Abstract
We have used Mitomycin C while treating patients with difficult laryngeal stenosis, stenosis of the subglottic area, and also for patients suffering from choanal atresia. The stenosis was originally caused by posttraumatic, post-intubation, and congenital causes. Mitomycin C was used locally after laryngotracheoscopy and dilatation, or after rhinoscopy and dilatation of the choanal atresia. Mitomycin C was applied intraoperatively on saturated pledgets at a dose of 0.4 mg/ml for 4–7 min to the area where the scar had been lysed. The therapy was successful in 70% of cases. Mitomycin C is an antimetabolite known to inhibit fibroblast proliferation in vitro. The use of Mitomycin C for treating scar tissue in otolaryngology cases seems to be more than useful.
E-mail address: [email protected]
doi:10.1016/S0531-5131(03)01077-X
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Contents
1. Introduction
Mitomycin C is an antineoplastic antibiotic derived from Streptomyces caespitosus. It acts as an alkylating agent to inhibit DNA synthesis as well as to inhibit cell division and fibroblast proliferation. Mitomycin represents one possible non-surgical means of reducing postoperative granulation and scar tissue formation [1, 2], especially in laryngotracheal stenosis [3, 4] and choanal atresia [5, 6]. The drug has also been used to promote healing after pterigium surgery by ophthalmologists. Its efficacy and safety have been shown in numerous animal and clinical trials [7, 8].
2. Patients
2.1. Post-traumatic throat stenosis of the subglottic area
For laryngotracheal reconstruction, we performed dilatation to lessen scarring, followed by application of Mitomycin C (0.4 mg/ml for 7 min); after 1 month, decanylation followed a second treatment (Figs. 1 and 2).
2.2. Inborn throat stenosis of subglottic area
For laryngotracheal reconstruction, we performed dilatation to lessen scarring, followed by application of Mitomycin C (0.4 mg/ml for 7 min); after 1 month, decanylation followed a second treatment.
2.3. Post-traumatic throat stenosis of the subglottic area
Laryngotracheal reconstruction was repeated twice with stent application, laser treatment, and a tracheostomic canyla to lessen scarring. After 4 years, we performed dilatation with the application of Mitomycin C (0.4 mg/ml for 7 min) to lessen scarring. This has currently not been successful.
2.4. Post-intubation throat stenosis of the subglottic area in a heavy, cardiac patient
Laryngotracheal reconstruction was repeated three times with stent application and laser treatment, and the patient has a tracheostomic canyla to lessen scarring. After 6 years, we performed dilatation with the application of Mitomycin C (0.4 mg/ml for 7 min), which was repeated four times in 6 weeks. This has currently not been successful.
2.5. Congenital choanal atresia – bilateral
Repair using the transnasal endoscopic approach with stent application for 3 weeks. After 3 weeks, we performed dilatation with the application of Mitomycin C (0.4 mg/ml for 4 min) followed by a second application after 1 month. Since then, the passage through the nose has been unblocked.
2.6. Congenital choanal atresia – unilateral
Repair using the transnasal endoscopic approach with stent application for 3 weeks. After 2 months, the stent was reintroduced for 3 weeks. After 1 month, we performed dilatation with the application of Mitomycin (0.4 mg/ml for 7 min), followed by a second application. Since then, the passage through the nose has been unblocked.
2.7. Congenital choanal atresia – bilateral
Repair using the transnasal endoscopic approach with stent application for 3 weeks. After 1 month, we performed dilatation with the application of Mitomycin C (0.4 mg/ml for 4 min). Since then, the passage through the nose was unblocked.
At present, we have utilized Mitomycin C in seven patients. The female to male ratio was 6 to 1 and the mean age was 7.9 years. Success was observed in five of seven cases (70%), and failure occurred in two cases (30%).
3. Discussion
The exact effect of Mitomycin C is difficult to measure. We are fully aware of the fact that the particular group of patients treated by us is rather incongruent. Nevertheless, Mitomycin C was tested accordingly on patients with more difficult conditions. The final effect seems to be relatively promising. For patients with old, dated stenosis, the use of Mitomycin C proved ineffective. We assume that there is no outstanding difference between the duration of Mitomycin C solution application to the tissue.
4. Conclusion
No complications were noted in our patients. Although a longer follow-up and further controlled studies are needed, the use of topical Mitomycin C might prove useful in the treatment and prevention of subsequent restenosis and scar formation.