COMPARATIVE STUDY OF MIDDLE MEATAL ANTROSTOMY PATENCY WITH OR WITHOUT APPLICATION OF MITOMYCIN C

Abstract

Background: Chronic sinusitis produces long-term inflammation of the mucous lining of the sinuses. Functional endoscopic sinus surgery (FESS), as described by Messerklinger, has been fully accepted for treating chronic sinus disease, with the assumption that restoration of sinus ventilation and correction of mucous apposition will allow restoration of the muco-ciliary clearance system. One problem the surgeon often encounters is that of post-operative adhesion occurring between the middle turbinate and the lateral nasal wall in the region of the ethmoid sinuses. If severe, the recurrence of symptoms is often due to these synechiae, and further surgery may be required to restore normal function. Various surgical approaches, as well as the use of systemic drugs3 and site-specific barriers, have been used to minimize inflammation and injury during surgery so as to reduce the risk of adhesion formation. Mitomycin C is an antibioticantineoplastic agent isolated from Streptomyces caespitosus. It acts as an alkylating agent by selectively inhibiting deoxyribonucleic acid (DNA) synthesis and cross-linking DNA. At higher concentrations, cellular ribonucleic acid and protein synthesis are also suppressed. The purpose of this study was to determine whether mitomycin C could be used to prevent the closure of maxillary sinus antrostomies9 – 11 and to prevent frontal recess stenosis while promoting drainage of the ethmoidal and sphenoid sinus by preventing post-operative scarring.1,2 Objective: To study the role of mitomycin C in reducing adhesion formation following middle meatal antrostomy Study design: Prospective Interventional Comparative study Patients: Fifty patients were selected suffering long-term problems with bilateral chronic rhinosinusitis, with no relief obtained from medical therapy for more than 12 weeks. Patients with unilateral chronic rhinosinusitis and undergoing unilateral FESS, Acute exacerbation of symptoms, established asthma, uncontrolled hypertension, uncontrolled diabetes, suspected cystic fibrosis, drug induced and hormonal causes of rhinitis, presence of bleeding diathesis, previous history of nasal surgeries, Patients refusing to undergo CT scan, patients refusing endoscopic surgery, patients with established or impending complications were all excluded from the study. XV Material and Methods: Diagnostic nasal endoscopies and non-contrast computerized tomography of nose and paranasal sinuses were undertaken and following confirmation of the diagnosis, functional endoscopic sinus surgery (FESS) was carried out bilaterally using the Messerklinger technique. On completion of the surgery, a cotton wick soaked in mitomycin C was placed in one or other side of the nose in the middle meatus. Follow up was for three weeks, three months and six months, patients were assessed for subjective and objective improvement in their symptoms. Results: In the study there was significant difference in Grade of Ostia between cases and controls at 3 months and 6 months. Grade of Ostia at intraoperative period among cases and controls was Grade 1 (1cm*1cm). At 3 weeks among cases and controls, not much difference were found compared to ostia size made intra-operatively. At 3 months among cases and controls was Grade 2. There was significant difference in Median Grade between two groups. At 6 months among cases and controls was Grade 2 and Grade 3 respectively. There was significant difference in Grade of Ostia between two groups Conclusion: Mitomycin C may be topically applied in post-operative FESS cases to reduce adhesion formation and hence the need for revision surgery.