Postoperative periorbital edema and ecchymosis after rhinoplasty are mainly caused by osteotomies with hammer and chisel. Piezoelectric surgery could lead to a decreased postoperative morbidity due to improved preservation of soft tissues in comparison to conventional osteotomies. The aim of this systematic review was to evaluate the methods and results of studies comparing a conventional osteotomy with a piezoelectric osteotomy relative to postoperative morbidity.
A systematic literature search was conducted using PubMed/MEDLINE and Google Scholar. All studies related to the comparison of conventional and piezolectric osteotomies with regard to postoperative periorbital edema and/or ecchymosis were identified (primary selection). In a further step, only study designs with a control group were evaluated and compared (secondary selection).
A total of 15 thematically relevant publications were identified in the primary selection. Between 2007 and 2017, a notable increase in yearly published articles was recorded. Six studies with control groups were selected secondarily. Qualitatively and methodologically, the studies were heterogeneous. The results of five of the six studies indicated a significant advantage of the use of piezo technology compared to conventional osteotomy. Only in one study no significant difference in the postoperative outcome was found.
According to the analyzed literature piezoelectric osteotomy resulted in a reduced propensity to postoperative edema and ecchymosis compared to the conventional osteotomy technique with a chisel. At this time the results should be regarded as a trend. However, a definite recommendation favoring piezoelectric osteotomy cannot be made until more studies with higher patient numbers become available.
