Background/Aims: Laryngotracheal stenosis (LTS) is a difficult entity to treat, with many patients requiring multiple procedures. Our study assessed the efficacy of mitomycin C (MMC) application as complimentary treatment of LTS. Methods: We reviewed clinical charts of patients with operative procedures for LTS between January 2005 and May 2013. Patients were grouped according to mitomycin use. Several outcome measures were assessed, including the number of procedures and time between procedures. Results: Seventy-one patients were included in the study (30 MMC, 41 non-MMC). They underwent similar numbers of procedures (2.3 MMC, 2.0 non-MMC, p > 0.05). The average time between procedures was 360 (MMC) and 178 (non-MMC) days (p = 0.015). Multiple treatments with mitomycin increased the duration between procedures (366 vs. 340 days, multiple vs. single application, p > 0.05). Fewer mitomycin patients underwent procedures for respiratory distress than non-MMC patients (6.6 vs. 19.5%, p > 0.05). Mitomycin use increased the duration between procedures in patients treated specifically for subglottic stenosis (375 vs. 186 days, p > 0.05). Conclusion: Our results and experiences with mitomycin demonstrate it is an effective agent for adjuvant treatment of LTS. Its use lengthens the symptom-free period, with further improvement demonstrated when patients expected to undergo multiple surgeries receive multiple mitomycin treatments.

Keywords:
Laryngotracheal stenosis, Mitomycin C, Adjuvant treatment
1.
Fernando HC, Sherwood JT, Krimsky W: Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading? Ann Thorac Surg 2010;89:S2183-S2187.
2.
Spier BJ, Sawma VA, Gopal DV, Reichelderfer M: Intralesional mitomycin C: successful treatment for benign recalcitrant esophageal stricture. Gastrointest Endosc 2009;69:152-153; discussion 153.
3.
Gil-Carcedo E, Gil-Carcedo LM, Vallejo LA, Ortega C, López C: Total idiopathic laryngotracheal stenosis. Treatment with mitomycin C (in Spanish). Acta Otorrinolaringol Esp 2007;58:219-221.
4.
Valdez TA, Shapshay SM: Idiopathic subglottic stenosis revisited. Ann Otol Rhinol Laryngol 2002;111:690-695.
5.
Cortés de Miguel S, Cabeza Barrera J, Gallardo Medina M, Cassini Gómez de Cádiz LF, Salmerón-García A, Rodríguez Lucas F: Topical endotracheal mitomycin C as a complementary treatment for endoscopic treatment of recurrent laryngotracheal stenosis (in English and Spanish). Farm Hosp 2011;35:32-35.
6.
Roediger FC, Orloff LA, Courey MS: Adult subglottic stenosis: management with laser incisions and mitomycin-C. Laryngoscope 2008;118:1542-1546.
7.
Parker NP, Bandyopadhyay D, Misono S, Goding G Jr: Endoscopic cold incision, balloon dilation, mitomycin C application, and steroid injection for adult laryngotracheal stenosis. Laryngoscope 2013;123:220-225.
8.
Quesnel AM, Lee GS, Nuss RC, Volk MS, Jones DT, Rahbar R: Minimally invasive endoscopic management of subglottic stenosis in children: success and failure. Int J Pediatr Otorhinolaryngol 2011;75:652-656.
9.
Ubell ML, Ettema SL, Toohill RJ, Simpson CB, Merati AL: Mitomycin-c application in airway stenosis surgery: analysis of safety and costs. Otolaryngol Head Neck Surg 2006;134:403-406.
10.
Vira D, DeConde A, Chhetri DK: Endoscopic management of supraglottic laryngopharyngeal stenosis. Otolaryngol Head Neck Surg 2012;146:611-613.
11.
Smith ME, Elstad M: Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one? Laryngoscope 2009;119:272-283.
12.
Perepeliitsyn I, Shapshay SM: Endoscopic treatment of laryngeal and tracheal stenosis - has mitomycin C improved the outcome? Otolaryngol Head Neck Surg 2004;131:16-20.
13.
Heran MK, Pham TH, Butterworth S, Robinson A: Use of a microporous polytetrafluoroethylene catheter balloon to treat refractory esophageal stricture: a novel technique for delivery of mitomycin C. J Pediatr Surg 2011;46:776-779.
14.
Sen S, Meteoglu I, Ogurlu M, Sen S, Derincegoz OO, Barutca S: Topical heparin: a promising agent for the prevention of tracheal stenosis in airway surgery. J Surg Res 2009;157:e23-e29.
15.
Simpson CB, James JC: The efficacy of mitomycin-C in the treatment of laryngotracheal stenosis. Laryngoscope 2006;116:1923-1925.
16.
Daher P, Riachy E, Georges B, Georges D, Adib M: Topical application of mitomycin C in the treatment of esophageal and tracheobronchial stricture: a report of 2 cases. J Pediatr Surg 2007;42:E9-E11.
17.
Ward RF, April MM: Mitomycin-C in the treatment of tracheal cicatrix after tracheal reconstruction. Int J Ped Otorhinolaryngology 1998;44:221-226.
18.
Roh JL, Kim DH, Rha KS, Sung MW, Kim KH, Park CI: Benefits and risks of mitomycin use in the traumatized tracheal mucosa. Otolaryngol Head Neck Surg 2007;136:459-463.
19.
Shvidler J, Bothwell NE, Cable B: Refining indications for the use of mitomycin C using a randomized controlled trial with an animal model. Otolaryngol Head Neck Surg 2007;136:653-657.
20.
Hueman EM, Simpson CB: Airway complications from topical mitomycin C. Otolaryngol Head Neck Surg 2005;133:831-835.
21.
Roh JL, Lee YW, Park CI: Can mitomycin C really prevent airway stenosis? Laryngoscope 2006;116:440-445.
22.
Iñiguez-Cuadra R, San Martín Prieto J, Iñiguez-Cuadra M, et al: Effect of mitomycin in the surgical treatment of tracheal stenosis. Arch Otolaryngol Head Neck Surg 2008;134:709-714.
23.
Yamamoto K, Kojima F, Tomiyama K, Nakamura T, Hayashino Y: Meta-analysis of therapeutic procedures for acquired subglottic stenosis in adults. Ann Thorac Surg 2011;91:1747-1753.
24.
Arebro J, Henriksson G, Macchiarini P, Juto JE: New treatment of subglottic stenosis due to Wegener's granulomatosis. Acta Otolaryngol 2012;132:995-1001.
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2015
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