John M Carter1, Claire Lawlor2, J Lindhe Guarisco3. 1. Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States. Electronic address: jcarter9@tulane.edu. 2. Tulane University Department of Otolaryngology - Head & Neck Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, United States. Electronic address: clawlor@tulane.edu. 3. Ochsner Medical Center - Department of Otolaryngology - Head & Neck Surgery, 1514 Jefferson Hwy, Jefferson, LA 70121, United States. Electronic address: lguarisco@ochsner.org.
Abstract
OBJECTIVE: To determine the efficacy of topical mitomycin and stenting in patients that have undergone endoscopic repair of choanal atresia. METHODS: Retrospective review of 37 endoscopic operations on pediatric patients for choanal atresia. RESULTS: Twenty-six sides were operated on in 17 patients; 37 total operations were performed. All 17 patients were repaired endoscopically with 1 patient requiring transpalatal revision surgery. Eight patients (47%) had a unilateral atresia and 9 (53%) were bilateral. Eleven total sides (42%) were treated initially with mitomycin. Eighteen percent of those sides required post-operative dilation vs. 40% of the sides not treated with mitomycin (p=0.39) and no patient in the mitomycin group required revision surgery compared to 20% of patients not treated with mitomycin (p=0.24). Significantly fewer sides in the mitomycin group (9%) developed granulation vs. those treated without (53%) (p=0.03). The average number of procedures performed (1.18 vs. 2.53; p=0.002) was significantly fewer in those patients treated with mitomycin vs. not. A greater amount of sides in the stent group developed granulation tissue (50% vs.0%; p=0.023). The average number of procedures performed was significantly greater in those patients treated with a stent (2.33 vs. 1.12; p=0.008). The average time spent in the hospital was significantly shorter (7.09 vs. 2.33 days; p=0.02) in those patients treated without stenting. CONCLUSION: Topical mitomycin is efficacious as an adjuvant therapy as it was associated with the formation of less granulation tissue, a lower rate of restenosis and fewer surgeries. Stenting was associated with significantly more procedures, greater formation of granulation tissue and longer overall hospital stays. However, consideration should be given toward stent placement in all neonates for the prevention of post-operative airway obstruction. LEVEL OF EVIDENCE: 2c.
OBJECTIVE: To determine the efficacy of topical mitomycin and stenting in patients that have undergone endoscopic repair of choanal atresia. METHODS: Retrospective review of 37 endoscopic operations on pediatric patients for choanal atresia. RESULTS: Twenty-six sides were operated on in 17 patients; 37 total operations were performed. All 17 patients were repaired endoscopically with 1 patient requiring transpalatal revision surgery. Eight patients (47%) had a unilateral atresia and 9 (53%) were bilateral. Eleven total sides (42%) were treated initially with mitomycin. Eighteen percent of those sides required post-operative dilation vs. 40% of the sides not treated with mitomycin (p=0.39) and no patient in the mitomycin group required revision surgery compared to 20% of patients not treated with mitomycin (p=0.24). Significantly fewer sides in the mitomycin group (9%) developed granulation vs. those treated without (53%) (p=0.03). The average number of procedures performed (1.18 vs. 2.53; p=0.002) was significantly fewer in those patients treated with mitomycin vs. not. A greater amount of sides in the stent group developed granulation tissue (50% vs.0%; p=0.023). The average number of procedures performed was significantly greater in those patients treated with a stent (2.33 vs. 1.12; p=0.008). The average time spent in the hospital was significantly shorter (7.09 vs. 2.33 days; p=0.02) in those patients treated without stenting. CONCLUSION: Topical mitomycin is efficacious as an adjuvant therapy as it was associated with the formation of less granulation tissue, a lower rate of restenosis and fewer surgeries. Stenting was associated with significantly more procedures, greater formation of granulation tissue and longer overall hospital stays. However, consideration should be given toward stent placement in all neonates for the prevention of post-operative airway obstruction. LEVEL OF EVIDENCE: 2c.
Authors: Wolfgang Hohenforst-Schmidt; Paul Zarogoulidis; Georgia Pitsiou; Bernd Linsmeier; Drosos Tsavlis; Ioannis Kioumis; Eleni Papadaki; Lutz Freitag; Theodora Tsiouda; J Francis Turner; Robert Browning; Michael Simoff; Nikolaos Sachpekidis; Kosmas Tsakiridis; Bojan Zaric; Lonny Yarmus; Sofia Baka; Grigoris Stratakos; Harald Rittger Journal: J Cancer Date: 2016-01-13 Impact factor: 4.207
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