Abstract
Cyanoacrylate adhesives can make the placement of spreader grafts in open septorhinoplasty
technically easier, but its use is off-label beneath the skin. There is a theoretical
risk of toxicity from cyanoacrylate breakdown products, but this risk has not been
thoroughly studied in rhinoplasty. The objective was to evaluate the effects of subcutaneous
cyanoacrylate use during spreader graft placement in rhinoplasty in a retrospective
review of open septorhinoplasties in which 2-octyl cyanoacrylate was used to aid placement
of spreader grafts. The review was carried out in a tertiary care military academic
medical center. A total of 140 adults underwent open septorhinoplasty between September
2013 and May 2016 with spreader graft placement. The authors excluded patients in
whom 2-octyl cyanoacrylate was not used to aid graft placement and those who did not
follow up postoperatively in our clinic. 108 (85 males and 23 females) patients were
included in the final analysis. Nine (8.3%) patients had inflammatory reactions possibly
attributable to 2-octyl cyanoacrylate toxicity. The overall rate of postoperative
inflammation possibly attributable to 2-octyl cyanoacrylate was 17% among females
and 5.9% among males, and this difference was not statistically significant (p = 0.07). However, the rate of postoperative inflammation attributable to 2-octyl
cyanoacrylate that required an intervention (incision and drainage or antibiotics)
was 2.7% overall, 13% among women and 0% among men, and this difference was significant
based on chi-square testing (p < 0.001). Further, revision cases were significantly more likely to develop abnormal
postoperative inflammation than initial cases (p = 0.02). Herein, the authors present the largest series of patients in whom 2-octyl
cyanoacrylate was used to assist placement of cartilage spreader grafts during open
septorhinoplasty. While 2-octyl cyanoacrylate is an effective adjunct to facilitate
graft placement, they recommend against its use, as the risk of postoperative inflammation
is significant.
Keywords
rhinoplasty - cyanoacrylate - nasal spreader grafting
