Radiological Comparison of Piezosurgery and Classical Osteotomies in Rhinoplasty

Kandemir S, Özdemir A, Caner LN, Deniz BK, Bayar Muluk N, Taş BM, Şencan Z, Cömert E.

PubMed 40908317 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 30 piezo and 30 chisel osteotomies on scans, appearance outcomes were equal, breathing scores were better with piezo, but the piezo cut line ran closer to the tear duct canal.

Overview

The authors compared radiological measurements and outcome scores in 60 rhinoplasty patients, half done with a piezoelectric device and half with a classical osteotome. Before and after surgery they measured nasofrontal angle, nasal bone length, pyramidal angle at root and tip, and the shortest distance from the fracture line to the nasolacrimal canal, plus NOSE and ROE scores.

Sections of note

Groups matched for age, sex and follow-up; operative time was longer with piezo (p < 0.001).
ROE (satisfaction) was similar between groups before and after surgery.
Postoperative NOSE was significantly lower (better) in the piezo group (p = 0.004).
Nasofrontal and pyramidal angles did not differ; postoperative nasal bone length was shorter with piezo (p < 0.001).
Distance from fracture line to nasolacrimal canal was shorter with piezo on both sides (right p = 0.025; left p = 0.010). Level of Evidence II.

What it means for a patient

Both methods produced the same aesthetic result by scan and by satisfaction score.
Breathing scores were better after piezo in this study.
The piezo cut ran nearer the tear duct, which the authors flag as a reason for caution about tearing or duct injury.

Why this paper matters

It uses imaging to compare the two bone-cutting methods and raises a new safety consideration about the lacrimal canal. Limits: 60 patients, follow-up interval not stated in the abstract, no lacrimal complications actually reported.

Terms

Piezosurgery: ultrasonic bone cutting.
Osteotome: a chisel used to cut nasal bone.
Nasolacrimal canal: the bony channel carrying tears from the eye to the nose.
Nasofrontal angle: the angle between the forehead and the bridge.
Pyramidal angle: the angle of the nasal bones seen from the front, measured on CT.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Objective: The aim of this study is to compare the radiological measurements of patients who underwent rhinoplasty using a piezo device with those of patients who underwent rhinoplasty using a classical osteotome.

Methods: A total of 60 patients were included in the study: 30 rhinoplasty patients who underwent piezosurgical osteotomy and 30 who underwent classical osteotomy. Preoperative and postoperative functional and aesthetic outcomes were compared using NOSE and ROE scores. Four anthropometric parameters were measured radiologically before and after surgery: nasofrontal angle (NFA), nasal bone length (NL), pyramidal angle (PA) and the closest distance between the nasolacrimal canal and the rhinoplasty fracture line (N-R). The pyramidal angle (PA) was measured separately at two levels: at the nasal root (PA-R) and at the tip of the nasal bone (PA-T).

Results: The two groups were similar in terms of age, gender, and follow-up period (p > 0.05). The operative time was significantly longer in the Piezo group (p < 0.001). Preoperative and postoperative ROE values, as well as preoperative NOSE values, were comparable between the two groups (p > 0.05). However, postoperative NOSE values were statistically significantly lower in the Piezo group compared to the Osteotome group (p = 0.004). Surgery significantly affected both NOSE and ROE values in each group (p < 0.001). No statistically significant differences were found between the groups in terms of preoperative and postoperative NFA, PA-R, and PA-T values (p > 0.05). Preoperative NL values were also similar between the groups; however, postoperative NL values were significantly shorter in the Piezo group (p < 0.001). A statistically significant difference was observed in both right and left side N-R values between the groups (right: p = 0.025; left: p = 0.010), with the N-R distance being shorter in the Piezo group.

Conclusion: The long-term aesthetic outcomes of the piezosurgery and conventional osteotomy groups were similar; however, the piezosurgery group demonstrated better functional results. The safe margin for the nasolacrimal canal was narrower when osteotomy was performed using piezosurgery. This finding warrants caution regarding potential complications in the lacrimal system.

Level Of Evidence Ii: 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).