A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review

Kisel J, Khatib M, Cavale N.

PubMed 36163553 Publisher (DOI)Free full text (PMC)

What this paper says

Reviewing eight randomized trials covering 440 patients, piezoelectric bone cutting significantly reduced early swelling in 75 percent of the trials and early bruising in 87.5 percent.

Overview

Piezoelectric instruments cut bone with ultrasound waves and have become increasingly common for nasal bone cuts. Swelling and bruising are common after rhinoplasty and affect satisfaction, healing and recovery. The review compared these two outcomes between piezoelectric and conventional bone cutting, searching PubMed, Cochrane, Science Direct and a trial registry for English publications between 2015 and 2020.

Sections of note

Systematic review of eight randomized controlled trials with 440 patients, 191 male and 249 female; level of evidence III.
Piezoelectric cutting significantly reduced short term swelling in 75 percent of the included papers.
In 50 percent of papers that reduction persisted across the whole follow up period.
Bruising scores were initially significantly lower with piezoelectric cutting in 87.5 percent of the trials.
In 75 percent that difference persisted across the whole follow up period.
Pain was significantly reduced with piezoelectric cutting.
Injury to the nasal lining was also significantly reduced.
Length of surgery varied, and the authors note surgery time and cost as reported disadvantages.

What it means for a patient

Less swelling and bruising in the first weeks is the measured benefit, seen in most but not all trials.
Pain and damage to the nasal lining were also lower with the powered instrument.
Operating time varied between studies, and the equipment costs more.
Eight trials with 440 patients is a modest evidence base, and no long term appearance or breathing outcomes were compared.

Why this paper matters

Adoption of piezoelectric instruments turns on whether the early recovery benefit justifies the added cost and possible operating time. This review synthesizes the randomized evidence on that question. It does not address whether the final result differs.

Terms

Piezosurgery: cutting bone with a high frequency vibrating instrument.
Osteotomy: a controlled cut in bone so it can be repositioned.
Oedema: swelling from fluid in the tissues.
Ecchymosis: bruising, meaning blood collected under the skin.
Mucosal injury: damage to the lining inside the nose.
Randomized controlled trial: a study assigning treatment by chance to reduce bias.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Piezosurgery use has become increasingly prevalent in osteotomies. Piezoelectric ultrasound waves can cut bone effectively, and some studies have shown reduced post-operative morbidities compared to conventional osteotomies. Oedema and ecchymosis are common complications of rhinoplasty and can impact patient satisfaction, wound healing, and recovery. We aim to provide an up-to-date comparison of post-operative oedema and ecchymosis in piezosurgery and conventional osteotomies. A literature search was conducted using the following online libraries; Pubmed, Cochrane, Science Direct, and ISRCTN (International Standard Randomised Controlled Trial Number). English publications between 2015 and 2020 were included. A systematic review was completed, and a comparison of oedema and ecchymosis in piezosurgery and conventional osteotomies was examined alongside other outcomes such as pain, mucosal injury, and surgery time. Eight randomised controlled trials (RCTs) met our criteria with a combined total of 440 patients: 191 male and 249 female. Piezosurgery had statistically significant (p < 0.05) reduction in short-term oedema compared to conventional osteotomies in 75% of the papers included, and in 50% this persisted across the whole follow-up period. Similarly, ecchymosis scoring was initially statistically lower (p < 0.05) in piezosurgery in 87.5% of the RCTs, and in 75% this persisted across the whole follow-up period. A reduction in pain (p < 0.05) and mucosal injury (p < 0.05) was also seen in piezoelectric osteotomies. The length of surgery time varied. Piezoelectric osteotomies reduce oedema and ecchymosis compared to conventional osteotomies, in addition to improving pain and mucosal injury. However, disadvantages such as length of surgery time and cost have been reported. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).