Does Topical Mitomycin-C Improve the Surgical Outcomeof Bilateral Congenital Choanal Atresia Repair?

Abstract

Bilateral congenital choanal atresia (CCA) in newborns carries significant morbidity and mortality. Many surgical approaches have been described for its correction but none of the approaches have proved superior in preventing postoperative granulation tissue and restenosis. Recently, topical Mitomycin C (MMC) has been used intraoperatively to prevent the formation of granulation tissue and restenosis in choanal atresia repair. We report a series of three consecutive patients who underwent bilateral CCA repair and received topical MMC intraoperatively. We have used topical MMC in CCA repair for the first time in Qatar and report the outcome of these patients. Case 1 was a preterm child (29 gestational weeks) who underwent transnasal repair. Case 2 had CHARGE association and case 3 had no other anomalies, both of whom underwent transpalatal repair. In case 1, we had used topical MMC \ during revision surgery with improved outcome. In cases 2 and 3, topical MMC was applied during primary repair and in addition both received a second application selectively at the margins of the choanae 6 weeks after stent removal. Case 3 needed further dilatation of the choanae four months after second application of topical MMC. None of our patients developed any local or systemic side effects. To our knowledge, bilateral CCA repair in a 29 weeks gestational age child has not been reported in the literature. Our study suggests that topical MMC may be a useful adjunctive therapy in choanal atresia repair.