Effect of topical application of mitomycin-c as an adjuvant treatment of laryngotracheal stenosis

Abstract

Background Laryngotracheal stenosis (LTS) has become more frequent because of prolonged endotracheal intubation (PEI). The endoscopic treatment of LTS is often associated with high recurrence rate owing to excessive fibrosis. Mitomycin-c (MMC) inhibits fibroblast proliferation, so it is used at the time of endoscopic dilation to improve outcomes. Objective The aim was to assess the effect of application of topical MMC in the treatment of LTS to prevent recurrence of stenosis. Patients and methods A prospective study was carried out on 20 patients with LTS subjected to endoscopic dilatation. All patients were divided to two groups: group A (case group) included 10 patients with LTS who were subjected to endoscopic dilatation with topical application of MMC (0.5 mg/ml), and group B (control group) included 10 patients with LTS who were subjected to endoscopic dilatation without topical application of MMC. A neck computed tomography scan was done for all patients to detect the site and length of stenotic area. Results In group A, LTS was due to PEI in six (30%) patients, due to laryngoscleroma in three (30%) patients, and due to Wegener’s granulomatosis in one (10%) patients, whereas in group B, it was due to PEI in four (40%) patients, due to rhinoscleroma in four (40%) patients, and due to Wegener’s granulomatosis in two (2%) patients. The most common site of stenosis was subglottic and trachea in both groups. Most of the patients in case group ended up with grade 2 dyspnea (mild dyspnea with no limitation to daily activities), whereas three patients in control group achieved this outcome, with a statistically significant difference (P=0.043). None of the patients in the case group developed postoperative stridor 6 months after surgery, compared with four patients in the control group. Conclusion Topical application of MMC as an adjuvant treatment for endoscopic management of LTS has shown good results, low recurrence rate, and high success rate.