gms | German Medical Science

Background: Mitomycin C (MMC) inhibits the proliferation of fibroblasts. Therefore, it has been used successfully for 30 years for prevention of re-stenosis in the surgery of lacrimal duct or glaucoma. In the last years, the use of MMC is also increasing in the prevention of scares in Otorhinolaryngology, e.g. also in the laryngeal and tracheal surgery.

Patients and Methods: In the time from 02/02 to 10/07 MMC was applicated topically during surgery of 38 patients (mean age 56 [2–84] years) as off-label use. In 29 of 38 patients there was the history of an operated malignant tumor. After laser-surgical dissection of the scares, they were swabbed with MMC [2 mg/ml] for 2 minutes. MMC was used in following indications: 16 patients suffered from a glottic stenosis, 15 from a postoperative scarry fixation between tongue and floor of the oral cavity, 3 patients each from a subglottic or tracheal stenosis and one from a keloid.

Results: Observation of the postoperative progress showed a notable and constant improvement of tongue motility in 9 of 15 cases after combination of laser-surgical detaching of the tongue and application of MMC. The 3 cases of subglottic stenosis were also improved significantly after that therapeutical procedure. After glottic application of MMC – mostly anterior synechia after laser-surgical partial laryngectomy – the outcome (endoscopy, stroboscopy, RBH-score) was satisfying in 10 of 16 patients, in 6 – one with laryngeal involvement of Churg-Strauss-syndrome – a re-stenosis was observed after only few weeks.

Discussion: These first results are encouraging, so that a prospective randomized study is initiated to evaluate the value of local application of MMC added or omitted to the laser-surgical therapy.