Postoperative Nasal Septal Abscess Following Use of 2-Octylcyanoacrylate and Polydioxanone Plate in Open Septorhinoplasty: A Case Series

Use of alloplastic implants for correction of deviated nasal septum: Systematic review and meta-analysis

PURPOSE

To systematically reviews the safety and effectiveness of alloplastic implants (AI) in septoplasty.

METHODS

We conducted a comprehensive search in Medline, EMBASE, SCOPUS, CINAHL, and Cochrane Library databases to identify articles on septoplasty using AI. We also manually searched reference lists of included articles. Inclusion criteria involved prospective or retrospective case-series studies of adults with deviated nasal septum (DNS) who underwent septoplasty with AI, with sufficient follow-up data. Two authors independently screened articles, reviewed full manuscripts, and extracted data.

RESULTS

Out of 5370 articles, 16 met inclusion criteria, encompassing 884 patients from 14 eligible studies. Most studies had fair quality. AI materials included Polydioxanone (PDS), Polycaprolactone (PCL), Titanium, Macropore, and PolyMax. AI usage improved nasal obstruction in most patients, with 95.6 % (84.8 %-100 %) based on physical examination and 96.9 % (89.6 %-100 %) based on symptoms. AI-related complications occurred in 4.3 % (0 %-12.8 %) of cases, mostly non-serious.

CONCLUSIONS

AI use can be considered as a useful adjunct in septoplasty, with uncommon complications similar to standard procedures. However, due to limited-quality evidence, further prospective controlled studies are needed.

A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up

OBJECTIVE

Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty.

METHODS

Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes.

RESULTS

All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ:P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time (P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery.

CONCLUSION

N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.

Cartilage Framework Fixation with 2-Octyl Cyanoacrylate in a Prelaminated Radial Forearm Free Flap Total Auricular Reconstruction

Autologous total auricular reconstruction requires an intricately sculpted, curved, and stacked cartilaginous framework implanted under healthy vascularized tissue. The ideal fixation technique would be readily available, easy to deploy, and free of complications. Commonly used sutures can fracture fragile pieces, inadequately maintain shape, or migrate. Steel wire can erode through soft tissues, extrude, fracture, or become infected. We successfully used 2-octyl cyanoacrylate alone to fixate an autologous costal cartilage framework designed for a total auricular reconstruction in an adult trauma patient. We had no sutures or wires in the final construct. The key aspects of our technique included the following: use of small aliquots, application only at cartilage-to-cartilage interfaces, use of temporary shaping (needles and lasso sutures), and avoidance of excess spillage of adhesive on any portion that would directly contact soft tissue. The framework was implanted into a prelaminated radial forearm free flap, which was then transferred to the head and neck region at a second stage. At two-year follow-up, the framework held satisfactory shape without any complications such as resorption, exposure, or infection.