In a recent meta-analysis published in , Kim et al. [ ] reviewed six selected articles and concluded that osteotomy without periosteal tunneling is associated with less periorbital ecchymosis and edema than osteotomy with periosteal tunneling. The authors [ ] used the term “periosteal preservation” to indicate the absence of periosteal tunneling, but in fact, the osteotome eventually shears the periosteum during osteotomy when 4-mm or 6-mm osteotomes are used.
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