Comparison of the Effects of Conventional and Piezoelectric Osteotomy on Intracranial Pressure Changes in Rhinoplasty Using Ultrasonographic Measurement of Optic Nerve Sheath Diameter

Gunes A, Karali E, Bicer YO, Yildiz I, Halicioglu S, Gunes NA.

PubMed 41491324 Publisher (DOI)Free full text (PMC)

What this paper says

In 40 randomised patients, hammer-and-chisel osteotomies produced a measurable widening of the optic nerve sheath (an indirect sign of raised pressure inside the skull), whereas piezoelectric osteotomies did not.

Overview

Optic nerve sheath diameter (ONSD) on ultrasound rises when intracranial pressure rises. The authors randomised 40 rhinoplasty patients to conventional (n = 20) or piezoelectric (n = 20) osteotomy and measured ONSD five times: before anaesthesia, after intubation, before hump removal and osteotomy, immediately after osteotomy, and before extubation.

Sections of note

Intubation increased ONSD in both groups.
Conventional group: ONSD rose significantly after osteotomy compared with both post-intubation and pre-osteotomy values (p < 0.001).
Piezo group: no significant change between pre- and post-osteotomy (p = 0.694).
Post-osteotomy and pre-extubation values differed significantly between groups (p < 0.001 and p = 0.011).
Level of Evidence IV.

What it means for a patient

Breaking the nasal bones with a chisel transmitted enough force to produce a transient sign of raised brain pressure in this study; ultrasonic cutting did not.
The clinical importance is unknown; no patient had a neurological problem reported.
It is one more argument, alongside less bruising, for ultrasonic bone work.

Why this paper matters

It is the first study to link osteotomy method to an intracranial pressure surrogate. Limits: 40 patients, surrogate marker rather than direct pressure measurement, no clinical outcomes.

Terms

Osteotomy: a controlled cut or fracture of bone, used to narrow the nasal bones.
Piezoelectric osteotomy: ultrasonic bone cutting that spares soft tissue.
Intracranial pressure (ICP): pressure inside the skull.
Optic nerve sheath diameter (ONSD): the width of the membrane around the optic nerve, measurable by ultrasound through the closed eyelid.
Intubation: placing a breathing tube for general anaesthesia.

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

Abstract

Background: The aim of this study is to compare piezoelectric osteotomy with conventional osteotomy in rhinoplasty using ultrasonographic techniques in terms of ICP and the measurement of the optic nerve sheath diameter (ONDM).

Methodology: A total of 40 patients who underwent rhinoplasty surgery were included in the study. The patients were randomly divided into two groups of 20. Conventional osteotomy was performed in the first group during surgery. Piezoelectric osteotomy was performed in the second group. ONDMs were measured. Prior to anesthesia induction, baseline ONDM was determined as ONDM-1. A total of five measurements were taken: after intubation (ONDM-2), immediately before hump resection and osteotomy (ONDM-3), immediately after osteotomy (ONDM-4), and immediately before extubation (ONDM-5).

Results: ONDM-2 was significantly larger than ONDM-1 in both groups. In group 1, significant differences were found between ONDM-2 and ONDM-4 (p < 0.001) and between ONDM-3 and ONDM-4 (p < 0.001). In the second group, significant differences were observed between ONDM-2 and ONDM-4 (p < 0.001). No significant difference was observed between ONDM-3 and ONDM-4 (p= 0.694). Additionally, significant differences were found between the two groups in terms of ONDM-4 and ONDM-5 values (p < 0.001, p = 0.011).

Conclusion: Both intubation and conventional osteotomy can increase ONDM, suggesting a possible increase in ICP in the conventional osteotomy group. In patients who underwent piezoelectric osteotomy, an increase in ONDM was observed only after intubation. This suggests that piezoelectric osteotomy is safer in terms of ICP.

Level Of Evidence Iv: 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).