ABSTRACT
Endoscopic dacryocystorhinostomy [DCR] has many advantages over the external approach as being less invasive technique and with better aesthetic results with no external facial scar. Rhinostomy closure by granulation tissue or scarring is the primary cause of failure in endoscopic DCR. In this study a wound healing inhibitor mitomycin-C [MM-C] was used topically and intraoperatively to prevent the closure of the ostium after the operation. The objective of this study was to investigate whether MM-C applied topically to the rhinostomy site can affect the outcome of endoscopic DCR or not. In this prospective study, we randomly allocated 32 patients with nasolacrimal duct obstruction [40 surgical procedures] to a control group [endoscopic DCR without MM-C] and a MM-C treated group [endoscopic DCR with MM-C]. Patients and the investigator were masked to the choice of treatment. All patients underwent endoscopic DCR with silicon intubation. A neurosurgical cottonoid soaked in isotonic normal saline or 0.5 mg/ml MM-C, randomly, was applied to the rhinostomy site for 5 minutes intraoperatively. All patients were followed-up for 18 to 24 months and were evaluated subjectively [relief of the patient's symptoms] and objectively [endoscopic visualization of rhinostomy site, lacrimal irrigation and endoscopic observation of fluorescein dye flowing through the ostium into the nose]. In this study, the overall success rate of endoscopic DCR was 87.5%. In MM-C treated group [endoscopic DCR with MM-C], all the 20 procedures [100%] were successful, while the success rate of 75% was achieved in endoscopic DCR without MM-C [control group]. The difference between the two groups was statistically significant. Based on the increase in the patency rate of rhinostomy site with no reported systemic side effects or postoperative complications, we can conclude that intraoperative topical use of mitomycin-C [MM-C] is safe and effective in increasing the success rate of endoscopic DCR
ABSTRACT
Intranasal topical synthetic salmon-clcitonin [SCT] has been widely used in the treatment of osteoporosis. Although the medication is well tolerated, adverse side effects of specific relevance to Rhinologist had been reported. This study was conducted to determine the histopathological changes induced by topical SCT on the nasal mucosa. A total of 48 patients suffering from osteoporosis and requiring SCT nasal spray of 200 IU/day were selected. Tiny punch biopsies were taken before the start of treatment and histopathological changes were observed in group A, B and C after 3, 6 and 9 months of treatment, respectively. In our study, epithelial changes in the form of partial loss of the epithelial cilia were noted in 12.5% of patients in group A, while epithelial cells destruction and exfoliation were observed in 56%, and 25% of patients in group B and C. respectively. Infiltration with mononuclear inflammatory cells were found in 69%, 56% and 44% of patients in group A. B, C, respectively. The mucous acini were found to be increased in number and diameter in group A [25%], group B [31%] and group C [25%]; while congestion and diltation of the blood vessels were observed in the lamina propria in 69%, 44% and 12.5% in patients of group A, B and C, respectively. In addition connective tissue changes in the form of an increase in the collagen fibres were found in group A [25%], group B [44%] and group C [56%]. Scanning electron microscopic findings showed a decrease in the number of ciliated cells and an increase in the number of goblet cells; and the cilia themselves became shortend and decreased in numbers in 12.5%, 56% and 25% in patients of group A, B and C, respectively. The grades of the ciliary changes varied from near normal state to scattered decrease in ciliated cells and occasionally, extreme decrease in the ciliated cells and substitution by a remarkable increase in the goblet cells. The adverse clinical side effects of topical SCT were found in 12 patients [25%]. A positive correlation was found between the clinical adverse side effects and salmon-calcitonin-induced histopathological changes. In conclusion and based on the histopathological changes we can suggest that the adverse nasal side effects of topical salmon-calcitonin may be due to allergic inflammatory reactions. Therefore, periodic nasal examination should be done before the start of treatment and also, at any time that nasal complaints, may occur. Also, immunological studies about the effect of topical salmon-calcitonin on the nasal mucosa to be recommended