Objectives: The present study aimed to evaluate effect of application of mitomycin C immediately and 1-month after surgery (PO) on the outcome of functional endoscopic sinus surgery (FESS).
Patients & Methods: The study included 30 patients (23 males and 7 females with mean age of 25.3±2.6 years) with treatment-resistant chronic rhinosinusitis (CRS) assigned for FESS. All patients completed the Rhinosinusitis Symptom Inventory (RSI), which includes major and minor sinonasal symptoms on a 6-point scale (0= absence & 5= maximally severe symptoms). Then, all patients underwent preoperative CT scanning and endoscopic nasal examination. Endoscopic findings were graded according to Lund-Kennedy scoring system to bilaterally assess the nasal mucosa edema, presence of secretion and presence of polyps. FESS was conducted using Kennedy technique. At the end of endoscopic surgery and four weeks PO, all patients received a piece of gauze soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatus for 5 minutes. At 6- months PO, patients were assessed using RSI for symptoms scoring and underwent follow-up endoscopy for re-assessment for the presence of synechiae and/or antrostomy stenosis.
Results: All patients had bilateral mucosal edema and nasal discharge; 11 noses (18.4%) were free of nasal polyposis with a mean total Lund-Kennedy score for both sides/patient was 10.4±1.4. For all evaluated symptoms, postoperative RSI scores were significantly lower at both 1-month and 6-months postoperative compared to preoperative scores with significantly lower RSI scores at 6-months compared to at 1-month PO. Three patients (10%) reported significant improvement of facial tenderness, nasal obstruction and discharge but non-significant improvement of the other presenting symptoms with a non-significant difference in RSI scores estimated at 6-months compared to that estimated at 1-month PO. Another 2 patients reported recurrence of symptoms at 6-months after surgery after reporting complete relief at 1-month PO despite significantly lower RSI scores at both 1-month and 6-months compared to preoperative scores. Follow-up endoscopy detected mild unilateral synechiae in 2 and moderate unilateral synechiae in one patient; but detected bilateral synechiae (mild on right and moderate on left side) in the 4th patient. Ostial re-stenosis was reported in one patient (right side) with technical success rate of 90%.
Conclusion: It could be concluded that application of mitomycin C immediate and one-month postoperative prevents re-stenosis and synechiae development with clinical success rate of 90% and progressive significant reduction of postoperative RSI scores Tanta medical journal 2008
|
