The Effect of Piezoelectric (Piezo) Versus Classic Lateral Osteotomy on the Lacrimal Drainage System (LDS): A Retrospective, Single-Center, Controlled Study
Medicina (Lithuania), cilt.61, sa.11, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 61 Sayı: 11
- Basım Tarihi: 2025
- Doi Numarası: 10.3390/medicina61111979
- Dergi Adı: Medicina (Lithuania)
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
- Anahtar Kelimeler: dacryocystorhinostomy (DCR), epiphora, fluorescein dye disappearance test, lacrimal drainage system, nasolacrimal duct, piezoelectric osteotomy, rhinoplasty
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background and Objectives: Lateral osteotomies in rhinoplasty run adjacent to the lacrimal drainage system (LDS), risking postoperative tearing. Piezoelectric (piezo) devices enable precise bone cuts that may reduce LDS trauma. We compared the 1-month incidence of objective lacrimal dysfunction after piezo versus classic osteotomy. Materials and Methods: Retrospective, single-center controlled cohort (1 January 2024–1 January 2025) at a tertiary ENT clinic. Consecutive patients aged 19–45 with pre-operative paranasal sinus CT and no prior lacrimal disorder were grouped by osteotomy technique (piezo vs. classic; n = 65 per arm). Assessments were performed at postoperative day 7–10 and at 1, 3, and 6–12 months. The primary endpoint was 1-month objective lacrimal dysfunction, defined as fluorescein dye disappearance test (FDDT) grade ≥1 or reflux/resistance on irrigation plus symptoms (Munk ≥2). Pre-specified statistical tests were used. Results: Early tearing favored piezo. At week 1, epiphora occurred in 32.3% with piezo versus 46.1% with classic (p = 0.041); by month 6, rates were 4.6% versus 15.1% (p = 0.031). Differences at months 1 and 3 also favored piezo but were not statistically significant (p = 0.062 and p = 0.088). FDDT positivity was lower with piezo at week 1 (23.0% vs. 38.4%, p = 0.045) and month 6 (3.0% vs. 10.7%, p = 0.048). Irrigation obstruction was less frequent with piezo at week 1 (7.6% vs. 21.5%, p = 0.026), but groups converged by months 1 (15.4% vs. 12.3%, p = 0.80) and 3 (6.2% vs. 4.6%, p > 0.99). Punctum stenosis/occlusion remained uncommon in both groups without significant differences. Conclusions: Piezo-assisted lateral osteotomy is associated with less early lacrimal dysfunction and lower 6-month epiphora compared with the classic technique. Convergence of irrigation findings by 1–3 months suggests postoperative edema as the dominant transient mechanism. Given the retrospective, single-center design and low event rates, multicenter prospective studies powered for early LDS outcomes are warranted.