The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2006 The American Laryngological, Rhinological and Otological Society, Inc. The Efficacy of Mitomycin-C in the Treatment of Laryngotracheal Stenosis C. Blake Simpson, MD; Joshua C. James, MD Objective: The purpose of this study is to evalu- ate whether the addition of topical mitomycin-C (MMC) application to the wound site after endoscopic treatment of laryngotracheal stenosis (LTS) resulted in measurable improvement in clinical outcomes. Study Design and Setting: A retrospective chart re- view of patients with LTS treated by the senior au- thor over a 6-year period was performed. The treat- ment groups were stratified into two main categories: 1) endoscopic treatment alone and 2) endoscopic treatment  topical MMC. The “symptom-free” in- terval was determined (in months) for each subject us- ing a two-tailed t test for statistical analysis of the con- trol/study groups. Results: Sixty-seven procedures were performed in 36 patients with LTS with a mean of 1.86 surgical treatments per patient. The mean duration of the symptom-free interval after endoscopic treatment for LTS was 4.9 months in the endoscopic-only treat- ment group and 23.2 months in the endoscopic group receiving topical MMC. The symptom-free interval ob- served in the MMC group was significantly longer than the control subjects (P  1  10 11 ). Conclusions: The results of this study suggest that MMC is an effective adjuvant in the treatment of LTS. The results of this study provide strong supporting evidence that topical MMC is an effective adjuvant in the treatment of LTS. Key Words: Laryngotracheal stenosis, mitomycin-C, air- way stenosis, subglottic stenosis, airway treatment. Laryngoscope, 116:1923–1925, 2006 INTRODUCTION Despite advancements in the treatments of laryngo- tracheal stenosis (LTS), cicatrix formation and recurrence of stenosis continue to be the primary reasons for failure. 1 Often, multiple endoscopic surgical procedures are neces- sary to maintain a patent airway. Endoscopic CO 2 laser treatments combined with rigid dilation remain a cornerstone in the treatment of LTS. 2 A number of adjuvant modalities have been used in addition to standard laser radial incisions/dilation in an attempt to in- crease the long-term success of endoscopic LTS treatment. Unfortunately, most adjuvant modalities have failed to demon- strate clinically significant improvement over standard endo- scopic laser treatment. Topical application of mitomycin-C (MMC) has been used in the treatment of LTS. Its chief mech- anism of action appears to be related to the inhibition of fibro- blast proliferation and, ultimately, scar formation in the laryn- gotracheal complex. 3 The purpose of this study is to evaluate whether the addition of topical MMC application to the wound site after endoscopic treatment of LTS resulted in measurable improvement in clinical outcomes. METHODS The University of Texas Health Science Center San Antonio Institutional Review Board approved this study. A retrospective chart review of all patients treated by the senior author (C.B.S.) for supraglottic, glottic, and subglottic/tracheal stenosis between Janu- ary 1999 and December 2004 was performed. Subjects were consid- ered for the study if they were treated using endoscopic CO 2 laser radial incisions/rigid dilation with or without topical MMC. Patients were excluded if any additional adjuvant therapies (i.e., cidofovir or corticosteroid injection) were used in conjunction with their endo- scopic airway treatment. Thirty-six patients met criteria for this study. Of these patients, seven underwent endoscopic treatment alone with six eventually receiving treatment with MMC. Twenty- nine patients received endoscopic treatment plus topical MMC as their initial therapy. All patients included in the study were treated under the direction of the senior investigator at a single institution. The site of stenotic lesions included the posterior glottis, subglottis, su- praglottis, and trachea. A total of 67 endoscopic laser procedures were identified in 36 patients with LTS. A standard protocol was used in the treatment of the patients, including pre- and postop- erative acid-suppressive medications (proton pump inhibitors in most patients), perioperative antibiotic prophylaxis, laser radial incisions using a setting of 4 to 6 W superpulse, and progressive serial dilation (in adult patients only) before topical MMC appli- cation. Mitomycin-C was applied to the surgical bed either as a 0.04% solution (0.4 mg/mL) or a 1.0% supersaturated preparation (10 mg/mL) for 5 minutes. The 1.0% concentration was used only on patients with an indwelling tracheostomy given the potential risk of fibrinous debris accumulation and possible airway com- From the University of Texas Health Science Center at San Antonio, Department of Otolaryngology–Head and Neck Surgery, San Antonio, Texas, U.S.A. Editor’s Note: This Manuscript was accepted for publication June 21, 2006. Presented at the AAO-HNS Academy Meeting, Los Angeles, Califor- nia, U.S.A., September 26, 2005. Send correspondence to C. Blake Simpson, MD, University of Texas Health Science Center at San Antonio, Department of Otolaryngology– Head and Neck Surgery, 7703 Floyd Curl Drive, MC-7777, San Antonio, TX 78229-3900, U.S.A. E-mail: simpsonc@uthscsa.edu DOI: 10.1097/01.mlg.0000235934.27964.88 Laryngoscope 116: October 2006 Simpson and James: Efficacy of Mitomycin-C for Laryngotracheal Stenosis 1923