Topical mitomycin C as a postoperative adjunct to endonasal dacryocystorhinostomy in patients with anatomical endonasal variants.

PURPOSE: Unusual intranasal conditions may increase the rate of complications and affect success rate of endonasal dacryocystorhinostomy (DCR) surgery. The purpose of this study was to find the influence of endonasal abnormalities on outcome of endonasal DCR surgery and to find the role of topical mitomycin C (MMC) as a postoperative adjunct to endonasal dacryocystorhinostomy in these patients.

METHODS

A total of 23 patients (19 males and 4 females) of bilateral chronic dacryocystitis in the age range of 18-60 years, having endonasal anatomical variants were included in this study. After endonasal DCR, the right side of nasal cavity was packed with 0.05% MMC nasal pack and left side of nasal cavity was packed with normal saline pack for 48 hours. During postoperative visits, the patients were checked for improvement in clinical symptoms and watched for complications including formation of adhesions and/or synechaie. The statistical association between endonasal pathologies and 3 dichotomous outcome variables (clinical features, adhesions, synechaie) was assessed by applying Fisher's Exact Test.

RESULTS

Postoperative retention of nasal packs for 48 hours after endonasal DCR, did not cause any side effect in our patients. An improvement in clinical symptoms (23/23 = 100%) was seen in all the patients on side with 0.05% MMC soaked nasal pack, while 10/23 i.e., 43.47% patients did not show improvement in symptoms on side of saline nasal pack. Postoperatively, the MMC nasal pack side nasal cavity had a healthy nasal mucosa during the entire follow up, while the saline nasal pack side nasal cavity had synechiae in 15/23 (65.2%) patients and adhesions in 15/23 (65.2%) patients. In our study, none of the anatomical endonasal variants had a statistically significant association with either formation of adhesion or formation of synechiae, as the p-value was > 0.05 in all these instances.

CONCLUSIONS

The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.