Prevention of anterior glottic stenosis after bilateral vocal fold stripping with mitomycin C.
OBJECTIVE
To examine the effects of immediate application of topical mitomycin C (MMC) on the prevention of anterior glottic stenosis (AGS) after microsurgical stripping of both vocal folds, including the anterior commissure, in a canine model.


METHODS
Prospective randomized experimental study.


METHODS
Twelve canine larynges were injured by a stripping procedure of both entire membranous vocal folds. The dogs were randomly divided into 2 groups for treatment with 1.0 mg/mL of MMC or with isotonic sodium chloride solution (control) for 5 minutes immediately after surgery. Three and 6 weeks after surgery, the glottic webs were lysed and repeatedly treated with MMC or isotonic sodium chloride solution. The glottic wound healing and AGS formation were examined every week. Ten weeks after the initial surgery, all larynges were collected and examined histologically.


RESULTS
The stripping procedure induced AGS, affecting 58% to 86% (mean, 72%) of the length from the anterior commissure to the vocal process in the control group. The application of MMC at the time of initial surgery significantly lowered the incidence and extent of the web formation (P = .004). The AGS lesions were resolved by web lysis and treatment with MMC, without significant local adverse effects. Histological staining for collagen and elastin revealed that MMC treatment did not induce excessive fibrotic or atrophic changes in the lamina propria of the vocal folds.


CONCLUSIONS
Bilateral stripping of the membranous vocal folds induces significant AGS, which can be minimized by use of MMC at initial surgery.
Roh
Jong-Lyel
JL
Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Chung-Gu, Daejeon, Korea. rohjl@cnu.ac.kr
Yoon
Yeo-Hoon
YH
D000477:Alkylating Agents / Q000494:pharmacology*; D000818:Animals; D004285:Dogs; D005931:Glottis / Q000601:surgery*; D007829:Laryngostenosis / Q000517:prevention & control*; D008297:Male; D016685:Mitomycin / Q000494:pharmacology*; D011446:Prospective Studies; D011897:Random Allocation; D018709:Statistics, Nonparametric; D014827:Vocal Cords / Q000187:drug effects*
D000477:Alkylating Agents; D016685:Mitomycin