Advances in Rhinoplasty—Piezoelectric Nasal Osteotomy

The Background

A piezotome is an electrically powered ultrasonic tool that delivers rapid and controlled cutting of bone ( Fig. 30.1 ; Video 30.1). It has been available to dentists, maxillofacial surgeons, and neurosurgeons for dental and craniofacial osteotomy, but also more recently to otolaryngologists and plastic surgeons for burring or osteotomy of nasal bones during rhinoplasty. The ultrasonic tool has a variety of cutting tips to suit the fracture required ( Fig. 30.2 ). Due to heat being produced during the osteotomy, a fluid delivery system is an integral part of the machine that helps to cool the tissues to an optimum temperature. The piezotome fracture technique is noted for its reduction in collateral soft tissue injury compared to alternative methods, although there are some concerns about the amount of dissection required to enable the tool to gain access for simple infracture using a closed approach. Although the nasal bony hump can be reduced with the piezotome with closed rhinoplasty, an open rhinoplasty with wide exposure of the dorsal bony vault is the optimal approach, especially if tip work, spreader flaps, or spreader grafts are required.