Use of 2-Octyl cyanoacrylate in Cartilage Interposition Adherence During Ossiculoplasty.

INTRODUCTION Cartilage interposition grafting is commonly utilized during allograft ossiculoplasty as a way to prevent extrusion of the prosthesis through the tympanic membrane. Even with the earliest materials such as Plastipore (Xomed, Jacksonville, FL) and hydroxyapatite, use of cartilage interposition has led to lower extrusion rates without the expense of poorer hearing outcomes. Allograft implants are now almost universally made of titanium due to its lightweight nature and high biocompatibility. Similar to precursor materials, interposition of a thin cartilage sheet between the titanium prosthesis and tympanic membrane has resulted in low extrusion rates (1%–8%) with good hearing outcomes. The traditional method of ossiculoplasty includes placement of the prosthesis and cartilage graft as separate units between the stapes footplate or superstructure and the tympanic membrane. Despite overall excellent results if the reconstruction remains intact, one of the pitfalls continues to be the potential for dislocation of the prosthesiscartilage graft in the early postoperative period. Even with gentle buttressing with absorbable packing, there is a risk of dislocation with a forceful emergence from anesthesia, minor head trauma, or a contained sneeze. Although there is no way to mitigate the risk completely, it would be ideal to reduce the number of moving parts to optimize the reconstruction. Topical medical adhesives, specifically cyanoacrylates, were investigated in otologic surgery beginning in the 1970s but have not gained sufficient popularity secondary to lack of U.S. Food and Drug Administration (FDA) approval and concerns for ototoxicity with some derivatives. 2-octyl cyanoacrylate (Dermabond, Ethicon Inc., Somerville, NJ) is an FDA-approved topical medical adhesive that has been shown to have excellent adhesive properties and low reactivity in vivo. It has been studied in a variety of ophthalmologic, neurosurgical, and cardiothoracic procedures, among others. Early reports of use of cyanoacrylate derivatives in the middle ear to augment ossiculoplasty using hydroxyapatite prostheses exist; however, there are no detailed reports of extrusion rates using this technique in the long term with use of titanium prostheses. In this study, we review our method of utilizing Dermabond (Ethicon) for adhering a titanium ossicular prosthesis to the cartilage graft prior to insertion as a unit into the middle ear. We also report complications and extrusion rate with this method in our patient population using this technique.