Laser and topical mitomycin C for management of nasal synechia after FESS: a preliminary report

Abstract

The objective of the study is to assess the role of diode laser coupled with topical mitomycin C (MMC) in the management of synechia after endoscopic sinus surgery. Twenty-five patients with recurrent sinusitis due to synechia between the middle turbinate and lateral nasal wall after endoscopic sinus surgery were included in this study. Diode laser was used to divide the synechia and MMC was applied topically in the area of the middle meatus for 5 min. Patients were followed for 6 months to assess symptoms improvement, recurrence of synechia and CT scan changes. Most of our patients reported improvement of their symptoms, recurrent synechia occurred in 15% of the patients with significant improvement of the CT scan findings. In conclusion, the diode laser with topical MMC is an outpatient procedure which is simple, safe and effective in managing postoperative nasal synechia.

Efficacy of Mitomycin-C for Prevention of Adhesion Formation after Functional Endoscopic Sinus Surgery in Cases of Chronic Rhinosinusitis: A Prospective Cross-sectional Study

“…Attempts to limit such adhesion formation with anatomical barriers have met with limited success. 4 Animal studies in rabbits suggest that MMC slows the postoperative healing process of nasal mucosa, reduces stenosis without affecting re-epithelialization. Experimental studies observed the effects of brief exposure of MMC on cultured human nasal mucosa fibroblasts.…”

“…5 Mitomycin-C (MMC): MMC is an alkylating antineoplastic antibiotic that prevents replication of fibroblasts and epithelial cells, in otolaryngology MMC is currently under inquiry for the prevention of laryngotracheal stenosis, as an adjunct to FESS to prevent closure of the maxillary sinus antrostomy. 4 MMC operates by disrupting base paring of DNA molecules in the G-1 phase of cell cycle, and inhibits formation of RNA and protein synthesis-this way inhibits proliferation of fibroblasts. Additional function is inhibition of apoptosis in fibroblasts and blockage of angiogenesis.…”

“…3 Though there are advances in instrumentation and surgical technique, postoperative adhesions, synechiae formation continue to occur between 1 and 27%. 4 The incidence of adhesions requiring surgical intervention is 1 to 2%. 5 Mitomycin-C (MMC): MMC is an alkylating antineoplastic antibiotic that prevents replication of fibroblasts and epithelial cells, in otolaryngology MMC is currently under inquiry for the prevention of laryngotracheal stenosis, as an adjunct to FESS to prevent closure of the maxillary sinus antrostomy.…”