Piezoelectric Osteotomy versus Conventional Osteotomy in Rhinoplasty: A Systematic Review and Meta-analysis

Khajuria A, Krzak AM, Reddy RK, Lai K, Wignakumar T, Rohrich RJ.

PubMed 36448013 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 10 studies covering 554 patients, piezoelectric bone cutting produced significantly less swelling, bruising and pain than conventional chisels, with no difference in operating time.

Overview

Previous systematic reviews of piezoelectric bone cutting were of critically low quality, so the authors conducted a higher quality review and meta analysis. The protocol was registered in advance. MEDLINE, Embase, Web of Science and CENTRAL were searched for studies comparing piezoelectric against conventional osteotomes and reporting at least one clinical or patient reported outcome. Methodological quality and risk of bias were formally assessed.

Sections of note

Systematic review and meta analysis; 10 of 347 articles included, nine randomized controlled trials and one prospective cohort, covering 554 patients.
Swelling was significantly reduced with piezoelectric cutting, standardized mean difference minus 0.67, P less than 0.0004.
Bruising was significantly reduced, standardized mean difference minus 0.93, P less than 0.00001.
Pain was significantly reduced, standardized mean difference minus 1.48, P less than 0.00001.
Odds of injury to the nasal lining were significantly lower, odds ratio 0.06, P equals 0.01.
There was no difference in duration of the bone cutting step, P equals 0.22, or total procedure duration, P equals 0.31.
Only one study reported patient reported outcomes, favouring piezoelectric cutting.
The authors describe the support as weak because the underlying evidence is of low quality.

What it means for a patient

The measured advantages are all in early recovery: less swelling, less bruising and less pain.
Injury to the nasal lining during bone cutting was far less likely with the powered instrument.
The operation did not take longer despite the different instrument.
Only one included study asked patients themselves, so the patient perspective is barely represented.

Why this paper matters

Piezoelectric instruments cost more and require different training, and the case for them rests on early recovery. This is the highest quality synthesis of that evidence, and it finds real but modestly supported benefits. Long term appearance and breathing outcomes were not addressed.

Terms

Piezoelectric osteotome: a powered instrument that cuts bone with high frequency vibration.
Conventional osteotome: a hand chisel used to cut bone.
Standardized mean difference: a pooled measure of effect size across studies using different scales.
Odds ratio: how much more or less likely an event is in one group than another.
GRADE: a system for rating the certainty of evidence.
Mucosal injury: damage to the lining inside the nose.

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

Abstract

Unlabelled: Previous systematic reviews evaluating piezoelectric osteotomy are of critically low quality. We conducted a high-quality systematic review and meta-analysis to evaluate outcomes for piezoelectric versus conventional osteotomy.

Methods: The study protocol was published a priori (PROSPERO: CRD42021287877). MEDLINE, Embase, Web of Science, and CENTRAL were searched for studies comparing piezoelectric versus conventional osteotomes and reporting at least one outcome of interest (clinical or patient-reported outcomes, PROs). Methodological quality and risk of bias were assessed using GRADE and Cochrane's RoB-2/ROBINS-I tools, respectively. Random effects models were applied.

Results: Of 347 articles, 10 studies (nine randomized controlled trials; one prospective cohort study) including 554 patients were included. Piezoelectric osteotomy was associated with significantly reduced edema [standardized mean difference (SMD), -0.67; 95% confidence interval (CI), -1.03 to -0.30; P < 0.0004], ecchymosis (SMD, -0.93; 95% CI, -1.13 to -0.73; P < 0.00001), and pain (SMD, -1.48; 95% CI, -2.07 to -0.88; P < 0.00001) compared with standard osteotomy. Odds of mucosal injury were significantly lower following piezoelectric osteotomy (odds ratio, 0.06; 95% CI, 0.01 to 0.52; P = 0.01). There was no difference in duration of osteotomy (SMD, 3.15; 95% CI, -1.82 to 8.12; P = 0.22) or total procedure duration (SMD, 0.46; 95% CI, -0.43 to 1.36; P = 0.31). One study reported PROs, favoring piezoelectric osteotomy.

Conclusion: This systematic review and meta-analysis provides support (albeit weak, due to low-quality evidence) for piezoelectric over conventional osteotomy, for reducing morbidity in the early postoperative period. High-quality level I data reporting PROs will optimize shared decision-making/informed consent.

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