Mitomycine C : prévention et traitement des synéchies glottiques antérieures

Abstract

Topical applications of mitomycin C to the anterior glottis may prevent anterior glottic synechia (prevention group) or restenosis (treatment group). In the prevention group, six patients with glottic carcinoma involving the anterior commissure were treated by transoral laser surgery. Repeated procedures were performed in one patient. For the six patients in the treatment group, the anterior glottic synechia was secondary to frontolateral laryngectomy (three patients), transoral laser therapy for laryngeal papillomatosis (two patients) or bilateral glottic carcinoma (one patient). Mitomycin C (0.4 mg/ml) was used as a topical application on the anterior commissure for a duration of 4 minutes. Outcome was assessed clinically at three months using a visual scale: no synechia (success), micro-synechia (partial failure), and synechia (failure). In the prevention group, there were six successes and one partial failure. In the treatment group, there were two successes, three partial failures, and one failure. No side effects were noted. Topical application of mitomycin C was effective to prevent anterior glottic synechia after transoral laser surgery for glottic carcinoma involving the anterior commissure. It is an alternative to endolaryngeal keel in patients with sequellar synechia. These preliminary results should be further evaluated in a larger series.