Piezosurgery Versus Conventional Osteotomy in Prelacrimal Approach for Maxillary Sinus

The prelacrimal recess approach (PLA) is a minimally invasive approach to maxillary sinus lesions, especially those of the anterior and inferior wall. Innovative advances, for example, the piezosurgery ultrasonic device (PZD), have been developed aiming at facilitating surgical procedures in terms of efficient hemostasis, dissection, safety, and reduction in surgical time. The current study aimed to evaluate the efficacy of piezosurgery versus conventional osteotomy while performing a prelacrimal approach.

A prospective randomized controlled study was conducted in the Otorhinolaryngology Department, Mansoura University, Egypt on 40 patients diagnosed with different maxillary sinus pathologies amenable to a prelacrimal approach. Patients were randomly allocated into two groups: Group A underwent piezosurgery while conventional osteotomy was used in Group B.

Operative time was significantly higher in the PZD group (16.30 ± 2.16 vs. 9.05 ± 1.88; p = 0.001) whereas the blood loss was much less (14 ± 3.84 vs. 42 ± 16.81; p = 0.001). Postoperative pain, hypoesthesia, and epiphora were transient, significantly less in the PZD group (p < 0.001, p = 0.006, p = 0.002), and spontaneously resolved. Both groups witnessed a significant improvement in their NOSE and SNOT-22 scores in the 3-month and 6-month follow-up visits compared to the preoperative ones (p < 0.001). Other complications were comparable in both groups including cheek swelling, minimal epistaxis, dry nose, wound dehiscence, alar collapse, and recurrence of the original pathology.

The PZD was associated with less bleeding, pain, hypoesthesia, and epiphora in comparison to traditional osteotomy. It also allowed for precise cutting with no bone loss; however, the procedure was time-consuming when compared to conventional osteotomy.