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Topical Mitomycin as an Adjunct to Choanal Atresia Repair
Mukesh Prasad, MD;
Robert F. Ward, MD;
Max M. April, MD;
John P. Bent, MD;
Patrick Froehlich, MD
Arch Otolaryngol Head Neck Surg. 2002;128:398-400.
Objective To evaluate the use of topical mitomycin in choanal atresia repair to
reduce the development of granulation tissue and cicatrix.
Design and Setting Retrospective case series in 2 tertiary care centers.
Patients Twenty patients with either unilateral or bilateral congenital choanal
atresia underwent repair using the transnasal endoscopic approach, the transpalatal
approach, or both.
Interventions The surgeons favor the use of the endoscopic transnasal drillout technique
for all unilateral cases of choanal atresia and for selected bilateral cases.
We describe our experience and treatment paradigm for these 20 patients (15
with unilateral atresia, 5 with bilateral atresia). Topical application of
mitomycin was used, and in some cases postoperative stenting, for a period
of 1 to 2 weeks. In 8 cases, a second application of mitomycin was used. Follow-up
ranged from 3 months to 2 years (mean, 9 months).
Outcome Measure The patency of the choanae without respiratory distress or nasal drainage,
as assessed by endoscopic evaluation, determined a successful repair.
Results Of the 20 patients, 17 retained patent airways. Three patients experienced
improvement from a total atresia to a narrowed, stenotic choana.
Conclusions The use of mitomycin as an adjunct to the surgical repair of choanal
atresia may offer improved patency with a decreased need for stenting, dilatations,
and revision surgery. Newer endoscopic techniques with powered instrumentation
further enhance the safety and efficacy in the repair of choanal atresia.
From the Department of Otorhinolaryngology, Cornell University Medical
Center, Ithaca, NY (Drs Prasad and Ward); and the Departments of Otolaryngology,
New York University Medical Center, New York, NY (Dr April), Albert Einstein
College of Medicine of Yeshiva University, Bronx, NY (Dr Bent), and the University
of Lyon, Lyon, France (Dr Froehlich).
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