Closure of mucosal defects over exposed mandibular plates using fibrin glue
H P Gaboriau1, P C Belafsky, N Pahlavan
1Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, La., USA. hgaboriau@hotmail.com
Background:
Mandibular plates may become exposed following radiation therapy, infection, and mucosal necrosis. This may lead to early removal of the mandibular plates with subsequent instability of bone fragments.
Objective:
To compare fibrin glue, a bioadhesive, with traditional sutures in closing mucosa over exposed mandibular plates in a cat.
Design:
Prospective matched-pairs analysis.
Subjects:
Nine cats were used, and each cat served as its own control.
Intervention:
Bilateral mandibular plates were fixed on the buccal side of the mandible of 9 cats. The surgical defects over the plates were left uncovered. After 4 days, the plates on the right side were covered with a mucosal graft fastened with fibrin glue, and on the left side the grafts were secured with sutures. After 10 days, the grafts were excised and a histological examination was performed.
Results:
The mean operative time for coverage was 2 minutes 11 seconds for the fibrin glue and 12 minutes 48 seconds for the sutures (P < .001). Gross examination revealed granulation or ulceration in 3 of the fibrin and 9 of the suture specimens (P < .005). All specimens displayed mild-to-moderate acute and chronic inflammation. All sutured specimens showed focal foreign body-type giant cells surrounding fragments of bone and suture. Two mandibular plates were partially exposed on the fibrin glue side.
Conclusions:
The use of fibrin glue to cover exposed mandibular plates is safe and well tolerated in cats. Glue application requires a shorter operative time and is associated with fewer occurrences of granulation and ulceration when compared with suture fixation. Further studies are indicated to titrate the concentration of fibrin glue and to prevent plate exposure.
