A comparison of piezo surgery osteotomies with conventional internal osteotomies as performed by trainee surgeons: a cadaveric study

Abstract

Introduction Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. Materials and methods Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann–Whitney test for statistical analysis was used. Results The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. Discussion Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.

Double Lateral Osteotomy: Not Only the Correction of Crooked Noses but a Relevant Aesthetical Refinement in Structural Rhinoplasty

“…In this study, we did not use piezotome; however, it could be possible to perform double lateral osteotomies with piezotome, keeping the integrity of internal mucosa to avoid collapse of the bony fragments. Good indications for the use of piezotome could be cases with significant bone curvature, where the use of piezotome could allow a real osteoplasty with reduction in bone thickness, and cases with short, osteoporotic or brittle nasal bones, where the piezotome could reduce the risk of comminution of fragments [27,28]. In the treatment of these complex cases with conventional endonasal osteotomies, we would like to stress even more the importance of avoiding damage to the soft tissue above and below the osteotomy lines; the osteotome should progress by cutting the bone in a tunnel under the periosteum and over the mucosa, leaving these tissues as intact as possible.…”