The role of mitomycin C in preventing synechia and stenosis after endoscopic sinus surgery.
BACKGROUND
Synechia and stenosis formation after endoscopic sinus surgery (ESS) represents a potential source of surgical failure. Mitomycin C (MMC) has been used successfully in other fields to decrease postoperative scar formation. We hypothesize that the topical application of MMC reduces the incidence of stenosis and synechia formation after ESS.


METHODS
This study is a randomized, controlled, single-blinded study based in a tertiary care teaching hospital. After routine ESS, a pledget soaked in MMC (0.5%) was randomly placed into the middle meatus of one nasal cavity for 5 minutes and a pledget soaked in saline was placed in the contralateral side in each patient. A blinded observer followed the patients for any evidence of stenosis or synechia formation. The medical records of enrolled patients were reviewed for demographics, diagnosis, prior surgery, type of sinus surgery, complications, incidence of stenosis/synechia, and need for further procedures.


RESULTS
Twenty-nine patients were included in the final analysis. The mean follow-up period was 15 months (range, 3-32 months). There were no complications in this series. Eight patients experienced 10 episodes of synechia formation and one patient experienced 1 episode of synechia formation and 1 episode of stenosis of the maxillary sinus ostium. Seven of the 12 episodes of synechia/stenosis occurred on the side of the MMC application and the remaining 5 episodes occurred on the side opposite to the MMC application. This difference was not statistically significant.


CONCLUSIONS
The topical application of MMC did not decrease the incidence of stenosis and synechia formation after ESS.
Anand
Vijay K
VK
Department of Otorhinolaryngology-Head and Neck Surgery, Weill Cornell Campus of New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Tabaee
Abtin
A
Kacker
Ashutosh
A
Newman
Jason G
JG
Huang
Clark
C
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use*; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin