Comparison of Piezoelectric and High‐Speed Drills for Frontal Beak Osteotomy in Endoscopic Sinus Surgery—Exploratory Study

INTRODUCTION: Frontal beak reduction is a critical and challenging step in endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Traditional high-speed drills can risk thermal injury and soft tissue trauma, whereas piezoelectric surgery uses ultrasonic vibrations for selective bone cutting and may improve surgical precision. This study compared piezoelectric devices with conventional drills for frontal beaks reduction. METHODS: A double-blind exploratory study with randomisation was conducted during the years 2019-2022. Adult CRS patients (n = 43) with prominent nasofrontal beak undergoing ESS were randomised to piezoelectric knife (n = 22) or high-speed drill (n = 21). Exclusion criteria included prior sinus surgery, septoplasty, neoplasms or systemic contraindications. Outcomes included Lund-Kennedy, Lund-Mackay, Sino-Nasal Outcomes Test (SNOT-22), Visual Analogue Scale (VAS) scores and frontal sinus ostium dilatation, measured pre-operatively and at 1, 4 and 24 weeks post-operatively. RESULTS: Both groups showed significant post-operative improvements in Lund-Mackay and SNOT-22 scores (p < 0.05). At 1 week, the piezo group had significantly lower Lund-Kennedy scores (p = 0.022), suggesting better mucosal healing. Correlations in the piezo group were observed between ostium dilatation and improved Lund-Mackay (R = -0.527; p = 0.008) and SNOT-22 (R = -0.405; p = 0.049) at 24 weeks. No significant differences were found in ostium width gain, VAS scores or complications. With piezo devices, the median time of surgery was increased. CONCLUSION: Piezoelectric surgery is a safe, effective alternative to drills for frontal beak reduction in ESS, with potential benefits for early mucosal healing. Further studies are warranted to confirm long-term advantages.