Management of congenital nasal pyriform aperture stenosis

Abstract

Background: Upper nasal airway obstruction in neonates is a dangerous condition because infants are predominantly nasal breathers. Congenital stenosis of the nasal pyriform aperture (CNPAS) is a rare but important condition to consider. Treatment varies from conservative measures, to surgical intervention with widening of the pyriform aperture. Objectives: To present surgical management of CNPAS as an alternative to conservative treatment. Methods: Six patients with CNPAS were presented at the tertiary care Academic Medical Center, diagnosed with respiratory insufficiency, obstructive breathing pattern and/or feeding difficulties. All patients underwent computed tomography scan and nasal endoscopy. Distance measurements of the pyriform aperture were performed. Findings: The mean age on presentation was 12 days. The widest and smallest mean distances of the pyriform aperture were 6.4 mm (range, 5.6–7.8 mm) and 5.1 mm (range, 3.6–6.1 mm). One conservatively treated patient showed no improvement in aperture width after 7 months. Three patients received surgical widening of the pyriform aperture. All patients recovered successfully. No complications occurred. Conclusion: CNPAS is a rare disorder, which can be very well managed by surgical widening of the pyriform aperture. Considering the fact that recovery of the surgically treated patients was quickly and without complications, one might think that surgical widening could be a good alternative for long-term conservative treatment with unknown outcome. Standardised documentation of patients is necessary to get insight in the (dis)advantages of conservative treatment versus surgical treatment.