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

Abstract

Objective: Piezosurgery, used in different otolaryngology procedures, was a breakthrough in surgery. We systematically reviewed the differences in outcomes after lateral nasal osteotomy with peizosurgery and conventional osteotome and quantified the differences through a meta-analysis.Methods: Medline, Embase, and Cochrane library databases were selected to search for randomized clinical trials (RCTs) published before January 2019 that detailed differences between piezosurgery and conventional osteotomy. The key search terms included "rhinoplasty" and "piezosurgery." Only RCTs in English with patients >18 years who underwent lateral osteotomy by percutaneous or internal approaches were included. PRISMA guidelines were followed in data extraction and study inclusion. Two independent reviewers assessed the relevance of the studies. The point of estimate in the meta-analysis was the standardized mean difference and was pooled with the random-effects model. The measured outcomes were ecchymosis, edema, postoperative pain, and duration of surgery.Results: Five RCTs met our criteria and were analyzed in primary subsequent meta-analyses. Piezosurgery demonstrated significantly lower edema (SMD = -0.75; 95% CI, -1.26, -0.24) and ecchymosis scores (SMD = -0.85; 95% CI, -1.49, -0.20) on postoperative days (POD) 2 or 3 than conventional surgery. They were also significantly lower with piezosurgery than conventional surgery on POD 7 (SMD = -0.64; 95% CI, -1.21, -0.06; and SMD = -0.64; 95% CI, -1.14, -0.14, respectively). Two studies that estimated the degree of pain showed that after piezosurgery, patients experienced lesser pain than after conventional surgery. The mean difference was -0.73 (95% CI, -1.06, -0.39).Conclusions: Piezosurgery causes less ecchymosis, edema, and pain than conventional osteotomy, without extending the duration of surgery.

Surgical Burr-Assisted Lateral Osteotomy Technique in Septorhinoplasty

“…Postoperative pain is an early and annoying complication of septorhinoplasty, and its primary etiology is osteotomy 33 33 .…”

“…Postoperative pain is an early and annoying complication of septorhinoplasty, and its primary etiology is osteotomy 33 33 . Thus, many techniques, instruments, and agents have been used to reduce postoperative pain following septorhinoplasty.…”

The use of piezoelectric instrumentation and platlet rich fibrin matrix in septorhinoplasty: Report of two cases

“…Meta-analysis from 2019. published by Mirza et al proved that PEI causes less ecchymosis, edema and pain than conventional osteotomy, without extending the duration of surgery. It included six randomized clinical trials from 2015. to 2019. and additionaly proved that PEI has no longer duration in surgery, unlike some previous trials have suggested [13]. The study by Otake et al was the first to prove the clinical advantage of PEI in the soft tissue [14].…”

The Traumatic Nasal Deformity

“…Recently, a much-needed meta-analysis was published. 13 A total of six randomized, controlled trials were identified and accepted for meta-analysis. Evaluation for key outcomes such as edema, bruising, pain, and time of operation was performed.…”