Laryngotracheal stenosis (LTR) is a difficult condition to manage, and the effectiveness of surgical treatment is limited by the tendency of scar tissue to reform. Mitomycin has been used as a controversial adjuvant to surgical treatment for many years. Drawbacks include limited evidence of efficacy, the practicalities of administering a cytotoxic drug and the theoretical risk of malignant transformation. The authors of this paper describe a retrospective series of patients with LTR undergoing endoscopic surgery with (n = 30) or without adjuvant mitomycin (n = 41), applied for four minutes intraoperatively on a pledget. Overall, the mitomycin patients had a longer period between procedures compared to those in the non-mitomycin group. The patients who received multiple applications of mitomycin also had a longer symptom-free period between procedures than those who only had a single application. There is a lower incidence of patients undergoing emergent airway procedures in the mitomycin group, although it is not statistically significant. Although this is a retrospective case series, the authors do account for some confounding factors by removing patients with incomplete data, and no one received concurrent steroid injections. They do comment that the patients were selected for mitomycin if they were likely to require multiple airway procedures. The mitomycin group comprised mainly of patients with subglottic stenosis whereas the non-mitomycin group had a larger variety of airway pathology such as epiglottic and glottic lesions. Further randomised or well controlled cohort studies are required to shed light on this difficult clinical entity. 

The efficacy of mitomycin C in the treatment of laryngotracheal stenosis: results and experiences with a difficult disease entity.
Reichert LK, Zhao AS, Galati LT, et al.
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Zi Wei Liu

Whipps Cross Hospital, Middlesex, UK.

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