Study Evaluating Benefit of Using Fibrin Glue in Septorhinoplasty

Study Overview
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Brief Summary
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The purpose of this study is to determine whether the use of fibrin glue during nasal surgery leads to a shorter recovery period with less bruising and/or swelling.

Detailed Description
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Septorhinoplasty is a well established technique to correct nasal deformity. Drawbacks of this procedure include a significant recovery following surgery which may often require nasal taping and casting. Swelling and bruising in and around the surgical site may persist for months after the operation. At present, there is no standard regarding the length of time nasal tape and cast should be used following septorhinoplasty. It has never been proven that taping or casting is required - in surgeries that require minimal amounts of tissue handling, we may not use any tape or cast following the procedure. Homologous fibrin glue has been used for various cosmetic facial plastic procedures since the early 1980's. It has been shown to decrease bruising and swelling following surgery. This study is being undertaken to evaluate these benefits of using fibrin glue in nasal surgery.

Official Title
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The Use of Fibrin Sealant During Septorhinoplasty: Short and Long Term Benefits

Conditions
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Recovery Time, Bruising

Intervention / Treatment
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* Drug: Fibrinogen
* Procedure: Septorhinoplasty
* Procedure: Taping after septorhinoplasty.
* Procedure: Cast applied to the nose after nasal surgery
* Other: Saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any patient over 18 years of age undergoing septorhinoplasty. Exclusion Criteria: Any patient having more than one procedure performed during one anesthetic.(i.e.brow lift, face lift, blepharoplasty)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Control group<br>Septorhinoplasty with postoperative application of nasal taping and an external nasal cast. The tape and cast will be left in place for one week. No tissue glue will be used during the operation, although the nurse and surgical assistant will simulate the preparation and insertion of tissue glue using a syringe containing saline. | Procedure: Septorhinoplasty<br>* Septorhinoplasty to correct nasal deviation.<br>Procedure: Taping after septorhinoplasty.<br>* Simple taping over the nose following nasal surgery.<br>Procedure: Cast applied to the nose after nasal surgery<br>* A molded cast will be placed on top of the nose following nasal surgery.<br>Other: Saline<br>* Approximately 0.5 cc to 2 cc normal saline will be applied after the operation before the nasal taping and casting.<br>|
| Experimental: Fibrinogen, tape, and cast<br>Septorhinoplasty will be performed. At the termination of the procedure, prior to closure, fibrin sealant will be applied by the surgical assistant to the surgical site. Approximately 0.5 cc to 2 cc of tissue sealant will be applied. After closure, tape and cast will be applied and left in place for one week. | Drug: Fibrinogen<br>* One time application of 0.5 cc to 2.0 cc of fibrinogen following surgery.<br>* Other names: Tisseel;Procedure: Septorhinoplasty<br>* Septorhinoplasty to correct nasal deviation.<br>Procedure: Taping after septorhinoplasty.<br>* Simple taping over the nose following nasal surgery.<br>Procedure: Cast applied to the nose after nasal surgery<br>* A molded cast will be placed on top of the nose following nasal surgery.<br>|
| Experimental: Fibrinogen and tape<br>Septorhinoplasty will be performed. At the termination of the procedure, prior to closure, 0.5 cc to 2 cc of tissue sealant will be applied. Nasal tape will be applied after closure. | Drug: Fibrinogen<br>* One time application of 0.5 cc to 2.0 cc of fibrinogen following surgery.<br>* Other names: Tisseel;Procedure: Septorhinoplasty<br>* Septorhinoplasty to correct nasal deviation.<br>Procedure: Taping after septorhinoplasty.<br>* Simple taping over the nose following nasal surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Assessments of Disease-specific Quality of Life, Nasal Symptoms, and Nasal Form at 6 Months as Measured by Rhinoplasty Outcomes Evaluation (ROE), Nasal Obstructive Symptoms Evaluate Scale (NOSE), and Global Measure of Nose Deformity | ROE: 6 items for subject's opinion re: nasal appearance, each item on 0-4 scale. Total score sum of 6 items, dividing total by 24 X 100, core ranges from 0 (least satisfied) to 100 (most satisfied). NOSE: Assess five conditions over the past month, each item on 0-4 scale X 5, then summed. Total score ranges from 0 (no problem) to 100 (severe problem). Global measure of nose deformity: Pictures of 4 indices of nasal anatomy: length, width, tip, and hump. Each index cored from 1-7, with 1=ideal nose, and 7=deformed nose. Total score = sum of 4 indices, range 4-28, lower score=more ideal nose | 6 months post operative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the Results of Surgery 6 Months Post Operative by Review of Post Operative Photographs by the Operating Surgeon and 3 Blinded Reviewers Using a Mayo Clinic Surgeon Septorhinoplasty Questionnaire | At the end of the study standard post operative rhinoplasty photos will be obtained, and the photos will be reviewed by three blinded observers, who are experienced rhinoplasty surgeons. The photos will be presented to the evaluators in a completely random fashion at a single session. These photos will be graded at that time using the same questionnaire used by the operating surgeon. The questionnaire covers bruising, swelling, tenderness, and length, width, hump and tip of nose, with a range 4-40, 4=ideal nose to 40=many postoperative problems and disfigured nose. | 6 months postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nasal Surgery, Septorhinoplasty, fibrin glue, fibrinogen, Swelling, fibrin, tisseel