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<p>Synechiae formation and ostial stenosis are among the most common causes of failure after functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Mitomycin C (MMC), an antiproliferative agent, has been proposed to reduce postoperative fibrosis and adhesion formation. To evaluate the efficacy of intraoperative topical Mitomycin C in reducing postoperative adhesions, crustation, and ostial stenosis following FESS. This prospective controlled study included 60 patients with bilateral CRSwNP refractory to medical treatment who underwent FESS. A split-nose design was used: one nasal cavity received topical MMC (0.4&#xa0;mg/ml for 5&#xa0;min), while the contralateral side received saline as control. Patients were followed for 6 months. Outcomes were assessed subjectively using the Visual Analogue Scale (VAS) and objectively by endoscopic examination according to the Modified Lund–Mackay scoring system. Maxillary and frontal sinus ostial patency were also evaluated. Statistical analysis was performed using SPSS version 24, with <i>p</i> &lt; 0.05 considered significant. At 6 months postoperatively, the MMC-treated side showed statistically significant improvement in VAS scores for nasal obstruction (<i>p</i> = 0.018), nasal discharge (<i>p</i> &lt; 0.001), facial pain (<i>p</i> &lt; 0.001), and olfactory disturbance (<i>p</i> = 0.005) compared to the control side. Endoscopic assessment demonstrated a significant reduction in synechiae formation at 1 month (<i>p</i> = 0.006), 3 months (<i>p</i> = 0.013), and 6 months (<i>p</i> = 0.023) in the MMC group. Crustation was also significantly reduced at 1 month (<i>p</i> = 0.026), 3 months (<i>p</i> = 0.005), and 6 months (<i>p</i> = 0.027). Although maxillary and frontal ostial stenosis rates were lower in the MMC group, the differences were not statistically significant. No major intraoperative or postoperative complications were observed. Topical application of Mitomycin C during FESS significantly reduces postoperative adhesions and crustation and improves subjective outcomes in patients with CRSwNP. MMC appears to be safe and may be considered as an adjunctive measure to improve surgical outcomes following FESS.</p>

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Effect of Topical Mitomycin-C on Outcomes of Endoscopic Sinus Surgery: A Comparative Study

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • Mohamed Atef Eid,
  • Abdelaziz Mohamed Elsherif,
  • Hager Eyas Mostafa,
  • Hesham Mohammed Ismail,
  • Amr Embaby Elsayed Karamany

摘要

Synechiae formation and ostial stenosis are among the most common causes of failure after functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Mitomycin C (MMC), an antiproliferative agent, has been proposed to reduce postoperative fibrosis and adhesion formation. To evaluate the efficacy of intraoperative topical Mitomycin C in reducing postoperative adhesions, crustation, and ostial stenosis following FESS. This prospective controlled study included 60 patients with bilateral CRSwNP refractory to medical treatment who underwent FESS. A split-nose design was used: one nasal cavity received topical MMC (0.4 mg/ml for 5 min), while the contralateral side received saline as control. Patients were followed for 6 months. Outcomes were assessed subjectively using the Visual Analogue Scale (VAS) and objectively by endoscopic examination according to the Modified Lund–Mackay scoring system. Maxillary and frontal sinus ostial patency were also evaluated. Statistical analysis was performed using SPSS version 24, with p < 0.05 considered significant. At 6 months postoperatively, the MMC-treated side showed statistically significant improvement in VAS scores for nasal obstruction (p = 0.018), nasal discharge (p < 0.001), facial pain (p < 0.001), and olfactory disturbance (p = 0.005) compared to the control side. Endoscopic assessment demonstrated a significant reduction in synechiae formation at 1 month (p = 0.006), 3 months (p = 0.013), and 6 months (p = 0.023) in the MMC group. Crustation was also significantly reduced at 1 month (p = 0.026), 3 months (p = 0.005), and 6 months (p = 0.027). Although maxillary and frontal ostial stenosis rates were lower in the MMC group, the differences were not statistically significant. No major intraoperative or postoperative complications were observed. Topical application of Mitomycin C during FESS significantly reduces postoperative adhesions and crustation and improves subjective outcomes in patients with CRSwNP. MMC appears to be safe and may be considered as an adjunctive measure to improve surgical outcomes following FESS.