Usefulness of topical Mitomycin C application via rigid bronchoscopy in the management of tracheal stenosis

Background: Excessive granulation tissue formation post tracheal stenting for tracheal stenosis is challenging. Mitomycin C has an inhibitory effect on fibroblast proliferation, and has been proposed as a possible adjunct to reduce the rate of restenosis from granulation tissue¹. Aims: The aim of this study was to evaluate the utility of topical Mitomycin C application via rigid bronchoscopy in patients with tracheal stenosis and excessive granulation tissue. Methods: Seven patients were selected both retrospectively and prospectively. 0.4mg/ml strength Mitomycin C solution was applied to gauze pledgets (2mls) and delivered under direct vision via rigid bronchoscope in 4 circumferential quadrants for 2 minutes each. Results: There were 2 males and 5 females with median age of 64 years. Six patients previously had tracheal stents deployed for tracheal stenosis secondary to post intubation/tracheostomy (2), tracheal compression secondary to lymphoma (3) and tracheal tear (1). One patient had idiopathic tracheal stenosis. Five patient obtained excellent results following Mitomycin C application with no or minimal granulation tissue was observed on follow up bronchoscopy. Reduction in intervention frequency was also observed in these 5 patients. Granulation tissue persisted in 2 patients although the rate of progression has reduced at interval bronchoscopy. No complications were encountered. Conclusion: Topical Mitomycin C application seems to be associated with good results for tracheal stenosis management with decrease in granulation tissue, reduced progression and sustained improvement in lumen diameter. References: 1. Queiroga TLO Et al Int Arch Otorhinolaryngol. 2020 Jan; 24(1):e112-e124