ABSTRACT
La atresia de coanas es la anomalía congénita nasal más común. Cuando es bilateral, se presenta con dificultad respiratoria desde el nacimiento. La atresia unilateral se manifiesta con insuficiencia ventilatoria y rinorrea unilateral, pudiendo pasar inadvertida. El diagnóstico se sospecha ante la ausencia de paso de aire en las fosas nasales y la imposibilidad de hacer progresar una sonda nasogástrica. Se confirma mediante examen endoscópico y tomografía computarizada. El tratamiento definitivo es quirúrgico, existiendo diferentes técnicas y vías de abordaje. Se presenta una revisión de la literatura, con especial énfasis en el tratamiento pos-quirúrgico con stents y mitomicina-C a través de una mirada desde la evidencia.
Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airflow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. A review of the literatureis presented, with special emphasis onthepost-surgical treatmentwithstents and Mitomycin-Cview from the evidence.
Subject(s)
Humans , Choanal Atresia/diagnosis , Choanal Atresia/therapy , Postoperative Care , Stents , Mitomycin/administration & dosage , EndoscopyABSTRACT
La atresia de coanas, es una patología poco frecuente, que habitualmente se diagnostica en las edades tempranas. Representa un reto quirúrgico por su alta tendencia a la reestenosis, considerándose en la actualidad de elección el tratamiento endoscóplco. Tratamientos como stents posoperatorios o la aplicación de mitomicina C tópica para disminuir la reestenosis son todavía controvertidos, sin que exista consenso. Presentamos el caso de un adulto con atresia de coana unilateral que se reparó vía endoscópica transnasal y se realiza una revisión bibliográfica sobre el estado actual del tratamiento de esta patología.
Choanal atresia is a very rare condition, usually it's diagnosticated in early age. It represents a surgical challenge for the high tendency to restenosis, being actually the endoscopic treatment first option. Other treatments like postoperative stents or topical mitomycin-C in order to avoid restenosis are controversial, and there is a lack of consensus. We present an adult case with unilateral choanal atresia treated by transnasal endoscopic technique and It's carry out a bibliographical review about the current treatment state of this pathology.
Subject(s)
Humans , Male , Adult , Choanal Atresia/surgery , Endoscopy , Administration, Topical , Choanal Atresia/drug therapy , Mitomycin/administration & dosageABSTRACT
A 65- year old male presented with a reddish mass in left eye with diminution of vision for past four months. Based on clinical examination, a probable diagnosis of ocular surface squamous neoplasia with mature cataract was made. Excision biopsy of the lesion demonstrated intraepithelial neoplasia involving cornea and conjunctiva. Post-operatively patient was put on topical mitomycin –C (0.01%) eye drops 4 times a day for 12 weeks. Cataract surgery was done in the same eye 3 months after cessation of topical Mitomycin-C (MMC) treatment. Follow-up was done for 18 months. Patient’s vision improved to 6/9 in left eye.
ABSTRACT
PURPOSE: To evaluate the therapeutic effect of topical mitomycin C (MMC) on the diffuse conjunctival-corneal intraepithelial neoplasia (CCIN). METHODS: Three patients histopathologically confirmed the conjunctival-corneal intraepithelial neoplasia (CCIN) received topical drop of 0.04% MMC four times daily for 2 to 4 weeks. Ocular complications and recurrence were evaluated under slit lamp biomicroscope. RESULTS: One case received topical drop of 0.04% MMC four times daily for 2 weeks and two cases of CCIN received for 4 weeks in the same manner. These lesions were completely regressed and did not recur under slit lamp biomicroscope during the follow-up of 18 months, 6 months, and 5 months, respectively. Other complications except superficial punctate keratitis and conjunctival injection did not develope and visual acuities have been improved. CONCLUSIONS: It appears that the application of topical MMC alone could be a primary effective treatment for diffuse conjunctival-corneal intraepithelial neoplasia (CCIN).
Subject(s)
Humans , Follow-Up Studies , Keratitis , Mitomycin , Recurrence , Visual AcuityABSTRACT
PURPOSE: To investigate the effect of topical Mitomycin C(MMC) as a medical adjunct to incompletely excised conjunctival-corneal intraepithelial neoplasia(CCIN) for removal of remaining neoplastic cells and prevention of recurrence. METHODS: The authors applied postoperative topical 0.02% MMC adjunctively on 2 eyes of 2 patients with incompletely excised and histopathologically confirmed conjunctival-corneal intraepithelial neoplasia(CCIN) for 2weeks and if the lesion is not regressed, topical MMC treatment with the same regimen was added. RESULTS: Remaining lesions were completely regressed and no recurrence has been found with follow up to 25 months and 26 months in each case. CONCLUSIONS: Topical MMC chemotherapy would be an effective treatment modality on incompletely excised conjunctival-corneal intraepithelial neoplasia(CCIN) for removal of remaining neoplatic cells and prevention of recurrence.
Subject(s)
Humans , Biopsy , Drug Therapy , Follow-Up Studies , Mitomycin , RecurrenceABSTRACT
The purpose of this study is to evaluate the effect of topical mitomycin C as an adjuvant therapeutic agent on prevention of internal nasal ostium obstruction in experimental rabbit dacryocystorhinostomy model. Forty-two rabbits received an osteotomy between maxillary antrum and nasal cavity. Topical mitomycin C solution had been instilled postoperatively for five days. The diameter of remaining ostium was measured and histopathologic study was performed. At 8 postoperative weeks, the ostial diameter of mitomycin C treated group was larger than that of control group. Nasal mucosa of control group showed active fibroblast and abundunt collagen fibers. But nasal mucosa of MMC group showed degenerated fibroblast and scanty collagen fibers. In conclusion, these results suggest that topical MMC eyedrop may be used as an effective adjuvant in preventing fibrous obstruction of internal nasal ostium in dacryocystorhinostomy.
Subject(s)
Rabbits , Collagen , Dacryocystorhinostomy , Fibroblasts , Maxillary Sinus , Mitomycin , Nasal Cavity , Nasal Mucosa , OsteotomyABSTRACT
The authors evaluated the effect of topical mitomycin-C on the prevention of dacryocystorhinostomy internal ostium obstruction as antifibroblastic adjuvant. Topical 0.02% mitomycin-C(MMC) eyedrop was applied postoperatively to conjunctival sac of 75 patients who underwent endoscopic dacryocystorhinostomy-MMC group. MMC was instilled twice a day from postoperative 1 day for 7 days and from postoperative 4th week for 7 days. Properly matched another 75 patients without postoperative adjuvant MMC were compared with MMC goup regarding endoscopic findings, patency rates and other eyedrop complications. The internal ostium were patent in 85% in MMC group, and 77% in MMC and control group, respectively. Endoscopic examination of internal ostium showed mean final diameter of 3.4mm in MMC group and 2.5mm in control. There were no significant complications in MMC group except delayed epithelialization of nasal mucosa which had no relationship with surgical outcome.