Evaluation of the ultrasound osteotomy effectiveness in rhinoplasty
Introduction. Achieving a good result depends on factors such as experience, technique, equipment and methods of surgery. Osteotomy of the nasal bones is an important stage of rhinoplasty and requires careful planning and accurate performance. It is also the most traumatic stage of rhinoplasty. The ability to obtain an accurate osteotomy without serious damage to the soft tissues is a key point in the modern approach to preserving rhinoplasty. One of the obvious and promising areas is osteotomy using an ultrasound device (piezotome). We used the technique of ultrasound osteotomy of the nasal bones over the past 2 years, and 658 operations were performed (primary rhinoplasty and reconstructive repeated rhinoplasty). This article retrospectively analyzes the results of the piezosurgical technique used in rhinoplasty. Material and methods. In the period from January 2018 to October 2019, a retrospective assessment of 658 surgical interventions was performed. All patients included in the study underwent primary or repeated reconstructive rhinoplasty using an osteotomy of the nasal bones with an ultrasound device. All osteotomies were performed directly on the nasal bones with complete detachment of the soft tissues subperiosteally. After soft tissue detachment over the nasal-cartilaginous nose fornix, the mucous membrane of the nasal cavity was detached by tunneling along the bone arch of the nasal pyramid in the projection of the proposed lateral osteotomy line, starting from the Webster triangle. Then, with the help of ultrasound, lateral and transverse osteotomies were performed alternately on both sides with full mobilization of the bone-cartilaginous nose fornix. After the operation, tubular drains were used in all patients along lateral osteotomy lines for 2 days. Also, an external dressing of a hypoallergenic patch and a fixing thermoplate was given to all the patients. The data on the operation itself, intraoperative trauma, postoperative changes were evaluated, namely: the presence of hemorrhages (hematomas) and edema, postoperative complications. Results. In 625 (95%) patients, mild edema and subtle hematomas were observed in some cases, in the remaining 33 (5%) patients, mild or severe edema of the soft tissues of the face in the postoperative region, as well as hematomas, were observed. 645 (98%) people had no complaints of pain, rehabilitation was painless, and there was no need to use painkillers. The average hospital stay was 1 day. Conclusion. We have shown that the use of an ultrasound device makes it possible to carry out accurate, easy and controlled osteotomy of the nasal bones and at the same time has minimal damage to the surrounding soft tissues, which directly affects the easier and faster rehabilitation of patients.