month after surgery (PO) on the outcome ifff unctional endoscopic sinus surgery (FESS).
Patients & Methods : TTie study included 30 patients ^23 males and 7 females with mean age o/25.32.6
years) with treatment-resistant chronic rhinosinusitis (CRSj assigned far FESS. All patients completed the
Rhinosinusitis Symptom Inventory (RSI), which includes major and minor sinonasal symptoms on a 6-point
scale (0= absence & 5= maximally severe symptoms). Then, all patients underwent preoperative CT scanning
and endoscopic nasal examination. Endoscopic findings were graded according to Lund-Kennedy scoring
system to bilaterally assess the nasal mucosa edema, presence of secretion and presence of polyps. FESS was
conducted using Kennedy technique. At the end of endoscopic surgery and four weeks PO, all patients received
a piece of gauze soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatusfor 5 minutes. At 6- months
PO, patients were assessed using RSI for symptoms scoring and underwent follow-up endoscopy for re
assessment for the presence of synechiae and/or antrostomy stenosis.
Results t All patients had bilateral mucosal edema and nasal discharge; 11 noses (18.4%) were free of nasal
polyposis with a mean total Lund-Kennedy score for both sides/patient was 10.41.4. For all evaluated
symptoms, postoperative RSI scores were significantly lower at both 1-month and 6-months postoperative
compared to preoperative scores with significantly lower RSI scores at 6-months compared to at 1-month PO.
Three patients (10%) reported significant improvement off acial tenderness, nasal obstruction and discharge but
rum-significant improvement of the other presenting symptoms with a non-significant difference in RSI scores
estimated at 6-months compared to that estimated at 1-month PO. Another 2 patients reported recurrence of
symptoms at 6-months after surgery after reporting complete relief at 1-month PO despite significantly lower
RSI scores at both 1-month and 6-months compared to preoperative scores. Follow-up endoscopy detected mild
unilateral synechiae in 2 and moderate unilateral synechiae in one patient, but detected bilateral synechiae (mild
on right and moderate on left side) in the #' patient. Ostial re-stenosis was reported in one patient (right side)
with technical success rate of 90%.
Conclusion : It could be concluded that application of mitomycin C immediate and one-month postoperative
prevents re-stenosis and synechiae development with clinical success rate of 90% and progressive significant
reduction iff postoperative RSI scores |
