Airway complications from topical mitomycin-c

Abstract

Problem: Topical application of mitomycin-C appears to be a useful adjunct in reducing cicatricial scarring of the airways. Human and animal studies have demonstrated the efficacy and safety of mitomycin topically in the treatment of airway stenosis at concentrations ranging from 0.4 mg/cc to 10 mg/cc. Although no reports of mitomycin toxicicity have been reported in the otolaryngology literature, the ophthalmologic literature has documented serious, vision-threatening complications resulting from the use of topical mitomycin-C. The purpose of this study is to report complications related to mitomycin-C use in the treatment of glottic and subglottic stenosis. Risk factors associated with these complications are identified. Methods: A retrospective chart review of all patients treated by the senior author for glottic, subglottic, and tracheal stenosis during a 4-year period was performed to determine incidence of complications. Variables studied were: patient age and gender, location and severity of stenosis, medical comorbidities, length of procedure, postoperative instrumentation of the airway, and mitomycin-C concentration. Results: Sixty-six cases of adjuvant topical mitomycin-C use following laser laryngoscopic treatment and dilation for upper airway stenosis were identified in a total of 45 patients. Complications due to local toxicity of mitomycin-C occurred in 4 patients of 66 (or 6%), manifested by accumulation of fibrinous debris at the operative site, resulting in partial airway obstruction, and the need for emergent airway intervention. A significantly higher percentage of complications occurred when supersaturated mitomycin-C (10 mg/cc) was used ( P < 0.05). Conclusion: Caution should be exercised when using topical mitomycin-C in the treatment of airway stenosis. Local tissue effects from fibroblast inhibition may, in some instances, lead to the accumulation of fibrinous exudates that can obstruct the airway in the early postoperative period. Significance: This is the first study describing serious complications and potential risk factors related to topical mitomycin-c use in the endoscopic treatment of upper airway stenosis. Support: None reported.