Preliminary Results of Topical Mitomycin Application in Laryngotracheal Stenosis

후두기관협착증에 있어서 mitomycin 국소 도포 : 예비결과

Restenosis frequently develops with granulation and overgrowth of scar following surgical treatment for laryngotracheal stenosis. Various methods such as stenting or CO2 laser application have been used to prevent restenosis, but they were seldom unsatisfactory. Mitomycin is an antineoplastic antibiotics derived from Streptomyces caespitosus; it inhibits fibroblast proliferation and acts as an alkylating agent to inhibit DNA synthesis. This study was desinged to evaluate effectiveness and determine indications of usage of topical mitomycin for laryngotracheal stenosis as a nonsurgical means of reducing postoperative granulation and scar tissue formation. Patients and Method : A retrospective study was performed on eight cases of laryngotracheal stenosis with topical mitomycin application. The author analyzed clinical outcomes of operative treatment with topical mitomycin. Patients underwent laryngotracheal reconstruction, endoscopic granulation removal, or bronchoscopic bougienage followed by topical application of mitomycin (0.4 mg/$m{\ell}$, 4minuntes) on the lesion intraoperatively. Result : Overall success rate of decannulation was 38% ($\frac{3}{8}$). Successful decannulation was possible in 75% ($\frac{3}{4}$) of laryngeal stenosis patients, 75% ($\frac{3}{4}$) of children, 60% ($\frac{3}{5}$) of the patients without previous surgery, and 75% ($\frac{3}{4}$) of bronchoscopic bougienage. Conclusion : The topical application of mitomycin in laryngotracheal stenosis was effective in untreated pediatric laryngeal stenosis which underwent bronchoscopic bougienage. Our results show that the topical mitomycin application for laryngotracheal stenosis could be a effective adjuvant treatment.