A novel technique for mitomycin-c application in frontal sinus surgery.

Area of Science:

• Otolaryngology
• Surgical Innovation
• Pharmacological Intervention

Background:

• Functional Endoscopic Sinus Surgery (FESS) can lead to adhesions and stenosis, particularly in frontal sinusotomy.
• Mitomycin-C (MMC) is used locally to mitigate these post-surgical complications.
• Its efficacy in the frontal ostium requires further investigation, comparing delivery methods.

Purpose of the Study:

• To evaluate the effectiveness of local mitomycin-C (MMC) application in the frontal ostium.
• To compare the efficacy of MMC delivery using a foamy otowick versus traditional cottonoids.
• To assess the impact on frontal ostium patency and the need for revision surgery.

Main Methods:

• A prospective study involving 47 patients with chronic rhinosinusitis without polyps.
• Two subgroups received intraoperative and 4-week post-operative MMC: one with cottonoids, the other with MMC in an otowick.
• Control nostrils received normal saline; endoscopic assessment occurred at 6 months.

Main Results:

• Mitomycin-C application was superior to normal saline in both delivery groups.
• The otowick method demonstrated superior initial results in primary cases, improving ostium patency and reducing revision surgery.
• MMC cottonoids showed no significant benefit in primary cases.

Conclusions:

• Local MMC application, particularly with the otowick delivery system, appears effective for maintaining frontal ostium patency.
• The otowick technique facilitates precise and deeper drug delivery to the frontal ostium.
• This approach may reduce the incidence of adhesions and stenosis after frontal sinus surgery.