The Role of Piezoelectric Instrumentation in Rhinoplasty Surgery

Overview

The bony upper third of the nose is traditionally shaped with saws, chisels, osteotomes and rasps, which cut blind through the skin and can damage surrounding soft tissue. Piezoelectric instruments use ultrasonic vibration that cuts bone but not soft tissue. The authors report how their technique evolved across cadaver dissections and a consecutive clinical series.

Sections of note

• Two-part study: 30 cadaver dissections and 185 clinical cases over 19 months.
• The clinical series included 82 first-time and 103 revision rhinoplasties.
• An extended dissection under the periosteum was developed so that all parts of the operation, including the bone cuts, could be seen directly.
• Ultrasonic rhinosculpture was used in 95 patients to shape the bony vault without making osteotomies at all.
• 11 revisions have been performed to date, 6 percent of the series.
• No revision was required for bone asymmetry, irregularity or excessive narrowing. Level of evidence 4, therapeutic.

What it means for a patient

• The stated advantage is that the surgeon can see the bone being shaped rather than working by feel through the skin.
• In roughly half the cases the bones were sculpted directly instead of being cut and repositioned.
• The 6 percent revision rate covers the whole series, and none of those revisions was for a bone problem.
• Single practice, no comparison group operated with conventional instruments, and the wider dissection required to see the bone is itself a change from standard technique.

Why this paper matters

Bone work has historically been the least controlled step in rhinoplasty, done largely blind, and asymmetry of the bony bridge is a common reason for revision. Ultrasonic instruments allow it to be done under direct vision. Whether the added dissection carries its own cost in swelling or healing, and how results compare with conventional osteotomy, is not tested here.

Terms

• Piezoelectric instrument: a tool that cuts bone with ultrasonic vibration while sparing soft tissue.
• Osteotomy: a planned surgical cut through bone.
• Osteotome: a chisel-like instrument used to cut bone.
• Rasp: a file used to shave down a bony hump.
• Subperiosteal dissection: lifting tissue beneath the membrane covering the bone.
• Bony vault: the upper third of the nose, formed by the paired nasal bones.