A comparison of piezosurgery with conventional techniques for internal osteotomy

Graft Paste to Tackle Nasal Dorsal Irregularities: A Comparative, Prospective, Double Blinded Study

BACKGROUND

Preventing dorsal irregularities, especially in noses with high humps, is still a challenging process. Classic treatment with diced grafts may itself result in dorsal irregularities.

OBJECTIVES

It was aimed to investigate the effectiveness of graft paste in preventing and correcting the dorsal irregularities.

METHODS

A total of 60 patients were included in this study. While diced cartilage was used in group A, graft paste was used in group B. Hump heights and collected graft volume were recorded. To evaluate aesthetic outcomes, preoperative and postoperative ROE questionnaire and postoperative physical examination were performed.

RESULTS

Although the hump height of group A (5.9 ± 1.02 mm) was greater than that of group B (5.6 ± 1.15 mm), the collected graft volume in group B was statistically higher (P < 05) (0.26 ± 0.05 cc and 0.16 ± 0.13 cc, respectively). Group B showed higher postoperative ROE scores (84.67 ± 8.9) compared to group A (80.15 ± 7.6). While the mean physical examination score for group A was 1.12 ± 0.96, this value was 0.62 ± 0.71 for group B (P < 05). None of the patients of group B had visible irregularities, but two patients of group A had.

CONCLUSION

The graft paste is a safe and reliable method to prevent and treat the dorsal irregularities. The paste has a soft and cohesive structure which makes it to ideal for filling the irregularities and the dead spaces on the surface of the dorsum. Graft paste was associated with a better aesthetic outcome compared to diced cartilage.

LEVEL OF EVIDENCE I

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 https://www.springer.com/00266 .

Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.

Piezoelectric instrumentation in secondary cleft rhinoplasty: Techniques and clinical experience

INTRODUCTION

Cleft rhinoplasty is a challenging procedure, with precision required to achieve good results. Cases often present with more complex structural and soft tissue asymmetries than non-cleft cases. Piezoelectric instrumentation uses ultrasonic vibrations to cut bone. At certain frequency, it will only cut bone, sparing soft tissue and is reported to decrease postoperative pain, oedema and echymosis. It allows nasal bony work to be performed under direct vision without losing stability of the bony fragments by preserving the underlying periosteum. There is good evidence on the use of piezoelectric instrumentation in cosmetic rhinoplasty; however, none to date has focused exclusively on cleft rhinoplasty. We present a single surgeon experience using piezoelectric instrumentation in cleft rhinoplasty.

METHODS AND PATIENTS

We reviewed the case histories of 21 consecutive patients who had Piezo-assisted cleft rhinoplasty surgery between 2017 and 2021. We present our operative techniques and results of piezoelectric cleft rhinoplasty and compare it with 19 patients undergoing cleft rhinoplasty with conventional instrumentation over the same time period, by the same surgeon.

RESULTS

Piezo-assisted rhinoplasty steps included bony osteotomies, dorsal hump removal, modification of composite cartilage/ ethmoid grafts and instrumentation of the anterior nasal spine. There were no significant complications and no revision surgeries. There was no difference in operative time compared to conventional instruments.

CONCLUSION

Piezoelectric instrumentation is a valuable and efficient tool in cleft rhinoplasty. It offers potentially significant advantages in terms of the precision of bony work, whilst minimising trauma to the surrounding soft tissues.

Piezoelectric Condylectomy Through Transoral Endoscopic Approach: A Cadaveric Study

Surgical approaches in the treatment of TMJ pathologies are a much-debated topic in literature. We propose a new surgical approach performed by intraoral access and completed by endoscopic magnification and long-tip piezosurgery assistance. A piezosurgery (Piezosurgery Plus, Mectron s.p.a. 2014) with a long angled tip (MT5-10 L) was used to perform an endoscopically assisted condylectomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03168-0.

Postoperative Periorbital Edema and Ecchymosis After External Lateral Osteotomy "Comparing Conventional Osteotome and Piezo Scalpel in Rhinoplasty"

The piezo surgery was reported to cause minimal trauma to the soft tissue. The aim of this study was to compare the periorbital edema and ecchymosis after transcutaneous lateral osteotomy in rhinoplasty using 2-mm osteotome versus Piezo scalpel respectively. In a randomized clinical trial and split-mouth-design, we performed primary rhinoplasty in 15 patients (7 men, 8 women; age 18-35 years, mean age 26.6 ± 5.7 years). Transcutaneous lateral osteotomy was performed using a 2-mm osteotome on the one side and a piezo scalpel on the opposite side. We took digital photographs of the face on 1, 3, 7 and 14 postoperative days. Three examiners used a standard 5-point Kara-Gokalan scale to assess the early postoperative periorbital edema and ecchymosis on each side. We found more difficult to use the piezo scalpel via only one incision and found easier to use two stab incisions for inserting the piezo scalpel. The time spend for each osteotomy was similar (P > 0.05). The inter-observer agreement was high (> 0.676). The postoperative edema showed to be significantly different on day 1, 3 and 7 (P-value < 0.05), ecchymosis was much less on piezo side but not significantly. It was more difficult to use piezo scalpel via only one incision. The piezo scalpel showed to reduce the postoperative edema significantly and improved the ecchymosis. Swelling and bleeding could have crossed the midline and blurred the comparison of two sides. However, this is the best design to achieve the highest similarity in study condition. Level of Evidence Level I, therapeutic study.

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

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.

ASSESSMENT OF THE EFFICIENCY OF PIEZOELECTRIC AND CLASSIC OSTEOTOMY WHEN PERFORMING SEPTORHINOPLASTY

OBJECTIVE

The aim: Comparison and analysis of the main intraoperative and postoperative results of piezoelectric and traditional osteotomy in septorhinoplasty.

PATIENTS AND METHODS

Materials and methods: Examination and treatment were carried out in 40 patients who were divided into two groups. The first included patients who underwent septorhinoplasty using a traditional osteotomy - 20 people (control group). In the second group of patients, piezoelectric surgery was used for septorhinoplasty. This research group consisted of 20 people. All patients of both groups underwent only primary septorhinoplasty by closed and open methods. Piezoelectric surgery was performed using a Japanese VarioSurg3 NSK piezotome.

RESULTS

Results: The research was conducted on the first day after surgery, 3 days and a week after treatment. The following indicators were evaluated: intraoperative complications (mucosa damage), postoperative complications: (swelling of the eyelids,periorbital ecchymoses, nasal secretion activity, inflammatory reaction of the nasal cavity, postoperative pain). Significantly fewer cases of mucosal damage were detected in the second study group compared to the first. And the severity of postoperative complications in the second group of patients who underwent septorhinoplasty with the help of a piezotome was statistically significantly (p<0.05) lower than in patients of the control group.

CONCLUSION

Conclusions: Piezoelectric surgery has a number of advantages over traditional osteotomy techniques, such as selectivity of impact on soft tissues, accuracy of bone destruction. Piezoelectric osteotomy during septorhinoplasty can reduce intra- and postoperative complications with statistical reliability.

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

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 .

Closed Piezo Preservation Rhinoplasty

BACKGROUND

The application of piezoelectric instruments (PEIs), which made the work with the nasal pyramid a predictable and controlled stage of rhinoplasty, is still more often related to the open approach. The intranasal approach is constantly associated with standard methods of osteotomies, including percutaneous techniques, which represent certain limitations in working with the bony vault without managing the surface and thickness of its walls and the risk of uncontrolled fractures.

OBJECTIVES

The authors apply PEIs for osteotomies and reshaping of the nasal pyramid through the closed approach with preservation rhinoplasty and complete subperichondrial and subperiosteal dissection.

METHODS

The technique of working with the nasal pyramid using PEIs with the closed approach is described. The patients were grouped according to the methods of nasal pyramid surgery-Push Down (PD), Let Down (LD) with Rhinosculpture (Rs), or the combinations. The results of the surgeries with the application of PEIs on 134 patients were retrospectively analyzed before the surgery and 12 months after it according to the "Rhinoplasty Outcome Evaluation" (ROE).

RESULTS

The average age of the patients was 28, 125 were female and 9 were male. The patients' satisfaction was excellent in 96% of all the cases included. There were two cases with residual humps and four cases with residual asymmetries in cases of severe deviations.

CONCLUSIONS

Via intranasal approach, it is possible to use PEIs for managing the bony vault in primary rhinoplasty. The limitations for this technique are underdevelopment of the nasal dorsum, cleft lip nose situations, post-traumatic and previous rhinoplasty cases.

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 .

The use of piezoelectric instrumentation and platlet rich fibrin matrix in septorhinoplasty: Report of two cases

Introduction. Rhinoplasty is one of the most commonly performed surgeries in the area of aesthetic surgery. Surgical instruments, which are used in traditional rhinoplasty, like saws, chisels and osteotomes are relatively imprecise and their usage can lead to uncontrolled fractures of the bone and consequently to inadequate final results. Piezoelectric-powered ultrasonic instruments (PEI) are currently the most innovative instrumentation available for minimally traumatic reshaping of the bony vault and lateral walls. There are many studies which have shown positive effects of platelet-rich fibrin (PRF) in postoperative course of rhinoplasty patients. Case report. We presented two innovative approaches in rhinoplasty combined PEI and PRF matrix through two case reports. In both patients, satisfying results were achieved by use of PEI technique. Also, usage of PRF membrane provided good healing and small postoperative edema. Conclusion. Based on our experience, the use of of PEI technique has many benefits. It is safe, practical and effective method and it demonstrates valuable and favourable results in osteotomies. Also, usage of PRF membrane helps patients in better healing and less postoperative edema.

Piezosurgery versus Conventional Cutting Techniques in Craniofacial Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery.

METHODS

A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed.

RESULTS

Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, -0.86; 95 percent CI, -1.20 to -0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, -1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, -2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent).

CONCLUSIONS

Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.

A Novel Approach to First-Rib Resection in Neurogenic Thoracic Outlet Syndrome

Objectives: The treatment for neurogenic thoracic outlet syndrome (NTOS) conventionally involves first-rib resection (FRR) surgery, which is quite challenging to perform, especially for novices, and is often associated with postoperative complications. Herein, we report a new segmental resection approach through piezo surgery that involves using a bone cutter, which can uniquely provide a soft tissue protective effect.

Methods: This retrospective study involved the examination of 26 NTOS patients who underwent piezo surgery and another group of 30 patients who underwent FRR using the conventional technique. In the patient group that underwent piezo surgery, the rib was first resected into two pieces using a piezoelectric device and subsequently removed. In the patient group that underwent conventional surgery, the first rib was removed as one piece using a rib cutter and rongeurs.

Results: The piezo surgery group had significantly shorter operative time (96.85 ± 14.66 vs. 143.33 ± 25.64 min, P < 0.001) and FRR duration (8.73 ± 2.11 vs. 22.23 ± 6.27 min, P < 0.001) than the conventional group. The posterior stump length of the residual rib was shorter in the piezo surgery group than in the conventional group (0.54 ± 0.19 vs. 0.65 ± 0.15 cm, P < 0.05). There were no significant differences in postoperative complications and scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Cervical Brachial Symptom Questionnaire (CBSQ), and the visual analog scale (VAS). Even the TOS index (NTOS Index = [DASH + (0.83 × CBSQ) + (10 × VAS)]/3) and patient self-assessments of both the groups showed no significant differences. Univariate analyses indicated that the type of treatment affected operative time.

Conclusion: Our results suggest that piezo surgery is safe, effective, and simple for segmental FRR in NTOS patients. Piezo surgery provides a more thorough FRR without damaging adjacent soft tissues in a relatively short duration and achieves similar functional recovery as conventional techniques. Therefore, piezo surgery can be a promising alternative for FRR during the surgical treatment of NTOS.

Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

OBJECTIVE

Understanding the postoperative dynamics of the nasal soft-tissue envelope (NSTE) is necessary to obtain the desired cosmetic results after rhinoplasty. This study was conducted to determine the changes of NSTE thickness and its effects on periorbital edema and ecchymosis following rhinoplasty.

METHODS

Thirty-five patients who underwent rhinoplasty were included in the study. Nasal skin and subcutaneous tissue thickness at the tip, supratip, rhinion, and nasion were measured using ultrasonography preoperatively and at the postoperative 3rd and 10th months. Periorbital edema and ecchymosis were evaluated at postoperative days 1, 3, and 7. The patients were categorized as the thick NSTE group (n = 17) and the thin NSTE group (n = 18) according to the preoperative median NSTE thickness.

RESULTS

In the thin NSTE group, supratip skin, subcutaneous tissue, and total NSTE thickness were lowest on the preoperative day but no statistically significant difference was found for the thick NSTE group. In the thin NSTE group, total NSTE thickness of the rhinion was highest at the postoperative 3rd month, but in the thick NSTE group, there was no statistically significant difference between postoperative 3rd and 10th months. In both groups, total NSTE thickness of the nasion was highest at the postoperative 3rd month and lowest at the postoperative 10th month.

CONCLUSIONS

Supratip fullness occurs more prominent in patients with thin NSTE. Postoperative edema in the rhinion is greater in patients with thin NSTE for the early postoperative period but it lasts longer in patients with thick NSTE. Soft-tissue envelope atrophy at the nasion occurs in both groups in the late postoperative period. Periorbital edema and ecchymosis severity are not affected by NSTE thickness.

Endoscopic Sphenopalatine Ganglion Block Efficacy in the Management of Periorbital Edema and Ecchymosis After Septorhinoplasty

AIM

This study aims to evaluate the efficacy of sphenopalatine ganglion block (SPGB) on postoperative edema and ecchymosis for the patients undergoing septorhinoplasty (SRP).

METHODS

In the study, a total number of 55 participant patients (40% male and 60% female, aged between 18 and 42 years) undergoing hump resection and osteotomies were allocated into 2 groups. The SPGB (+) group consisted of 27 patients who underwent SPGB, while the SPGB (-) group consisted of 28 patients who underwent SRP without SPGB. On the first, third, and seventh postoperative days (POD1, POD3, POD7), the score marks of periorbital edema and ecchymosis of the patients were evaluated. Additionally, postoperative upper eyelid edema and upper eyelid ecchymosis as well as lower eyelid edema, and lower eyelid ecchymosis on POD1, POD3, POD7 were evaluated. A comparison with regard to intraoperative bleeding, surgical field, and operation time between the 2 groups was also conducted.

RESULTS

Upper eyelid edema, upper eyelid ecchymosis, lower eyelid edema, lower eyelid ecchymosis on POD 1, 3, 7 were found to be significantly lower in SPGB (+) group in comparison to SPGB (-) group (P < 0.001). Intraoperative blood loss and surgical field were found to be significantly lower in SPGB group (+) than in SPGB (-) group (P < 0.00). The operation time was not found statistically significant between the 2 groups (P = 0.212).

CONCLUSION

Sphenopalatine ganglion block is a safe and effective way of reducing postoperative edema and ecchymosis after SRP. Besides, it provides a better surgical field and reduced bleeding intraoperatively.

Surgical Burr-Assisted Lateral Osteotomy Technique in Septorhinoplasty

ABSTRACT

Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Patients who underwent primary open septorhinoplasty were included in the study and were divided into 2 groups. The first group had lateral endonasal osteotomy with conventional guided osteotomes, and the second group had lateral osteotomy with surgical round burr. Edema and ecchymosis scoring systems were used on the postoperative first, third, and seventh day to evaluate postoperative edema and ecchymosis, and the visual analog scale was used to evaluate pain severity on the postoperative period. Out of 70 patients who had undergone septorhinoplasty, 36 received conventional osteotomy and 34 received surgical round burr osteotomy. Periorbital ecchymosis scores were significantly lower in the second group on the postoperative first, third, and seventh days. The periorbital edema scores were significantly lower in the second group on the first postoperative day but no difference was found between postoperative days 3 and 7. Also, the pain scores were significantly lower in the second group. Osteotomy with surgical round burr yields less ecchymosis, edema, and pain in the early postoperative period than conventional osteotomy in primary septorhinoplasty patients.

Effect of Nasal Skin Type on Skin Problems following Rhinoplasty

Skin problems following rhinoplasty may cause dissatisfaction concerning the esthetic expectations of the patients. This study was conducted to determine whether nasal skin type has an effect on skin problems after rhinoplasty. Thirty-five patients undergoing rhinoplasty in our tertiary referral center between May 2018 and August 2019 were included in the study. The nasal skin sebum level was measured with Sebumeter preoperatively and patients were divided into two groups according to the median sebum level. Among the 35 patients, half of them with higher nasal skin sebum were categorized as oily skin group (n = 17; 14 males, 3 females; mean sebum level: 200.3 ± 26.9), and the other half were categorized as dry skin group (n = 18; 10 males, 8 females; mean sebum level: 101.9 ± 38). Periorbital edema and ecchymosis were assessed at postoperative days 1, 3, and 7. Acne and seborrhea severity determined with Global Acne Grading System and Seborrheic Dermatitis Area Severity Index the day before operation and postoperative days 7 and 14 and months 1, 3, and 10. Compared with dry skin group, upper eyelid ecchymosis score at postoperative day 7 was statistically higher in oily skin group (p = 0.044). There was no significant difference in upper eyelid edema scores between postoperative days 1 and 3 for oily skin group (p = 0.020). No statistically significant differences were found for acne and seborrhea severity. Nasal skin sebum levels may affect periorbital edema and ecchymosis after the procedure but no significant effect has been observed for acne and seborrhea. Predicting the effect of nasal skin types on these problems may help the surgeon to inform patients more correctly.

[Comparison of piezoelectric and conventional osteotomy in rhinoplasty : A systematic review]

BACKGROUND

Postoperative periorbital edema and ecchymosis after rhinoplasty are mainly caused by the osteotomy with hammer and chisel. The introduction of piezoelectric surgery could lead to a better early postoperative outcome due to improved preservation of soft tissues. The aim of this systematic review was to evaluate the methods and results of studies comparing conventional osteotomy to piezoelectric osteotomy.

METHODS

A systematic literature search was conducted in the PubMed/MEDLINE and Google Scholar databases. In the primary selection, all studies on the comparison of conventional and piezoelectric osteotomies with regard to postoperative periorbital edema and/or ecchymosis were identified. Secondary selection included only study designs with a control group.

RESULTS

Primary selection resulted in 15 thematically relevant publications with a notable increase in annual publications between 2007 and 2017. Six studies with control groups were selected secondarily. Qualitatively and methodologically, the studies were very heterogeneous. The results of five of the six studies indicated a significant advantage of piezo technology compared to conventional osteotomy. Only in one study was no significant difference found in the investigated postoperative outcome.

CONCLUSION

Piezoelectric osteotomy resulted in a reduced propensity for postoperative edema and ecchymosis compared to the conventional osteotomy technique with a chisel. At this time, the results should be regarded as a trend. A definite recommendation favoring piezoelectric osteotomy cannot be made until more studies with higher patient numbers become available.

Ultrasonic versus conventional gap arthroplasty for the release of ankylosis of temporomandibular joint: a prospective cohort study

The purpose of this study was to compare the clinical outcomes of ultrasonic surgery to the conventional bone cutting technique using bur and saw for the release of ankylosis of temporomandibular joint. We conducted a prospective cohort study on 25 patients with 38 ankylotic joints at Chinese PLA General Hospital from March 01, 2012 to March 01, 2016. Patients were followed up at least 2 years postoperatively. The primary outcome was the intraoperative blood loss per joint. The secondary outcome was the long-term (≥2 years) improvement of maximum mouth opening. The blood loss was significantly reduced in the ultrasonic group compared to the conventional group (107.3 ± 62.3 ml vs. 186.3 ± 92.6 ml, P = 0.019). The long-term improvements of maximum mouth opening were substantial and stable in both groups (33.5 ± 4.8 mm in the ultrasonic group vs. 29.2 ± 6 mm in the conventional group, P = 0.06). Multivariate linear regression analysis showed a significant association between blood loss and technique used (coefficient: 66.3, 95% confidence interval: 22.1,110.4, P = 0.006). The ultrasonic surgery was associated with less intraoperative blood loss when compared to the conventional method for the release of ankylosis of temporomandibular joint while providing a stable and comparable long-term improvement of maximum mouth opening.

Effects of Rhinoplasty on Labyrinthine Function

BACKGROUND

Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations.

OBJECTIVES

To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system.

METHODS

Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation.

RESULTS

On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05).

CONCLUSIONS

Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear.

LEVEL OF EVIDENCE 2

Comparison of edema and ecchymosis in rhinoplasty candidates after lateral nasal osteotomy using piezosurgery and external osteotomy

Rhinoplasty is done with external and endonasal methods. One of the main stages of rhinoplasty in both external and endonasal methods is the lateral nasal osteotomy. Lateral nasal osteotomy is the main cause of edema and ecchymosis after rhinoplasty, which is annoying and unpleasant for patients. Piezosurgery is a new method that uses electronic-ultrasonic waves to perform nasal osteotomies. The aim of this study was to compare of edema and ecchymosis after lateral nasal osteotomy using piezosurgery with external osteotomy in rhinoplasty candidates. In this clinical trial, 66 experimental patients for rhinoplasty surgery were selected from Imam Reza hospital in Tabriz, Iran. After examination, the patients were randomly divided into two groups. One group of patients had lateral nasal osteotomy by using the piezosurgery technique, and the other group had a lateral osteotomy with the conventional method of external subcutaneous. On the third and 7 days after the operation, the level of edema and ecchymosis in the patients were examined as per the Gökalan questionnaire (adopted by Yucel) by two persons who were not aware of the goals of the study, and then, they evaluated and scored the questionnaire. The obtained data were analyzed by the SPSS 19 software. The highest level of edema and ecchymosis was observed 3 days after surgery in both groups. Meanwhile, the findings revealed a significant difference between the two groups in the amount of edema and ecchymosis on day 3 after surgery. Furthermore on day 7, the amount of edema and ecchymosis compared to that of the 3rd day was statistically significant for both groups. In general, in all studied groups, edema, and ecchymosis decreased in 7 days compared to 3 days and also piezosurgery is more promising and effective than osteotomy.