Evaluation of three cyanoacrylate glues for ossicular reconstruction

We evaluated and compared the separate effects of ethyl, isobutyl, and fluoroalkyl cyanoacrylate on the promontory mucosa and surgically disarticulated incudostapedial joint in the adult cat middle ear. The animals were sacrificed at 10-, 30-, and 60-day intervals after glue application. All three cyanoacrylates elicited a chronic inflammatory response when placed directly on the promontory mucosa. The use of ethyl and isobutyl cyanoacrylate resulted in persisting discontinuity of the incudostapedial joint with erosion of the incus. Fluoroalkyl cyanoacrylate maintained incudostapedial continuity without ossicular erosion. Ethyl and isobutyl cyanoacrylate are probably not appropriate for middle ear surgery. The less toxic fluoroalkyl cyanoacrylate may be useful as an ossicular adhesive in selected cases. Our findings are further contrasted with those obtained in similar studies with methyl and butyl cyanoacrylate. The effects of each of the five cyanoacrylates are reviewed in the continuing search for a safe and effective ossicular adhesive.