Mitomycin C in Otolaryngology

Mitomycin C (or Mutamycin) is an anti-cancer antibiotic that halts cell replication and results in eventual cell death. It cross-links complementary strands of DNA and inhibits DNA synthesis. It is used in cancers of stomach, pancreas, urothelial system, etc.

Mitomycin C is used for its anti-inflammatory actions also. This property makes it more valuable in ENT especially to prevent stenosis of different areas in ENT. A 10 mark question on this drug should have the following subheadings –

1. Introduction
2. Mechanism of action
3. Uses in ENT
4. Other uses
5. Side Effects
6. Dosage of topical application

Check the following pictures of my notes. This is just a concise note of some important points in this topic. It has been taken from Scot Brown, Cummings, the internet and Paperella.

In addition to the information in the above 2 images, kindly include the following points also in your answer.

ADVERSE EFFECTS

1. Bone marrow suppression causing thrombocytopenia and leukopenia- this worsens infections in a cancer patient
2. Hemolytic Uremia Syndrome- comprises microangiopathic hemolytic anemia, thrombocytopenia and irreversible renal failure
3. Renal and pulmonary toxicity can occur rarely with systemic doses
4. Local application of Mitomycin C usually doesn’t have any complications

topical application after fess

Principle of using Mytomicin C in FESS surgeries – delay in fibrosis will allow for re-epithelialization to occur before scar formation occurs. This increases the success rates by-

1. Reduces rate of closure of middle meatal antrostomy
2. Decreases adhesion rate
3. Improves symptoms like hyposmia and nasal obstruction

dosage and duration of topical application

A dosage of 0.1-0.4 mg/mL applied. A single 5 min topical application has positive effects on cell proliferation and cell morphology for 36 hours.

Another study has found out that two applications of topical mitomycin C spread 3-6 weeks apart is better than a single application in the endoscopic treatment of laryngotracheal stenosis.

From World ENT Care (Dr. Shyam and Dr. Mehak)

If you would like to read on Amphotericin B please click here.