Intra- and postoperative application of Mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS.
OBJECTIVE
Obstruction of the osteomeatal complex is the commonest anatomic finding in revision endoscopic sinus surgery. This study assesses the efficacy of topical mitomycin C in the middle meatus, intra- and postoperatively in the prevention of adhesion formation and restenosis of the maxillary sinus antrostomy.


METHODS
At the end of endoscopic surgery for chronic rhinosinusitis and four weeks postoperatively 30 patients received a pledget soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatus for 5 minutes while a pledget soaked in saline was placed in the contralateral side. Patients were assessed at least 6 months postoperatively by a blinded observer for the presence of synechiae and antrostomy stenosis. Medical records were reviewed for episodes of recurrent sinusitis.


RESULTS
Adhesions were observed in 8 patients. All adhesions rated as moderate to severe (4 patients) were observed in the control side (p = 0.043). Restenosis was observed in 2 sides treated with mitomycin C and in 9 control sides (p = 0.032). Recurrent symptoms of sinusitis occurred in three patients on the saline side.


CONCLUSIONS
Mitomycin C is safe and effective in the prevention of severe adhesions and antrostomy stenosis when applied twice, during surgery and the early postoperative period.
Konstantinidis
I
I
2nd University ORL, Department, Papageorgiou Hospital, Thessaloniki, Greece. jordan_orl@hotmail.com
Tsakiropoulou
E
E
Vital
I
I
Triaridis
S
S
Vital
V
V
Constantinidis
J
J
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage*; D012220:Rhinitis / Q000517:prevention & control / Q000601:surgery*; D055502:Secondary Prevention; D012852:Sinusitis / Q000517:prevention & control / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin