Effectiveness of fibrin coating in the management of web formation after laryngomicrosurgery.

ABSTRACT

PURPOSE: To explore the effectiveness of fibrin coating in reducing web formation after endoscopic management of the anterior commissure of the larynx. MATERIALS AND METHODS: Using a spray device that is generally used for laparoscopic operations, we covered the wound with fibrin glue (Bolheal®) to avoid web formation. This technique was employed in cases wherein the anterior commissure was mainly managed by laser operation; the glue was sprayed after vaporization. Fibrinogen was first sprayed and the wound was properly soaked with a swab, which was followed by application of thrombin. We used this method in 17 cases and evaluated voice function by acoustic analysis - pitch perturbation quotient (PPQ) and amplitude perturbation quotient (APQ) - and maximum phonation time (MPT) before and after the operation. RESULTS: No severe web formation was observed at three months after the operation. PPQ values improved from 3.048±2.801% to 0.653±0.463% (p<0.05, paired t-test). APQ values improved from 7.996±5.003% to 3.042±1.872% (p<0.05, paired t-test). Voice quality did not worsen in any of the cases. MPT values improved from 17.2±10.8s to 26.7±14.2s (p<0.05, paired t-test) Voice function improved 3months after the operation in all cases. CONCLUSION: The fibrin coating method is an easy and effective approach to avoid web formation without creating cervical wounds in cases that require handling of the anterior commissure under laryngomicrosurgery.