Mitomycin C For The Prevention Of Adhesion Formation After Functional Endoscopic Sinus Surgery In Chronic Rhinosinusitis Cases

Abstract

Background: Chronic Rhino-Sinusitis (CRS) is an extremely common clinical condition with a life time prevalence of around 15%. Messerklinger s technique of Functional endoscopic sinus surgery (FESS) has been accepted as treatment modality of choice for chronic sinus disease. Though there have been improvement in operative methods and instruments, postoperative adhesions and synechiae are seen in 11-36% of cases. Many anatomical barriers which were used to prevent adhesions have met with limited success. Topical Mitomycin-C (MMC) in prevention of adhesion formation at the end of FESS is a matter of debate and controversy and more studies are required in this field in establishing the role of topical MMC for prevention of adhesion formation after FESS. newlineObjective: To determine whether topical application of Mitomycin-C at the conclusion of Functional Endoscopic Sinus Surgery (FESS) decreases the incidence of postoperative adhesion formation. newlineMethodology: The study design was a clinical trial- static group comparison. The present study is comprised of 150 patients -75 patients in Group A (Interventional-MMC) and 75 patients in group B (Control-Normal saline). There were there were 30 unilateral and 45 bilateral sides -thus making a total of 120 operative sides in each group. In group-A, at the conclusion of the FESS operation cotton ribbon gauze piece soaked with 1 ml Mitomycin-C (0.4 mg/ml) was placed in middle meatus for a period of 4mins. Following application, nasal cavity was irrigated with sterile normal saline. In group-B normal saline was applied in middle meatus. Patients were examined weekly for 1 month after surgery. Additional examinations were done at the end of 2nd and 3rd month post-operatively. At 3rd month, outcome was assessed objectively using endoscopic findings and subjectively based on patient s symptoms. newlineResults: At third follow up, the rate of adhesions in group A was 5% and in group B was 25%.The difference was found to be statistically significant. (Chi-square=18.8241, p=0.00001). The diff