Topical Mitomycin C as an Adjunct to Surgical Debulking and Medical Treatment in Rhinoscleroma

Abstract

Background Rhinoscleroma is a chronic granuloma that is endemic in Egypt and is caused by gram-negative bacilli (Klebsiella rhinoscleromatis). The nasal mucosa is affected in almost all cases, which causes nasal obstruction, anosmia, and epistaxis. The disease usually passes through an atrophic stage (atrophic rhinitis) and a granulomatous stage before ending in the fibrotic stage, with possible bone destruction. Objective This study assessed the effect of topical mitomycin C (MMC) on reducing the recurrence of granulation tissue and intranasal adhesions after endoscopic debulking and continuous medical treatment of nasal rhinoscleroma. Materials and Methods This double-blind randomized clinical trial was performed with 30 patients who had rhinoscleroma (granulomatous and fibrotic stages). At the end of endoscopic debulking, meshes impregnated with MMC was placed in one nasal cavity for 5 minutes, while another meshes impregnated with saline solution were placed in the opposite side. Repeated meshes with MMC were placed in the same side during the follow-up period. Patients were followed up for 1 year. The recurrence of granulation tissue and the degree of intranasal adhesions were recorded and compared according to the Lund-Kennedy score. Results At 12 months’ follow-up, among the total 30 patients, 30 MMC sides were compared with 30 control sides: 69% of MMC sides versus 32% of control sides had no recurrence of granulation tissue (p = 0.01) and 65% of MMC sides versus 24% of control sides had no recurrence of intranasal adhesions (p = 0.03). The Lund-Kennedy score decreased from 2.1 ± 0.64 to 0.8 ± 0.41 and from 2.3 ± 0.33 to 1.9 ± 0.20 in the MMC sides and control sides, respectively, with a nonstatistically significant lower incidence of intranasal adhesions in the MMC sides. Conclusion Topical MMC may reduce granulation tissue and intranasal adhesion formation in patients with rhinoscleroma. Further studies with a larger number of samples and longer follow-up periods are recommended.