Aerosolized Fibrin Sealant Is Effective for Postoperative Edema and Ecchymosis in Open Rhinoplasty Without Osteotomy

Purpose: Fibrin sealant (FS) was approved as a hemostatic agent, sealant, and adhesive by the Food and Drug Administration in 1998. Our study sought to determine whether FS also reduced edema and pain in rhinoplasty without osteotomy. Materials and Methods: We conducted a prospective randomized trial involving patients who underwent open rhinoplasty without osteotomy. The patients were randomly assigned to 1 of 2 groups: those treated with aerosolized FS (FS group) and those not treated (control group). The effect of FS on edema of the eyelid, edema of the dorsum and tip of the nose, and periorbital ecchymosis was separately rated postoperatively using a scale of 0 to 4 or 0 to 3. Postoperative pain was evaluated using questionnaires quantified with a visual analog scale. The Mann-Whitney U and Wilcoxon tests were used to compare parameters between the groups. Results: A total of 41 patients were included in this study. The FS group (n = 20) consisted of 13 male and 7 female patients with a mean age of 34.8 +/- 5.8 years. The control group (n = 21) consisted of 15 male and 6 female patients with a mean age of 32.4 +/- 4.8 years. There were no statistically significant differences between the 2 groups with respect to age, gender, or combined surgical techniques (P > .05). Aerosolized FS significantly reduced not only ecchymosis and swelling in the periorbital area but also edema of the nasal dorsum (P < .05). Conclusions: Aerosolized FS can be effective for reducing eyelid edema, dorsal edema, and periorbital ecchymosis after open rhinoplasty. FS may serve as an adhesive for minimizing dead space by promoting adherence of the skin flap and as a hemostatic agent in reducing the amount of postoperative bleeding by sealing capillary vessels. (C) 2018 American Association of Oral and Maxillofacial Surgeons