Comparison of Application of Mitomycin C Vs Silicon Stenting Vs Conventional Method in Endonasal Dacrocystorhinostomy: A Randomized Controlled Trial of 150 Patients

Document Type : Original

Authors

Department of Otorhinolaryngology, Grant Medical College And Sir Jj Group Of Hospitals,Byculla, Mumbai, India.

Abstract

Introduction:
Since the days of Hippocrates, many modifications have been proposed in endonasal dacrocystorhinostomy (DCR), with the use of new drugs and implants showing variable results. The objective of this study was to analyze whether the use of silicon tubing or mitomycin C administration has an added advantage over conventional endonasal DCR.
 Materials and Methods:
A randomized controlled trial of 150 patients between the ages of 6 and 70 years presenting with epiphora was performed. Patients were randomly divided into three groups: endonasal DCR with mitomycin C administration, endonasal DCR with silicon stenting, or conventional endonasal DCR. Patients were followed up on Days 15, 30, 60 and 90 postoperatively for sac syringing to confirm patency.
 
Results:
The majority of patients (28.7%) were in the fourth decade of life, with a female predominance (65.3%). Dacrocystitis was most commonly seen in the left eye (58.7%). An intergroup comparison was performed using the Kruskal-Wallis test at the end of 3 and 5 months. The results suggest that the success rate was significantly higher in patients with a silicone stent (P=0.04) as compared with the other two groups, although no significant difference in failure rate was seen between patients on mitomycin C and conventional therapy (P=0.132 at Month 3 and P=0.481 at Month 5, Mann-Whitney U-test).
 Conclusion:
Our study shows that silicone tube stenting had a better success rate compared with the other two groups, with no significant statistical difference between the use of mitomycin C and the conventional technique.
 
 

Keywords

Main Subjects

References

1. Muscatello L, Giudice M, Spriano G, Tondini L. Endoscopic dacryocystorhinostomy: personal experience. Acta otorhinolaryngologica italica. 2005 Aug;25(4):209.
2. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction: a clinicopathologic report and biopsy technique. Ophthalmology. 1986 Aug 1;93(8):1055-63.
3. Bartley GB. Acquired lacrimal drainage obstruction: an etiological classification system, case reports and a review of literature, Part 1. Opthal Plat Reconstructi Surg 1992;8:237–42.
4. Bartley GB. Acquired lacrimal drainage obstruction: an etiological classification system, case reports and a review of literature, Part 2. Opthal Plat Reconstruct Surg 1993;8:243–49.
5. Bartley GB. Acquired lacrimal drainage obstruction: an etiological classification system, case reports and a review of literature, Part 3. Opthal Plat Reconstruct Surg 1993;9:11–26.
6. Hong-Ryull J, Je-Yeob Y, Mi YC. J Korean Med Sci 2005:21:719–7.
7. Vishwakarma R, Singh N, Ghosh R. A study of 272 cases of endoscopic dacryocystorhinostomy. Indian Journal of Otolaryngology and Head & Neck Surgery. 2004 Oct 1;56(4):259-61.
8. Belal A. Dacrocystorhinostomy; A Preliminary Report. J Laryngol Otol 1976;90:763–71.
9.  Summerskill WH. Dacryocystorhinostomy by Intubation. Brit J Opthalmol 1952; 36(5):240-4.

10. McDongh M, Meirring JH. Endoscopic Transnasal Dacrocystorhinostomy. J Laryng Otol 1989; 103: 585–7.

11.  Ziclioglu G, Ugubas SH, Anadolu Y, Akiner M, Akturk T. Adjunctive use of Mitomycin C on Endoscopic Lacrimal Surgery. Brit J Opthalmol 1998; 82:63 –6.
12. Munk PL, Lin DT, Morris DC. Epiphora: Treatment by means of dacrocystoplasty with balloon dilatation of the nasolacrimal drainage apparatus. Radiol 1990:177:687–90.
13. Mudhol RR, Zingade ND, Mudhol RS. Prospective Randomised comparison of Mitomycin C Application in Endoscopic and External Dacrocystorhinostomy. Indian J Otorhinolaryngol Head Neck Surg 2013;65 (Suppl 2):255–9.
14. Sperkelson MB, Barbarean MT. Endoscopic Dacroystorhinostomy; surgical technique results. Laryngoscope 1996;106;187–9.
15. Yung MW, Hardman Lea S. Analysis of the result of surgical Endoscopic Dacrocystorhinostomy: Effect of level of obstruction. Brit J Opthalmol 2002;86:          792-4.
16. Önerci M, Orhan M, Öğretmenoğlu O, İrkeç M. Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. Acta Oto-laryngologica. 2000;120(2):319–22.
17.Tirakunwichcha S, Sinprajakphcn SAS. Efficacy of Mitomycin C in endonasal endoscopic dacrocystorhinostomy.Laryngoscope 2011;121:433 -6.
18. Park DJ, Kwas MS. The Effect of Mitomycin C on the success rate of endoscopic Dacrocysto- rhinosomy. J Korean Opthalmol Soc 2000;41:1674-9.
19. Polmetsch AM, Gallon MA, Holds JB. Nonlaser endoscopic endonasal dacrocystorhinostomy with adjunctive Mitomycin C in children: Opthalmic Plastic Reconstruct Surg, 2010;117:1037–104.
20. Bambule G, Chamero J. Endonasal DCR. Rev Med Sisse Romande 2001;121:745–51.
21. Fayet B, Racy E, Assouline M. Systematic uncinectomy for a standardised endonasal DCFR. Ophthalmol 2002;109:530–36.
22. Weidenbacher M, Hoseman W, Buhr W. Endonasal Dacrocystorhinostomy: Results in 56 Patients. Ann Otorhinolaryngol 1994:103:363–367.
23. Yang JW. Success rate and complications of endonasal dacrocystorhinostomy with uncinectomy: Graefes Arch Clin Exp Opthalm 2012;250:1509–13.
24. Wormold PJ. Powered endoscopic dacrocystorhinostomy.Laryngoscope 2002:112;69-72.
25. Ambani K, Suri N, Parmar H. Study of the success rates of endoscopic dacrocystorhinostomy with and without stenting. Int Arch Int Med 2015; 2:52–56.
Iranian Journal of Otorhinolaryngology
Volume 30, Issue 1
January and February 2018
Pages 11-18

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