Combining Piezo and Power Tools for a Better Outcome in Hybrid Structural-Preservation Rhinoplasty.

Introduction: Over the past decade, rhinoplasty has seen an unprecedented evolution in concepts, techniques and tools. New concepts have led to new techniques, prevalently but not exclusively related to preservation rhinoplasty, and the use of new tools has made such techniques easier, more precise and thus better reproducible. Power tools can presently be considered only relatively new, while Piezo has gained great popularity over the last years.
Materials and Method: This article is focused on how power tools (diverse burrs with specific spherical, cylindrical, conical, discoid tips) can be integrated efficiently together with the use of Piezo and its different inserts in a logical and effective manner.
Discussion: This combination should be implemented in a progressive fashion into specific steps of surgery, although, in general, burrs should be used for reshaping and piezo for cutting bone. Specific and notable exceptions to this rule will be mentioned in the paper. Obviously, cost should be considered, but the benefits are evident: heightened control, reduced asymmetries, smoother bony and middle vault contour, and a more precise management of septum and turbinates. We have come to this conclusion following the combined experience of the two centers participating in the study, with over 350 patients over the last three years.
Conclusions: The article focuses on the modified dorsal split preservation hybrid rhinoplasty favored by the senior author, but its principles will easily apply to any structural, preservation, or hybrid rhinoplasty.
Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Competing Interests: Declarations. Conflict of interest: All the authors declare that they have no conflict of interest to disclose. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed Consent: A written informed consent to participate in the study and having their data and photographs published in the journal was obtained from all participants.
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