title: Piezotome Rhinoplasty Reduces Postsurgical Morbidity and Enhances Patient Satisfaction: A Multidisciplinary Clinical Study.
abstract: OBJECTIVE
  Experimental and clinical studies in various fields of oral and maxillofacial surgery suggest the use of piezotomes to reduce postsurgical morbidity and enhance healing. The aim of the study was to investigate if rhinoplasty surgery with piezotomes might decrease postsurgical morbidity and increase overall patient satisfaction when compared with rhinoplasty with traditional instruments and protocols.
  
  
  METHODS
  In this prospective clinical study, patients in a cosmetic surgery department, ear-nose-throat (ENT) department, and the department for maxillofacial surgery, scheduled for cosmetic reductive rhinoplasty, underwent rhinoplasty with traditional instruments or an ultrasonic surgical device called a "piezotome." Before rhinoplasty, all patients were evaluated by the Rhinoplasty Outcome Evaluation (ROE) questionnaire. Staging for ecchymosis/edema and for pain was performed on the seventh day after surgery, and at 6 months after surgery, patients were again evaluated by the ROE score. Female and male patients aged between 24 and 57 years were included; patients had to be free of functional impairments of nasal breathing. Data were anonymized and evaluated with SPSS software (version 22.0; IBM, Armonk, NY) (1-way analysis of variance, Games-Howell post hoc test for primary and secondary outcome evaluation, Levene test of equal variances, t test, and Pearson correlation of primary and secondary outcome evaluation).
  
  
  RESULTS
  Eighty-four patients were fully documented by ecchymosis/edema staging, pain staging, and ROE; of these, 51 women and 12 men underwent cosmetic rhinoplasty in a department of plastic and reconstructive surgery; an ENT department; or a department for maxillofacial surgery. A piezotome rhinoplasty was performed in 16 female and 5 male patients. Statistical evaluation verified that there were no significant differences between the three surgical disciplines when a rhinoplasty was performed with traditional instruments (P > .7), but showed that the use of ultrasonic surgical instruments significantly improved immediate postsurgical morbidity in terms of ecchymosis/edema and pain (P < .05), as well as ROE score after 6 months (P < .05). Correlation of ecchymosis/edema and pain with ROE score showed a significant difference (P ≤ .01) in favor of the piezotome.
  
  
  CONCLUSIONS
  The use of ultrasonic surgical devices in reductive rhinoplasty decreases postsurgical morbidity and increases overall patient satisfaction significantly. The results of this study suggest piezotomes to be the surgical instrument of choice not only for oral surgical procedures, but also for cosmetic surgery on facial bones.
authors.affiliation: Visiting Professor, Department of Maxillofacial Surgery and Dentistry, Health Science University Vientiane; Senior Physician, "Krankenhaus Hietzing," Institute for Oral & Maxillofacial Surgery and Dentistry, Vienna, Austria; and Consiliary Specialist in Oral and Maxillofacial Surgery, General Hospital-"Krankenhaus der Barmherzigen Brüder Eisenstadt," Eisenstadt, Austria. Electronic address: dr.troedhan@gmail.com.
authors.forename: Angelo
authors.initials: A
authors.lastname: Troedhan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D059745:Piezosurgery / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*