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

Abstract

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.

Use of piezoelectric instrumentation in craniofacial surgery

“…The utility of piezosurgical osteotomies for nasal osteotomies has been relatively well studied. Three recent systematic reviews [31 ▪▪ ] and metanalyses [32,33] comparing piezosurgery to conventional osteotomies in rhinoplasty found that the former was associated with less postoperative ecchymosis (namely periorbital ecchymosis), eyelid edema, and pain compared with conventional techniques. Reviews by Kisel et al [31 ▪▪ ] and Tsikopoulos et al [33] additionally found that piezoelectric osteotomies were associated with decreased overall mucosal injury (examined by either intraoperative or postoperative endoscopy) and postoperative pain.…”

“…Three recent systematic reviews [31 ▪▪ ] and metanalyses [32,33] comparing piezosurgery to conventional osteotomies in rhinoplasty found that the former was associated with less postoperative ecchymosis (namely periorbital ecchymosis), eyelid edema, and pain compared with conventional techniques. Reviews by Kisel et al [31 ▪▪ ] and Tsikopoulos et al [33] additionally found that piezoelectric osteotomies were associated with decreased overall mucosal injury (examined by either intraoperative or postoperative endoscopy) and postoperative pain. Prior studies have also compared long-term outcomes in nasal airflow, olfactory functions, and quality of life 8 weeks after surgery for patients that underwent rhinoplasty using piezoelectric versus conventional techniques.…”