The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty

Abstract

The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

Piezosurgery versus conventional osteotomy in rhinoplasty: A systematic review and meta‐analysis

“…Consequently, bleeding, ecchymosis, and edema become minimal. Some authors advocate that the main cause of ecchymosis during osteotomy is an injury to the angular vein or artery at the level of the medial canthus . Given this theory, approaching such delicate structures using more accurate instruments, such as the piezotome during piezosurgery, would significantly result in lower periorbital ecchymosis scores, as evidenced in our analysis.…”

“…Few studies showed no significant difference between the two techniques in terms of objective outcomes. In a cohort of 90 patients who underwent rhinoplasty (45 conventional versus 45 piezosurgery), Taskın et al reported a significant increase in the edema score on postoperative day 2 in all patients, without any statistically significant difference between the two groups . Similarly, they reported no significant difference in the ecchymosis scores between the two groups.…”

“…However, its main disadvantages include the high cost and the extended operating time . Several trials have been conducted to evaluate its utility and safety . Although, one study shows no difference between the conventional technique and piezosurgery in terms of ecchymosis and edema, several trials conclusively show that piezosurgery is advantageous .…”

“…Several trials have been conducted to evaluate its utility and safety . Although, one study shows no difference between the conventional technique and piezosurgery in terms of ecchymosis and edema, several trials conclusively show that piezosurgery is advantageous . Based on the current literature, there is a lack of quantitative reviews to compare this new modality of treatment with the traditional method of osteotomy.…”

Comments on: “The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.”

“…Dear Editor, I read the manuscript written by Taskın et al [1] with great interest. The authors performed a randomized study comparing two types of osteotomy in rhinoplasty: piezoelectric and conventional osteotomy.…”