title: Effectiveness of fibrin coating in the management of web formation after laryngomicrosurgery.
abstract: OBJECTIVE
  To explore the effectiveness of fibrin coating in reducing web formation after endoscopic management of the anterior commissure of the larynx.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: adakazu@qent.med.kyushu-u.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Adachi
authors.affiliation: Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: umetoshi@qent.med.kyushu-u.ac.jp.
authors.forename: T
authors.initials: T
authors.lastname: Umezaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D058993:Oral Sprays; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome; D064706:Vocal Cord Dysfunction / Q000517:prevention & control*; D014833:Voice Quality; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D058993:Oral Sprays