title: The efficacy of mitomycin and stenting in choanal atresia repair: a 20 year experience.
abstract: OBJECTIVE
  To determine the efficacy of topical mitomycin and stenting in patients that have undergone endoscopic repair of choanal atresia.
  
  
  METHODS
  Retrospective review of 37 endoscopic operations on pediatric patients for choanal atresia.
  
  
  RESULTS
  Twenty-six sides were operated on in 17 patients; 37 total operations were performed. All 17 patients were repaired endoscopically with 1 patient requiring transpalatal revision surgery. Eight patients (47%) had a unilateral atresia and 9 (53%) were bilateral. Eleven total sides (42%) were treated initially with mitomycin. Eighteen percent of those sides required post-operative dilation vs. 40% of the sides not treated with mitomycin (p=0.39) and no patient in the mitomycin group required revision surgery compared to 20% of patients not treated with mitomycin (p=0.24). Significantly fewer sides in the mitomycin group (9%) developed granulation vs. those treated without (53%) (p=0.03). The average number of procedures performed (1.18 vs. 2.53; p=0.002) was significantly fewer in those patients treated with mitomycin vs. not. A greater amount of sides in the stent group developed granulation tissue (50% vs.0%; p=0.023). The average number of procedures performed was significantly greater in those patients treated with a stent (2.33 vs. 1.12; p=0.008). The average time spent in the hospital was significantly shorter (7.09 vs. 2.33 days; p=0.02) in those patients treated without stenting.
  
  
  CONCLUSIONS
  Topical mitomycin is efficacious as an adjuvant therapy as it was associated with the formation of less granulation tissue, a lower rate of restenosis and fewer surgeries. Stenting was associated with significantly more procedures, greater formation of granulation tissue and longer overall hospital stays. However, consideration should be given toward stent placement in all neonates for the prevention of post-operative airway obstruction.
  
  
  METHODS
  2c.
authors.affiliation: Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States. Electronic address: jcarter9@tulane.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Carter
authors.affiliation: Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States. Electronic address: clawlor@tulane.edu.
authors.forename: Claire
authors.initials: C
authors.lastname: Lawlor
authors.affiliation: Ochsner Medical Center - Department of Otolaryngology - Head & Neck Surgery, 1514 Jefferson Hwy, Jefferson, LA 70121, United States. Electronic address: lguarisco@ochsner.org.
authors.forename: J Lindhe
authors.initials: JL
authors.lastname: Guarisco
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000477:Alkylating Agents / Q000627:therapeutic use*; D002648:Child; D002754:Choanal Atresia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin
keywords: Choanal atresia; Dilation; Mitomycin; Stent; Surgery