RİNOPLASTİ AMELİYATLARINDA PİEZOELEKTRİK YARDIMLI OSTEOTOMİ VE KONVANSİYONEL OSTEOTOMİLERİN PERİORBİTAL ÖDEM VE EKİMOZ ÜZERİNE ETKİSİ

Yıl 2025, Cilt: 58 Sayı: 3, 115 - 119, 24.02.2026

Güven Ozan Kaplan , Rabia Yudum Somuncu , Mert Çalış

https://izlik.org/JA29SJ67WM

Öz

ÖZET
Amaç: Rinoplasti cerrahisinden sonra en sık karşılaşılan morbiditelerden olan periorbital ödem ve ekimoz, hastaların iyileşme sürecini uzatmakta ve estetik memnuniyeti olumsuz etkilemektedir. Bu çalışmada, piezoelektrik yardımlı osteotomi ile konvansiyonel osteotomi yöntemlerinin postoperatif ödem, ekimoz ve osteotomi süresi üzerindeki etkilerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: 2023–2025 yılları arasında aynı cerrah tarafından primer rinoplasti uygulanan 80 hastanın verileri retrospektif olarak analiz edilmiştir. Hastalar uygulanan osteotomi yöntemine göre iki gruba ayrılmıştır: piezoelektrik osteotomi (n=40) ve konvansiyonel osteotomi (n=40). Her iki grupta da osteotomi süreleri kaydedilmiş; postoperatif 2. ve 7. günlerde periorbital ödem ve ekimoz skorları, osteotomi yönteminden habersiz ikinci bir cerrah tarafından standart sınıflamalar kullanılarak değerlendirilmiştir.
Bulgular: Çalışmaya dahil edilen 80 hastanın 19’u (%23.75) erkek, 61’i (%76.25) kadındı. Piezoelektrik osteotomi grubunda postoperatif 2. ve 7. günlerde ödem ve ekimoz skorları, konvansiyonel osteotomi grubuna göre anlamlı düzeyde daha düşüktü (p<0.001). Ancak piezoelektrik osteotomi süresi, konvansiyonel tekniğe kıyasla anlamlı şekilde daha uzundu (13 dk vs. 5 dk, p<0.001). Her iki grupta da zamanla ödem ve ekimozda azalma gözlenmiş olup, konvansiyonel grupta ödemdeki azalma hızı piezoelektrik gruba kıyasla daha fazlaydı (p=0.0377), ancak ekimozda bu fark anlamlı değildi (p=0.955).
Sonuç: Piezoelektrik yardımlı osteotomi, konvansiyonel yönteme kıyasla postoperatif dönemde daha düşük ödem ve ekimoz ile ilişkilidir. Osteotomi süresindeki uzamaya rağmen morbiditeyi azaltma potansiyeli göz önüne alındığında, piezoelektrik yöntem rinoplastide güvenli ve etkili bir alternatiftir.

Anahtar Kelimeler

rinoplasti , ödem , ekimoz , osteotomi

THE EFFECT OF PIEZOELECTRIC-ASSISTED AND CONVENTIONAL OSTEOTOMIES ON PERIORBITAL EDEMA AND ECCHYMOSIS İN RHINOPLASTY SURGERY

https://izlik.org/JA29SJ67WM

Öz

ABSTRACT
Objective: Postoperative periorbital edema and ecchymosis are among the most common morbidities following rhinoplasty, negatively affecting both recovery time and patient satisfaction. This study aims to compare piezoelectric-assisted osteotomy and conventional osteotomy techniques in terms of their effects on postoperative edema, ecchymosis, and osteotomy duration.
Materials and Methods: A total of 80 patients who underwent primary rhinoplasty by the same surgeon between 2023 and 2025 were retrospectively evaluated. Patients were divided into two groups based on the osteotomy technique: piezoelectric osteotomy (n=40) and conventional osteotomy (n=40). In both groups, osteotomy durations were recorded. Postoperative periorbital edema and ecchymosis were assessed on days 2 and 7 using validated scoring systems by an independent plastic surgeon who was blinded to the osteotomy technique.
Results: Among the 80 patients included to the study, 19 (23.75%) were male and 61 (76.25%) were female. The piezoelectric group exhibited significantly lower edema and ecchymosis scores on both postoperative days 2 and 7 compared to the conventional group (p<0.001). However, the osteotomy duration was significantly longer in the piezoelectric group, with a median of 13 minutes compared to 5 minutes in the conventional group (p<0.001). Both groups showed a reduction in edema and ecchymosis over time. The rate of edema reduction was significantly faster in the conventional group (p=0.0377), whereas the decrease in ecchymosis did not significantly differ between groups (p=0.955).
Conclusion: Piezoelectric-assisted osteotomy is associated with reduced postoperative periorbital morbidity, despite requiring a longer operative time. Considering its benefits in minimizing edema and ecchymosis, it presents a safe and effective alternative to conventional osteotomy techniques in rhinoplasty surgery.

Anahtar Kelimeler

rhinoplasty , edema , ecchymosis , osteotomy

Kaynakça

• KAYNAKLAR 1. Pribitkin EA, Lavasani LS, Shindle C, Greywoode JD. Sonic rhinoplasty: sculpting the nasal dorsum with the ultrasonic bone aspirator. Laryngoscope. Aug 2010;120(8):1504-7. doi:10.1002/ lary.20980
• 2. Kara CO, Gökalan I. Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plast Reconstr Surg. Dec 1999;104(7):2213-8. doi:10.1097/00006534-199912000-00041
• 3. Yücel OT. Which type of osteotomy for edema and ecchymosis: external or internal? Ann Plast Surg. Dec 2005;55(6):587- 90. doi:10.1097/01.sap.0000185396.94875.4a
• 4. Noguchi K, Gel YR, Brunner E, Konietschke F. nparLD: An R Software Package for the Nonparametric Analysis of Longitudinal Data in Factorial Experiments. Journal of Statistical Software. 09/18 2012;50(12):1 - 23. doi:10.18637/jss.v050.i12
• 5. Taşkın Ü, Batmaz T, Erdil M, Aydın S, Yücebaş K. The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty. Eur Arch Otorhinolaryngol. Feb 2017;274(2):861-865. doi:10.1007/s00405-016-4306-9
• 6. Labanca M, Azzola F, Vinci R, Rodella LF. Piezoelectric surgery: twenty years of use. Br J Oral Maxillofac Surg. Jun 2008;46(4):265-9. doi:10.1016/j.bjoms.2007.12.007
• 7. Saedi B, Sadeghi M, Fekri K. Comparison of the effect of corticosteroid therapy and decongestant on reducing rhinoplasty edema. Am J Rhinol Allergy. Jul-Aug 2011;25(4):e141-4. doi:10.2500/ajra.2011.25.3601
• 8. Yosry M, Othman IS. Controlled hypotension in adults undergoing choroidal melanoma resection: comparison between the efficacy of nitroprusside and magnesium sulphate. Eur J Anaesthesiol. Nov 2008;25(11):891-6. doi:10.1017/s0265021508004584
• 9. Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg. Jul 2007;120(1):271-274. doi:10.1097/01.prs.0000264397.80585.bd
• 10. Kienstra MA, Gassner HG, Sherris DA, Kern EB. A Grading System for Nasal Dorsal Deformities. Archives of Facial Plastic Surgery. 2003;5(2):138-143. doi:10.1001/archfaci.5.2.138
• 11. Kiliç C, Tuncel Ü, Cömert E, Şencan Z. Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis. J Craniofac Surg. Jul 2015;26(5):e430-3. doi:10.1097/scs.0000000000001885
• 12. Murakami CS, Larrabee WF. Comparison of osteotomy techniques in the treatment of nasal fractures. Facial Plast Surg. Oct 1992;8(4):209-19. doi:10.1055/s-2008-1064652
• 13. Rohrich RJ, Minoli JJ, Adams WP, Hollier LH. The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg. Apr 1997;99(5):1309-12; discussion 1313. doi:10.1097/00006534-199704001-00015
• 14. Giacomarra V, Russolo M, Arnez ZM, Tirelli G. External osteotomy in rhinoplasty. Laryngoscope. Mar 2001;111(3):433-8. doi:10.1097/00005537-200103000-00011
• 15. Sinha V, Gupta D, More Y, Prajapati B, Kedia BK, Singh SN. External vs. internal osteotomy in rhinoplasty. Indian J Otolaryngol Head Neck Surg. Mar 2007;59(1):9-12. doi:10.1007/s12070-007- 0002-9
• 16. Caglar E, Celebi S, Topak M, Develioglu NO, Yalcin E, Kulekci M. How can periorbital oedema and ecchymose be reduced in rhinoplasty? Eur Arch Otorhinolaryngol. Sep 2016;273(9):2549- 54. doi:10.1007/s00405-016-3907-7
• 17. Kara CO, Kara IG, Topuz B. Does creating a subperiosteal tunnel influence the periorbital edema and ecchymosis in rhinoplasty? J Oral Maxillofac Surg. Aug 2005;63(8):1088-90. doi:10.1016/j.joms.2005.04.008
• 18. Robiony M, Polini F, Costa F, Toro C, Politi M. Ultrasound piezoelectric vibrations to perform osteotomies in rhinoplasty. J Oral Maxillofac Surg. May 2007;65(5):1035-8. doi:10.1016/j. joms.2005.11.082
• 19. Robiony M, Polini F, Costa F, Zerman N, Politi M. Ultrasonic bone cutting for surgically assisted rapid maxillary expansion (SARME) under local anaesthesia. Int J Oral Maxillofac Surg. Mar 2007;36(3):267-9. doi:10.1016/j.ijom.2006.08.013
• 20. Kisel J, Khatib M, Cavale N. A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review. Aesthetic Plast Surg. Jun 2023;47(3):1144-1154. doi:10.1007/s00266-022- 03100-5
• 21. Koc B, Koc EA, Erbek S. Comparison of clinical outcomes using a Piezosurgery device vs. a conventional osteotome for lateral osteotomy in rhinoplasty. Ear Nose Throat J. Aug 2017;96(8):318- 326. doi:10.1177/014556131709600819
• 22. Ghavimi MA, Nezafati S, Yazdani J, et al. Comparison of edema and ecchymosis in rhinoplasty candidates after lateral nasal osteotomy using piezosurgery and external osteotomy. J Adv Pharm Technol Res. Jul-Sep 2018;9(3):73-79. doi:10.4103/japtr. JAPTR_294_18
• 23. Aydoğdu I, Bayram AA. Comparison of Early and LongTerm Effects of Piezosurgery With Conventional Techniques for Osteotomies in Rhinoplasty. J Craniofac Surg. Sep 2020;31(6):1539- 1543. doi:10.1097/scs.0000000000006337
• 24. Tirelli G, Tofanelli M, Bullo F, Bianchi M, Robiony M. External osteotomy in rhinoplasty: Piezosurgery vs osteotome. Am J Otolaryngol. Sep-Oct 2015;36(5):666-71. doi:10.1016/j.amjoto.2015.05.006
• 25. Fallahi HR, Keyhan SO, Fattahi T, Mohiti AK. Comparison of Piezosurgery and Conventional Osteotomy Post Rhinoplasty Morbidities: A Double-Blind Randomized Controlled Trial. J Oral Maxillofac Surg. May 2019;77(5):1050-1055. doi:10.1016/j. joms.2019.01.004
• 26. Koçak I, Doğan R, Gökler O. A comparison of piezosurgery with conventional techniques for internal osteotomy. Eur Arch Otorhinolaryngol. Jun 2017;274(6):2483-2491. doi:10.1007/ s00405-017-4514-y
• 27. Ghassemi A, Prescher A, Talebzadeh M, Hölzle F, Modabber A. Osteotomy of the nasal wall using a newly designed piezo scalpel--a cadaver study. J Oral Maxillofac Surg. Dec 2013;71(12):2155.e1-6. doi:10.1016/j.joms.2013.07.028
• 28. Sowerby L, Kim LM, Chow W, Moore C. Intra-operative nasal compression after lateral osteotomy to minimize post-operative Peri-orbital ecchymosis and edema. J Otolaryngol Head Neck Surg. Oct 16 2019;48(1):50. doi:10.1186/s40463-019-0370-7
• 29. Bouhadana G, ElHawary H, Alam P, Gilardino MS. A Procedure and Complication-Specific Assessment of Smoking in Aesthetic Surgery: A Systematic Review and Meta-Analysis. Plast Surg (Oakv). Feb 2024;32(1):115-126. doi:10.1177/22925503221085083