Powered versus Cold Instruments in Rhinoplasty: A Perspective

Overview

The author states rhinoplasty surgeons must continually refine their results, whether through new techniques, different medications around the time of surgery, or new technology. Piezoelectric osteotomes have recently gained popularity as a powered alternative to the traditional chisel. The article provides a history of both, reviews the most recent data on the powered version, and offers a framework for weighing the two.

Sections of note

• Perspective article; the abstract reports no patient numbers of its own, no rates and no follow up.
• Piezoelectric osteotomes are described as a powered alternative to the traditional chisel osteotome.
• The article gives a history of both instruments.
• It reviews the most recent data surrounding piezoelectric osteotomy.
• It provides a framework for comparing the advantages and disadvantages of each option.
• No specific data or conclusion favouring either instrument is stated in the abstract.

What it means for a patient

• The bone cuts that narrow the nose can be made with a hand chisel or with a vibrating powered instrument.
• Powered instruments cut bone while sparing the surrounding soft tissue, which is the basis for claims of less bruising.
• The article presents both sides rather than recommending one.
• No outcome figures appear in the abstract.

Why this paper matters

Bone cutting technique has changed more in the past decade than in the preceding fifty years, and surgeons are deciding whether to adopt powered instruments. This article assembles the history and the current evidence for that decision. It draws no conclusion of its own.

Terms

• Osteotomy: a controlled cut in bone so it can be repositioned.
• Osteotome: a chisel used to cut bone.
• Piezoelectric osteotome: a powered instrument that cuts bone with high frequency vibration.
• Cold instrument: a non powered hand instrument such as a chisel.
• Perioperative: relating to the period around the time of surgery.