Topical mitomycin as an adjunct to choanal atresia repair.
OBJECTIVE
To evaluate the use of topical mitomycin in choanal atresia repair to reduce the development of granulation tissue and cicatrix.


METHODS
Retrospective case series in 2 tertiary care centers.


METHODS
Twenty patients with either unilateral or bilateral congenital choanal atresia underwent repair using the transnasal endoscopic approach, the transpalatal approach, or both.


METHODS
The surgeons favor the use of the endoscopic transnasal drillout technique for all unilateral cases of choanal atresia and for selected bilateral cases. We describe our experience and treatment paradigm for these 20 patients (15 with unilateral atresia, 5 with bilateral atresia). Topical application of mitomycin was used, and in some cases postoperative stenting, for a period of 1 to 2 weeks. In 8 cases, a second application of mitomycin was used. Follow-up ranged from 3 months to 2 years (mean, 9 months).


METHODS
The patency of the choanae without respiratory distress or nasal drainage, as assessed by endoscopic evaluation, determined a successful repair.


RESULTS
Of the 20 patients, 17 retained patent airways. Three patients experienced improvement from a total atresia to a narrowed, stenotic choana.


CONCLUSIONS
The use of mitomycin as an adjunct to the surgical repair of choanal atresia may offer improved patency with a decreased need for stenting, dilatations, and revision surgery. Newer endoscopic techniques with powered instrumentation further enhance the safety and efficacy in the repair of choanal atresia.
Prasad
Mukesh
M
Department of Otorhinolaryngology, Cornell University Medical Center, Ithaca, NY, USA. mukeshprasad@post.harvard.edu
Ward
Robert F
RF
April
Max M
MM
Bent
John P
JP
Froehlich
Patrick
P
D000287:Administration, Topical; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002754:Choanal Atresia / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D016685:Mitomycin