Comparative Histologic Evaluation of Bone Healing Following Piezotome and Osteotome Techniques for Potential Applications in Rhinoplasty.

Rhinoplasty is a technically demanding procedure in which the precision of osteotomy creation directly influences cosmetic and functional outcomes. Traditional osteotomes often produce uncontrolled fracture lines and soft tissue trauma. Piezoelectric devices have been introduced as an alternative. They offer selective cutting of mineralized tissue while sparing surrounding soft tissue structures. Although the clinical benefits of this approach have been well documented, the biological processes defining this technique remain unsettled. The current study aimed to compare the histological changes in bone regeneration and long-term healing outcomes within piezotome-induced and osteotome-induced nasal bone defects in a translational, preclinical ovine model. Bilateral osteotomies were created on the nasal bone of n=12 skeletally mature sheep using a piezoelectric bone-cutting system (Piezotome CUBE, Acteon) or a traditional osteotome. Euthanasia was performed at either 3 or 12 weeks postoperatively (6 defects per group per time point). Histological analysis at 3 weeks postoperatively revealed limited bone ingrowth, followed by substantial bone regeneration in both groups by 12 weeks. Osteotome-treated sites displayed irregular margins and bone debris, while piezotome-treated defects demonstrated cleaner margins and less bony fragmentation. Despite qualitative differences, semi-quantitative scoring of new bone formation showed no statistically significant differences in healing between devices at 3 weeks (p=0.500) or 12 weeks (p=0.125). These findings suggest that although piezoelectric osteotomies may offer advantages in intraoperative precision and early postoperative morbidity, long-term bone regeneration appears comparable to that achieved with conventional osteotomes.