Safety of 2-Octyl Cyanoacrylate in Spreader Grafting

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.