Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery

Gupta, Manish; Motwani, Gul

doi:10.1017/s0022215106001952

Cited by 19 publications

(25 citation statements)

References 11 publications

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“…These 46 consisted of 11 case reports [10–20], 9 case series [21–29], 7 prospective clinical trials [3, 30–35], 5 RCTs [36–40], 2 reviews [41, 42], 12 animal studies [4, 5, 43–52]. The first article about the topical use of MMC in the upper aerodigestive tract dates from 1998 [19].…”

Section: Resultsmentioning

confidence: 99%

“…Some studies report adhesions and discharge at the MMC treated side, but these appeared significantly less frequently than on a similar wound treated with saline solution [30]. It is a principal point of discussion whether these effects can be seen as a result of the surgery proper and are in that notion not mentioned as being a side effect of topical MMC application.…”

Section: Discussionmentioning

confidence: 99%

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Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Veen

Dikkers

2009

Eur Arch Otorhinolaryngol

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Not much is known about the side effects of mitomycin C (MMC), an anti-fibrogenetic agent, in the upper aerodigestive tract. However, its use in ophthalmology is widely known and without quantitatively important side effects. A literature review was performed for side effects of MMC in the upper aerodigestive tract. Forty-six articles, describing the use of MMC to prevent scarring, were retracted from PubMed. Thirty-two are human studies. MMC is used in different concentrations (0.1–10 mg/ml) with different application times (2–5 min) and frequencies (up to 4 times). Five hundred and thirty-eight patients were included in those publications, of whom 19 developed side effects (3.53%). No side effects developed in studies, where post-application irrigation with saline was reported. The longest mean follow-up period is 75.5 months. Direct relations between the reported side effects and MMC seem absent in most studies. Serious complications seem to occur when MMC is used in high concentrations. Unfortunately, sometimes crucial information is lacking. One patient was described who supposedly developed laryngeal carcinoma after repeated treatment of hyperkeratosis and anterior commissure webbing. Animal studies show that excessive fibrin production can lead to acute airway obstruction. In conclusion, topical application of MMC on a wound with consecutive irrigation with saline can be performed safely to prevent scar formation in circular structures of the upper aerodigestive tract. Long-term yearly control of the application site seems advisable.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Veen

Dikkers

2009

Eur Arch Otorhinolaryngol

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“…Earlier animal studies by Ingrams et al [11] reported a delay in Wbrosis which allowed re-epithelialization to take place before scar tissue forms, thus increasing the success rate of FESS. Clinical work done by Chung et al [12], Gupta and Motwani [13], Konstantinidis et al [14] has shown a reduction in the incidence of synechiae with topical Mitomycin C. Gupta and Motwani [13] also reported an improvement in nasal obstruction in his patients who were treated with topical Mitomycin C. However, other authors have not found beneWt with topical Mitomycin C [15,16]. A recent review of literature by Karkos et al [17] suggested a favorable shortterm eVect of Mitomycin C, but no evidence regarding long-term prevention of re stenosis.…”

Section: Discussionmentioning

confidence: 99%

Topical Mitomycin C in functional endoscopic sinus surgery

Vaidyanathan

Balasubramanian

Gopalakrishnan

et al. 2011

Eur Arch Otorhinolaryngol

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In recent literature, there has been an interest in the use of Mitomycin C to reduce post-operative complications following endoscopic sinus surgery. We report our results on a prospective, randomized controlled trial involving 50 patients with chronic bilateral rhino sinusitis. We eliminated various confounding factors by studying a single group of patients, with symmetrical disease, without pre-existing gross anatomical abnormalities. Patients requiring revision sinus surgery were excluded. On completion of the surgery, a cotton pledget soaked in Mitomycin C was placed in one nostril (test) and saline-soaked pledget (control) was placed in the other side of the nose, both in the middle meatus. The side of the nasal cavity receiving the topical Mitomycin C was randomized. The patients were assessed periodically (first week, first month, third month and sixth month) for synechiae formation and presence or absence of their symptoms. At the first week follow up, there was a statistically significant difference in the incidence of synechiae between the saline and Mitomycin C side. Furthermore, there was a statistically significant improvement with regards to patient symptoms (nasal block and discharge) in the Mitomycin C side when compared to the saline side. At the third and sixth month, there was no difference between the two groups. The incidence of adverse tissue reaction (granulation, discharge, polypoidal mucosa and crusting) was less in the Mitomycin C side when compared to the saline side at the first month follow up. Topically applied Mitomycin C reduces the incidence of synechiae in the immediate post-operative period in patients undergoing endoscopic sinus surgery. There is also an improvement in nasal obstruction and discharge with a reduction in the incidence of adverse tissue reaction in the early post-operative period.

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“…The author had good experience of using MMC in reducing adhesion formation following endoscopic sinus surgery [9]. The concentration recommended for local application is 0.4mg/ml.…”

Section: Discussionmentioning

confidence: 99%

Bilateral nasal vestibular stenosis: a case of rhinoscleroma and review of surgical techniques

Gupta

2008

Indian J Otolaryngol Head Neck S

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Vestibular stenosis is an uncommon but debilitating cause of nasal obstruction. It is caused by disruption of the nasal vestibular lining with secondary proliferation of granulation and fi brous tissue. A number of techniques have been described for repair of the stenotic segment. Correction can be diffi cult because of the tendency of wound contracture and recurrence. We present a surgical technique that employs the concept of excision of the stenotic segment, enlargement of the vestibule and placement of a full thickness skin fl ap. Its ability to resist contracture obviates the need for post-operative stenting and gives good result.

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Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery

Abstract: Mitomycin C may be topically applied in post-operative FESS cases to reduce adhesion formation and hence the need for revision surgery.

Cited by 19 publications

References 11 publications

Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Topical Mitomycin C in functional endoscopic sinus surgery

Bilateral nasal vestibular stenosis: a case of rhinoscleroma and review of surgical techniques

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