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Vergleich von piezoelektrisch assistierter und konventioneller Osteotomie bei der Rhinoplastik

Ein systematisches Review

Comparison of piezoelectric and conventional osteotomy in rhinoplasty

A systematic review

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Zusammenfassung

Hintergrund

Bei der Rhinoplasik werden postoperative periorbitale Ödeme und Ekchymosen v. a. durch die konventionelle nasale Osteotomie mit Hammer und Meißel verursacht. Möglicherweise führt die Piezochirurgie zu einem verbesserten frühpostoperativen Verlauf durch Schonung des Weichgewebes. Ziel dieser Arbeit war eine systematische Übersicht über Methoden und Ergebnisse von Studien zum Vergleich einer konventionellen mit einer piezoelektrischen Osteotomie.

Methoden

Es erfolgte eine systematische Literaturrecherche in den elektronischen Datenbanken PubMed/MEDLINE und Google Scholar. Bei der primären Selektion wurden alle Studien über den Vergleich konventioneller und piezoelektrischer Osteotomie hinsichtlich postoperativer periorbitaler Ödeme und/oder Ekchymosen erfasst. Die sekundäre Selektion umfasste nur Publikationen mit einer Kontrollgruppe.

Ergebnisse

Die primäre Selektion ergab 15 thematisch relevante Publikationen mit deutlicher Zunahme an jährlichen Veröffentlichungen zwischen 2007 und 2017. Es wurden 6 Studien mit Kontrollgruppen sekundär selektiert, die qualitativ und methodisch sehr heterogen waren. Die Ergebnisse von 5 der 6 Studien wiesen auf einen deutlichen Vorteil der Piezotechnik im Vergleich zur konventionellen Osteotomie hin. Nur in einer Studie wurde kein signifikanter Unterschied bezüglich des untersuchten Ergebnisses festgestellt.

Schlussfolgerung

Nach piezoelektrischer Osteotomie fand sich eine geringere Neigung zu postoperativer Ödembildung und Ekchymose als bei konventioneller Osteotomietechnik. Derzeit sollten die Ergebnisse als Trend interpretiert werden. Eine abschließende Empfehlung zur Überlegenheit einer Methode kann erst bei Vorliegen von mehr Studien mit größeren Patientenzahlen erfolgen.

Abstract

Background

Postoperative periorbital edema and ecchymosis after rhinoplasty are mainly caused by the osteotomy with hammer and chisel. The introduction of piezoelectric surgery could lead to a better early postoperative outcome due to improved preservation of soft tissues. The aim of this systematic review was to evaluate the methods and results of studies comparing conventional osteotomy to piezoelectric osteotomy.

Methods

A systematic literature search was conducted in the PubMed/MEDLINE and Google Scholar databases. In the primary selection, all studies on the comparison of conventional and piezoelectric osteotomies with regard to postoperative periorbital edema and/or ecchymosis were identified. Secondary selection included only study designs with a control group.

Results

Primary selection resulted in 15 thematically relevant publications with a notable increase in annual publications between 2007 and 2017. Six studies with control groups were selected secondarily. Qualitatively and methodologically, the studies were very heterogeneous. The results of five of the six studies indicated a significant advantage of piezo technology compared to conventional osteotomy. Only in one study was no significant difference found in the investigated postoperative outcome.

Conclusion

Piezoelectric osteotomy resulted in a reduced propensity for postoperative edema and ecchymosis compared to the conventional osteotomy technique with a chisel. At this time, the results should be regarded as a trend. A definite recommendation favoring piezoelectric osteotomy cannot be made until more studies with higher patient numbers become available.

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Authors and Affiliations

  1. HNO-Zentrum Rhein-Neckar, Stresemannstraße 22, 68167, Mannheim, Deutschland

    M. Wähmann & F. Riedel

  2. HNO-Praxis Am Hanse-Viertel, Hamburg, Deutschland

    M. Kovacevic

  3. Klinik für Hals-Nasen-Ohrenkrankheiten & Kopf-Hals-Chirurgie, Charite – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    A. Hopf & A. E. Albers

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  1. M. Wähmann
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Correspondence to M. Wähmann.

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M. Wähmann, F. Riedel, M. Kovacevic, A. Hopf und A.E. Albers geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wähmann, M., Riedel, F., Kovacevic, M. et al. Vergleich von piezoelektrisch assistierter und konventioneller Osteotomie bei der Rhinoplastik. HNO 67, 98–109 (2019). https://doi.org/10.1007/s00106-018-0606-2

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