Piezo surgery: a promising alternative to conventional osteotomy

Surgical rhinoplasty is used to perform corrections to the external nose. This involves the use of various instruments, for applications like osteotomies. Instruments such as hammers and chisels are classified under conventional osteotomies. This method is associated with postoperative oedema and ecchymosis.

A new way of performing osteotomies is piezo surgery. The vibrating instruments used enable particularly precise incisions that are gentle on soft tissue. Piezo surgery is proving to be versatile because it is suitable for both open and closed approaches. So-called „preservation rhinoplasty" is also possible with piezo surgery. More information is provided in the following reports.

Taking into account two systematic reviews that investigated the use of piezosurgery for osteotomies in rhinoplasty compared to the conventional method concluded that piezosurgery offers advantages in terms of postoperative morbidity.

Wähmann et al. (2019) show that piezosurgery tends to result in reduced ecchymosis and less postoperative pain and oedema. Tsikopoulos et al. (2020) conducted a meta-analysis and found statistical advantages of piezosurgery with regard to postoperative pain, eyelid oedema, periorbital ecchymosis and intraoperative mucosal injury. These advantages were evident both within the first 3 days and on the 7th day after surgery. The authors conclude that piezosurgery reduces postoperative morbidity, especially in osteotomies that are not performed under direct vision.

Both systematic reviews indicate that piezo surgery is a promising alternative to conventional osteotomy. However, they also emphasise the need for further studies with larger numbers of patients to clearly confirm the advantages of piezo surgery and to investigate possible long-term effects.

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