How to repair total nasopharyngeal stenoses with functional obturators and mitomycin-c

Abstract

Objectives: Severe nasopharyngeal stenosis after uvulopalatopharyngoplasty (UPPP) is a dreaded complication. Very little is written about successful treatment as attempts at correction frequently fail. Severe stenosis of the nasopharynx drastically worsens speech, swallowing, and obstructive sleep apnea (OSA). We present our successful experience with severe stenosis focusing on a simple functional repair utilizing topical Mitomycin-C as well as differing daytime and nighttime palatal obturators. Methods: Three adults with near total nasopharyngeal stenosis secondary to UPPP were referred to our institution after multiple failed attempts at repair. Each presented with severe OSA on polysomnogram (PSG) with excessive daytime somnolence and voice and swallowing complaints. Under general anesthesia, a CO 2 laser creates an opening in the nasopharynx. Removable and adjustable palatal obturators are fashioned to keep the nasopharynx open with a daytime insert piece with a small obturator hole for diminished velopharyngeal insufficiency and a nighttime one without an insert to maximize recumbent airflow. Obturators are removed 6 months later with topical application of mitomycin-C as a fibroblast inhibitor. All patients were followed clinically for over 1 year and received posttreatment PSG. Results: All patients experienced resolution of their stenosis. Swallowing and voice complaints resolved. OSA was either eliminated or any residual OSA was successfully treated with nasal CPAP. Serial videoendoscopic images throughout the treatment phase demonstrate the effectiveness of this new technique. Conclusions: Severe nasopharyngeal stenosis is a rare but devastating complication of UPPP. We introduce a simple technique utilizing functional palatal obturators and topical mitomycin-C and describe our success with this treatment algorithm.