The Effect of Piezoelectric (Piezo) Versus Classic Lateral Osteotomy on the Lacrimal Drainage System (LDS): A Retrospective, Single-Center, Controlled Study.

Lateral osteotomies in rhinoplasty run adjacent to the lacrimal drainage system (LDS), risking postoperative tearing. Piezoelectric (piezo) devices enable precise bone cuts that may reduce LDS trauma. We compared the 1-month incidence of objective lacrimal dysfunction after piezo versus classic osteotomy. Retrospective, single-center controlled cohort (1 January 2024-1 January 2025) at a tertiary ENT clinic. Consecutive patients aged 19-45 with pre-operative paranasal sinus CT and no prior lacrimal disorder were grouped by osteotomy technique (piezo vs. classic; = 65 per arm). Assessments were performed at postoperative day 7-10 and at 1, 3, and 6-12 months. The primary endpoint was 1-month objective lacrimal dysfunction, defined as fluorescein dye disappearance test (FDDT) grade ≥1 or reflux/resistance on irrigation plus symptoms (Munk ≥2). Pre-specified statistical tests were used. Early tearing favored piezo. At week 1, epiphora occurred in 32.3% with piezo versus 46.1% with classic ( = 0.041); by month 6, rates were 4.6% versus 15.1% ( = 0.031). Differences at months 1 and 3 also favored piezo but were not statistically significant ( = 0.062 and = 0.088). FDDT positivity was lower with piezo at week 1 (23.0% vs. 38.4%, = 0.045) and month 6 (3.0% vs. 10.7%, = 0.048). Irrigation obstruction was less frequent with piezo at week 1 (7.6% vs. 21.5%, = 0.026), but groups converged by months 1 (15.4% vs. 12.3%, = 0.80) and 3 (6.2% vs. 4.6%, > 0.99). Punctum stenosis/occlusion remained uncommon in both groups without significant differences. Piezo-assisted lateral osteotomy is associated with less early lacrimal dysfunction and lower 6-month epiphora compared with the classic technique. Convergence of irrigation findings by 1-3 months suggests postoperative edema as the dominant transient mechanism. Given the retrospective, single-center design and low event rates, multicenter prospective studies powered for early LDS outcomes are warranted.