Selective Indications of Fibrin Sealing in Maxillofacial Surgery

Abstract

Properties of fibrin sealant, such as control of oozing hemorrhages, gluing effect, and enhancement of wound healing, have been scientifically elaborated and widely employed in surgery and have been common knowledge for years. This presentation deals with a number of indications associated with new operative techniques. In bone surgery the use of compressed bone spongiosa chips for packing of pits or cavities following osteotomy or surgical reconstruction of the mandible and maxilla may lead to a considerable improvement in primary shaping of a region. The sealant permits bone fixation in sites where the spongiosa chips are not exposed to any functional strain. Fibrin sealant is also useful for stabilization and fitting of cartilaginous chips (autologous or homologous cartilage) in order to restore facial contours. The use of alloplastic material such as calcium hydroxyapatite granules in combination with fibrin sealant does not only improve outer contours, but also facilitates the operative technique for the reconstruction of toothless mandible and maxilla. In soft tissue surgery oozing hemorrhages from large soft tissue wound areas, which are observed during the preparation of myocutaneous flaps or vascular pedicle flaps in polymorbid patients (hepatic dysfunction, coagulation disorders, and other parameters indicating a bleeding tendency), can often be avoided by spray application of fibrin sealant. Moreover, prior to the operative extirpation of small cavernous hemangiomas, which tend to occur in tongue and lip, it has proved effective to fill the hemangioma with fibrin sealant following slight compression of the surrounding tissue and then, after coagulation of the sealant is complete, extirpate the tumor.