Role of Fibrin Glue in palatoplasty to prevent formation of oro-nasal fistula – An in vivo study

Abstract

Objective

To decrease the incidence of oro-nasal fistula formation following palatoplasty using modified Von Langenbeck technique and Fibrin Glue adhesive between the oral and nasal layer.

Subjects and methods

Prospective study of 20 primary closure of cleft palate using modified Von Langenbeck technique with and without a adhesive medium between the oral and nasal layer to compare the incidence of oro-nasal fistula formation.

Results

The results showed decrease in the incidence of oro-nasal fistula formation. With 0% fistula formation in the cases where Fibrin Glue was used. And 30% fistula formation in patients/controls where Fibrin Glue was not used.

Introduction

A facial cleft deformity of the lip and palate is one of the most common birth defects encountered. Cheiloschisis and Palatoschisis, means cleft lip and cleft palate, which has been known to afflict man since prehistoric time [1].

The goals of palatal surgery are closure of the communication between the oral and nasal cavities, and construction of a functional velum that allows good speech production. Many techniques have evolved to achieve the primary goals of palate repair: single operation and primary healing [2], [3].

Oro nasal fistula (ONF) following palate repair is not uncommon. It is defined as a failure of healing or a breakdown in the primary surgical repair of the palate. Intentionally unrepaired nasoalveolar and/or anterior hard palate fistulas are not included in the condition [4], [5].

The incidence varies greatly among centers and surgeons, and has been reported to be between 5% and 29% and has been associated with severity and type of cleft, repair technique, timing of repair and the experience level of the operating surgeon [6], [7].

Palatal fistulae following cleft palate repair can range from being a straight forward simple procedure to that of one which tests the ingenuity and skill of the surgeon. Closure of the fistulae is done using a variety of methods, according to surgeon's preference and to the local condition. A simple one layer closure by approximation and leaving the nasal wound open for secondary epithelialization has given primary closure in 60% of patients. A two layer closure can be achieved by using different flaps like a buccal sulcus flap for anterior oronasal fistulas, tongue based flaps can also be used [8].

Biologic/Fibrin Glue can be effective substitute for sutures or pins to hold Flaps. The adhesive qualities of consolidated Fibrin Glue to the tissue may be explained in terms of covalent bonds between fibrin and collagen, or fibrin, fibronectin and collagen [9]. Fibrin Glue can be prepared from either pooled blood (blood from several donors) or single donor blood. In the case of single donor blood it can be autogenous or allogenic. Fibrinogen is a soluble blood component that comprises 0.2% by volume of whole blood. It is converted into an insoluble fibrin network in the presence of thrombin as part of the intrinsic and extrinsic blood coagulation cascades [10].

The following study therefore aims to decrease the post-operative oronasal fistula formations by using modified Von Langenbeck's technique of surgical repair of cleft palate along with Fibrin Glue Adhesive in between the oral and nasal flaps.