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.