Prevention of Adhesion after Endoscopic Sinus Surgery: Role of Mitomycin C
-
Mohammad-Hossein Baradaranfar
,
Jalal Khadem
,
Shokooh Taghipoor Zahir
,
Ali Kouhi
,
Mohammad Hossein Dadgarnia
,
Amin Baradarnfar
Abstract
Adhesions after endoscopic sinus surgery (ESS) are a potential cause of surgical failure. Mitomycin-C (MMC) is recently proposed as a solution for these adhesions. This study was performed to investigate the effect of Mitomycin C in reducing scar formation and adhesion in the nasal mucosa after endoscopic nasal surgery. This double blind randomized clinical trial study was performed on 37 patients with bilateral chronic rhinosinusitis. At the end of ESS, randomly impregnated mesh with MMC was placed in one side and another mesh impregnated with saline in the opposite side for 5 minutes. Patients were followed at least for three months, and the results of diagnostic endoscopy were recorded. Post operative adhesion occurred in 12 (32.4%) patients (2 bilateral/10 unilateral). Among total of 14 adhesions, 4 (10.8%) were in the MMC side and 10 (27%) in the control side. This differences was close to statistically significant (P=0.058). MMC may reduce adhesions after ESS, but further studies with different doses, sample size and frequent use of topical MMC is recommended.
Gupta M, Motwani G. Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery. J Laryngol Otol 2006;120:921-3.
Anand VK, Tabaee A, Kacker A, Newman JG, Huang C. The role of mitomycin C in preventing synechia and stenosis after endoscopic sinus surgery. Am J Rhinol 2004;18:311–314.
White A, Murray JA. Intranasal adhesion formation following surgery for chronic nasal obstruction. Clin Otolaryngol Allied Sci 1988;13:139–143.
Shone GR, Clegg RT. Nasal adhesions. J Laryngol Otol1987;101:555–557.
May M, Levine HL, Mester SJ, Schaitkin B. Complications of endoscopic sinus surgery: analysis of 2108 patients–incidence and prevention. Laryngoscope 1994;104:1080–1083.
Vleming M, Middelweerd RJ, de Vries N. Complications of endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 1992;118:617–623.
Hata T, Hoshi T, Kanamori K, Matsumae A, Sano Y, Shima T, Suga Wara R. Mitomycin, a new antibiotic from Streptomyces. I. J Antibiot 1956; 9:141–146.
Abraham LM, Selva D, Casson R, Leibovitch I. Mitomycin: clinical applications in ophthalmic practice. Drugs 2006; 66:321–340.
Rahbar R, Jones DT, Nuss RC, Roberson DW, Kenna MA,McGill TJ, Healy GB. The role of mitomycin in the prevention and treatment of scar formation in the pediatricaerodigestive tract: friend or foe? Arch Otolaryngol HeadNeck Surg 2002;128:401–406.
Hartnick CJ, Hartley BE, Lacy PD, Liu J, Bean JA, Willging JP, Myer CM 3rd, Cotton RT. Topical mitomycin application after laryngotracheal reconstruction: a randomized, double-blind, placebo-controlled trial. Arch Otolaryngol Head Neck Surg 2001; 127:1260–1264.
Warner D, Brietzke SE.Mitomycin C and airway surgery: how well does it work? Otolaryngol Head Neck Surg. 2008;138:700-709.
Prasad M, Ward RF, April MM, Bent JP, Froehlich P. Topical mitomycin as an adjunct tochoanal atresia repair. Arch Otolaryngol Head Neck Surg 2002;128:398–400.
Aksoy F, Demirhan H, Yildirim YS, Ozturan O. Bilateral choanal atresia in an adult - management with mitomycin C and without stents: a case report.Cases J 2009;2:9307.
Nayak DR, Balakrishnan R, and Hazarika P. Prevention and management of synechia in pediatric endoscopic sinus surgery using dental wax plates. Int J Pediatr Otorhinolaryngol 1998;46:171–178.
Hu KH, Lin KN, Li WT, Huang HM. Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis. Int J Pediatr Otorhinolaryngol. 2008;72:1535-1540.
Kim ST, Gang IG, Cha HE, Ha JS, Chung YS. Effect of mitomycin C on the size of antrostomy afterendoscopic sinus surgery. Ann Otol Rhinol Laryngol 2006;115:673-8.
Chung JH, Cosenza MJ, Rahbar R, Metson RB. Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: a randomized, controlled study. Otolaryngol Head Neck Surg 2002;126:468-474.
Konstantinidis I, Tsakiropoulou E, Vital I, Triaridis S, Vital V, Constantinidis J. Intra- and postoperative application of mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS. Rhinology 2008;46:107-11.
Kim HY, Dhong HJ, Min JY, Jung YG, Park SH, Chung SK. Postoperative maxillary sinus mucocoele: risk factors for restenosis after surgery and preventive effects of mytomycin-C. Rhinology 2009;47:79-84.
Karkos PD, Leong SC, Sastry A, Assimakopoulos AD, Swift AC. Evidence-based applications of mitomycin C in the nose. Am J Otolaryngol. 2011 (in press).
| Files | ||
| Issue | Vol 49, No 3 (2011) | |
| Section | Original Article(s) | |
| Keywords | ||
| Adhesion Endoscopic Sinus Surgery Mitomycin C Nasal packing | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
