specifically, hump reductions play a significant role in aesthetic rhinoplasty when the surgeon and patient wish to have a "smaller" and less projected nasal complex. There are several techniques available in order to perform a hump reduction. The purpose of this article is to review some of the surgical options available for dorsal hump reduction and management of the dorsum following this procedure.

Piezoelectric Technology in Rhinoplasty

Piezoelectric tools are the novel ultrasonic methods for effective and safe osteoplasty or osteotomy in comparison with traditional soft and hard tissue approaches using rotating instruments due to lack of microvibrations, ease of control and use, and safer cutting, mainly in complex anatomic areas. Piezoelectric indicates favorable and valuable outcomes based on the immediate postoperative morbidities, even though long-term results have not been investigated. It could be indicated that the piezosurgery in rhinoplasty can be considered as a reliable and safe method and should be taken into account as a part of the surgeon's repertoire for rhinoplasty.