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Otolaryngology–Head and Neck Surgery, 2012

Objectives (1) To conduct an adequately powered randomized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhinostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design A randomized controlled study. Setting General hospital. Subjects and Methods Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mitomycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and complete closure of nasolacrimal stoma with tough fibrous tissue (63%). There was no si...

Indian Journal of Otolaryngology and Head & Neck Surgery, 2011

The aim of the study is to compare the subjective (relief of symptoms) and objective (endoscopic visualization of ostium patency at the time of syringing) outcomes at the end of two procedures-Endonasal DCR versus External DCR with Mitomycin C and to assess the role of Mitomycin C in maintaining patency of nasolacrimal drainage system. Prospective randomized comparative study was performed. Thirty-five patients were enrolled in each endoscopic and external dacryocystorhinostomy groups with Mitomycin C (MMC) application. The 37 eyes underwent endonasal DCR (28 unilateral primary eyes ? 1 bilateral primary eyes ? 5 unilateral revision eyes ? 1 bilateral revision eye) while 35 eyes underwent external DCR (34 unilateral primary eyes ? 1 unilateral revision eye). Mitomycin C 0.2 mg/ml was applied intra-operatively for 5 min to the ostium site at the end of endonasal or external DCR procedure. Objective assessment by syringing at the end of 1 year in the endonasal group showed 35 eyes (94%) were patent, 1 (3%) was partially blocked and 1(3%) was completely blocked; while in external group all 35 eyes (100%) were patent. Endoscopic visualization of the ostium at the time of syringing showed only one eye (3%) in the endonasal group was blocked while all the other eyes in both groups were patent. Both groups had a mean follow-up of 6-36 months. No complications were associated with use of Mitomycin C. In conclusion, intra-operative use of Mitomycin C in both endoscopic DCR and external DCR is safe and effective in increasing the success rate.

2012

Aim: The aim of the study is to visualize the patency and measure the ostium size at the end of Endonasal DCR with mitomycin C (MMC) versus control and to assess the role of Mitomycin C in maintaining patency of nasolacrimal drainage system. Design: Prospective randomized controlled study Participants: Sixty patients who consented for this study was subjected to endonasal DCR and randomised into 2 groups (30 cases with mitomycin – C and 30 cases without MMC). Methods: Mitomycin-C 0.2mg/ml was applied intra-operatively for 5mins to the ostium site at the end of endonasal DCR in the MMC group. Results: In the mitomycin C group, 97% (29/30) of the ostium was found to be patent while in the control group 87% (26/30) were found to be patent. It was found that there was statistically significant difference in the osteotomy surface area between the MMC group and control group (p < 0.001).Both groups had a mean follow-up of 24-36 months. No complications were associated with use of Mitom...

Prospective study. Aim of the study: Aim of this study is to evaluate the efficacy of application of Mitomycin-C intraoperatively to the created stoma in endoscopic endonasal dacryocystorhinostomy(DCR)&compared the results with results of endoscopic endonasal DCR procedure without Mitomycin-C. Time and place: Study was performed in Al-Sadder medical city in AL-Najaf Governorate during the period from March 2012 to April 2014. Patients and methods: Sixty seven eyes of 64 patients , there were 46 females and 18 males ranging in age from 5 to 56 years. Patients were randomly divided into 2 groups: group1 an endonasal endoscopic DCR surgery done without Mitomycin-C application and group2 in which 0.2 mg/ml Mitomycin-C was applied to created stoma for 5 min. Results: Mean age for male is 21.7 years and for female 35.29 years. Nasal synecchia was identified in the ipsilateral site of surgery in 5(15.625%) patients in group1 and 3(9.375%)patients in group2. Two patient (6.25%) in group1, and one patient (3.125%) in group2 developed granulation tissue around the stoma and represent as failure operation. Conclusion: The endoscopic DCR is a relatively safe and effective procedure for treatment of distal lacrimal apparatus obstruction. Endoscopic DCR should be considered in all age group patients and in patients who wish to avoid a facial scar. It is difficult to make a definite evidence-based determination about the relative efficacy of Mitomycin-C application in endonasal endoscopic DCR because there was many studies that show highly successful rate of use of Mitomycin-C and other studies denied this possibility.Antimitotic agents is a new treatment modality in endoscopic lacrimal surgery , its intraoperative use seems to be easy and safe, but in our study and others limited series showed no benefit in the use of the drug.

An International Journal Clinical Rhinology, 2013

Aim To evaluate the role of intraoperative mitomycin-C application in primary endoscopic endonasal dacryocystorhinostomy (DCR) and compare the results with conventional endoscopic endonasal DCR. Study design Prospective comparative interventional study. Setting Tertiary referral hospital. Materials and methods Fifty patients in the age group of 16 to 50 years presenting with symptoms and signs suggestive of nasolacrimal duct blockage refractory to conventional medical treatment were included in the study. They were assigned randomly into two groups of 25 patients each. Group A patients underwent endoscopic endonasal DCR followed by application of mitomycin-C. Group B patients underwent endoscopic endonasal DCR without application of mitomycin-C. The two groups were compared with regard to success rate and complications. The main outcome measures for success were the resolution of epiphora and patency with lacrimal irrigation. Results After 1 year, 24 patients (96%) in each group had...

Journal of Evidence Based Medicine and Healthcare

BACKGROUND Endoscopic dacryocystorhinostomy (DCR) has certain advantages over the conventional external DCR. Failures in endo DCR are mainly due to reclosure of stoma in the lateral nasal wall. Mitomycin-C is an alkylating, an antiproliferative agent which reduces fibroblast collagen synthesis by inhibiting DNA dependent RNA synthesis and suppresses cellular proliferation when topically applied to mucosal tissues inhibit excessive scar tissue and granulation tissue formation. We wanted to evaluate the role of Mitomycin-C in endoscopic endo nasal DCR as an adjunct. METHODS Our prospective study was performed with 104 patients in 35-75 years age group who presented with chronic dacryocystitis. The study sample was designed randomly into Group A and group B. Group A patients were treated with Mitomycin-C to the incision site and Group B patients were not administered Mitomycin-C. These patients had 6 months of follow up. RESULTS 50 patients out of 52 in Group A had successful surgical outcome. In Group B 48 patients out of 52 were clinically free after the dacryocystorhinostomy. The results obtained had no significant difference between the Group A and Group B. CONCLUSIONS Use of intraoperative mitomycin-C is easy and safe but, in our study, it does not show any significant benefit in surgical outcome of endo DCR in preventing reclosure of stoma site.

This was a prospective randomized study. MATERIAL AND METHODS : 46 patients of epiphora with nasolacrimal duct obstruction, were enrolled in our study. These patients were assigned randomly into 2 groups of 23 patients each. Group A (with Mitomycin-C) group B(without Mitomycin-C) using a random allocation software. Consecutive endoscopic dacryocystorhinostomy was performed with and without local application of mitomycin-C from June 2011 to June 2013. In group A Mitomycn-C was applied with a cotton ball soaked in 0.5 mg/ml concentration to the prepared rhinostomy site. The post operative follow up was done at 1 week, 2 months, 6 months and 1 year to assess lacrimal patency using syringing. The ostium size was assessed at 6 months and 1 year of follow up. STATISTICAL ANALYSIS : The result of endoscopic DCR with and without application of Mitomycin-C were then recorded and analysed using paired t-test and Mann Whitney U test. RESULTS : The postoperative follow up period was 1 year. The mean area of Ostium at 1 year in group A was 3.8 mm 2 (SD 1.5) and in group B was 1.3mm 2 (SD 0.4) which was statistically significant (P value <0.001). The mean decreased in ostium size at the end of 1 year in group A was 3.1 (SD 2.3) and in group B was 1.4 (SD 1.4) which is also statistically significant (p value <0.004) CONCLUSION : Intraoperative use of o.5mg/ml mitomycin-C does not affect the success rates of endonasal endoscopic dacryocystorhinostomy at 1 year follow up. However it was found to maintain a larger ostium at the postoperative observational period.

Indian Journal of Otolaryngology and Head &amp; Neck Surgery, 2018

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative topical application of mitomycin-C. Methods: The procedure was carried out in 34subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C and the other 20cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcome measures were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6months, 1year and 2years. Results: The success rate was 100% at 3 and 6 months follow-up in both the groups. At the end of one year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. Conclusion: We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. They can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure.

ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY

The aim of this study is to evaluate and compare the changes in Quality of Life (QoL) before and after Endoscopic Dacryocystorhinostomy with & without Mitomycin C. Introduction: With the advent of Endoscopic Dacryocystorhinostomy over the last few decades there arises need for reducing failure and tackling the complications of this surgery. Studies done still show a better success rate for External Dacryocystorhinostomy over the endoscopic approach. Mitomycin-C can be used to reduce fibrous proliferation to maintain patency of stoma and improve the success rate. Objective and Study Design: A Prospective Randomized study to compare the patency of stoma and relief of epiphora after Endoscopic Dacryocystorhinostomy with Mitomycin C and without in cases of Chronic Dacryocystitis. Materials and Method: 22 patients with Chronic Dacryocystitis were included in the study after considering inclusion and exclusion criteria. 11 cases underwent Endoscopic Dacryocystorhinostomy with adjuvant application of Mitomycin-C 0.4mg/ml at the rhinostomy site and 11 without. They were followed up for 2 weeks, 4 weeks and 6 months after surgery and evaluated both subjectively and objectively Results: The success rate at 6 months after surgery was found to be 100% for Endoscopic Dacryocystorhinostomy irrespective of the use of Mitomycin C. Presence of synechae in the post-operative period was found to be less with the drug but not statistically significant. Conclusion: Mitomycin C has no significant bearing on the success of Endoscopic Dacryocystorhinostomy. It does appear to induce a good healing profile in terms of mucosal recovery and wound healing. An atraumatic and meticulous surgical technique ensures good results irrespective of the adjuvant usage of Mitomycin C .

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2017

Background: Inflammation of the lacrimal sac and duct is a common and unpleasant condition, leading to troublesome epiphora and recurrent dacryocystitis. Surgery is the preferred treatment modality of chronic dacryocystitis which can be performed by external approach or endoscopic nasal approach. Endoscopic dacrycocystorhinostomy (EnDCR) is now a well-established procedure to relieve nasolacrimal duct obstruction, becoming ENT surgeons' domain. The aim of this study is to assess the efficacy and compare results of intraoperative use of nasolacrimal stent in comparison of mitomycin-C (MMC) in endoscopic dacryocystorhinostomy. Methods: A prospective study of 56 patients with acquired NLDO with epiphora and recurrent dacryocystitis who were evaluated and managed between Oct 2014 and Oct 2016. All patients were offered surgical line of management by endoscopic route. They were randomly assigned into two groups-mitomycin-C group (Group A) and silastic nasolacrimal stenting (Group B). 46 patients who matched inclusion criteria's were included in the study after formal evaluation by ENT surgeon and Ophthalmologist. 26 patients underwent endoscopic dacryocystorhinostomy with Mitomycin-C application intraop, 20 patients underwent nasolacrimal silicone stent placement. Results: At 6-month follow-up visit, the management was considered successful if the lacrimal sac irrigation succeeded with relief of symptoms. The success rate in Group A was 92.30%. Group B had 85% success rate. However, no significant (p value=0.37) was noticed between two groups. Conclusions: Despite, no significant difference in outcome between two modalities, there is a trend towards the better outcome with use of mitomycin-C. Mitomycin-C is a safe, effective, and economical adjuvant in endoscopic DCR assisting in improved outcomes of surgery.