Nasopharyngeal Stenosis Research Articles

Treatment of Nasopharyngeal Stenosis after Revisional Palatopharyngoplasty with Balloon Dilatation and Topical Mitomycin-C Application

Treatment of Nasopharyngeal Stenosis after Revisional Palatopharyngoplasty with Balloon Dilatation and Topical Mitomycin-C Application

Acquired nasopharyngeal stenosis in a patient with sarcoidosis

Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

Chronische Erkrankungen der Nase und Nasennebenhöhlen der Katze: Eine retrospektive Studie

In this retrospective study of 41 cats with chronic nasal disease diagnoses included nasal neoplasia (n = 19), idiopathic chronic rhinosinusitis (ICRS) (n = 12), nasopharyngeal polyps (n = 3), foreign bodies (n = 2), nasopharyngeal stenosis (n = 1) and nasal aspergillosis (n = 1). In 3 cats diagnosis could not be established despite thorough work-up. Gender, indoor or outdoor housing, quality or quantity of nasal discharge, bacteriological findings of nasal flushes, radiology and CT findings did not differ significantly between cats with neoplasia and cats with ICRS. Cats with neoplasia were older (3 - 15, median 11 years) and showed clinical signs for a shorter period of time (1 - 8, median 2 months) than cats with ICRS (age 1 - 13, median 7.5 years; signs: 1 - 36, median 5 months). In all cats with neoplasia a mass was detected rhinoscopically, while this was only seen in 30 % of cats with ICRS. The exact diagnosis has to be established by examination of biopsy samples. A combination of physical examination, imaging studies and rhinoscopy with cytological and histopathological examination of samples enhances the likelihood for a correct diagnosis.

Palatal eversion: A new technique in treatment of nasopharyngeal stenosis

ObjectiveThe treatment of nasopharyngeal stenosis is challenging because of a high incidence of recurrence after surgical correction. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to assess the efficacy of palatal eversion as a new technique for treatment of nasopharyngeal stenosis after adenotonsillectomy. Study DesignCase series. MethodsThis study was conducted on 12 patients with nasopharyngeal stenosis after adenotonsillectomy were subjected to treatment by palatal eversion by dividing the soft palate in the midline and removal of the fibrous tissue causing stenosis followed by evertion and fixation of the two palatal division on either side for six weeks to allow complete epithelialization of the stenotic area followed by another operation to reunion the soft palate in the midline. Post-operative follow up was done for one year by flexible nasopharyngoscopy, perceptual speech analysis and polysomnography. ResultsFlexible nasopharyngosopic examination of the 12 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 12 cases. No obstructive episodes were recorded in polysomnograms. ConclusionsPalatal eversion is a promising technique in treatment of post-adenotonsillectomy nasopharyngeal stenosis and it is recommended to be used in a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. Level of evidence4 (case series).

Use of balloon dilatation as an adjunctive treatment for complete nasopharyngeal stenosis: a technical innovation

Use of balloon dilatation as an adjunctive treatment for complete nasopharyngeal stenosis: a technical innovation

CO2 laser ablation and balloon dilation for acquired nasopharyngeal stenosis: A novel technique

Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results. Retrospective review of case series. An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation. Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months. Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.

Nasopharyngeal stenosis with concurrent hiatal hernia and megaesophagus in an 8-year-old cat

A case of nasopharyngeal stenosis with secondary hiatal hernia is described. An 8-year-old castrated male domestic shorthair cat was referred for a chronic upper respiratory problem and presumptive vomiting. Despite conservative management by the primary care veterinarian, the cat's condition progressed. The cat was presented to an emergency facility prior to referral to a specialty hospital. On presentation, inspiratory stridor was evident. Thoracic radiography revealed a hiatal hernia. Computed tomography indicated pharyngeal edema and probable nasopharyngeal stenosis. Endoscopy confirmed the presence of nasopharyngeal stenosis consistent with either stricture or choanal atresia. Balloon dilation of the choana was performed. The hiatal hernia regressed spontaneously post-resolution of the nasopharyngeal stenosis. The cat remained asymptomatic at recheck 3 months later.

The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstr uctive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the anter o-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF tec hnique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, naso pharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and t reated with the EUPF technique. The patient’ s total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O 2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.

C02 Laser ablation and Balloon Dilation for Acquired Nasopharyngeal Stenosis: A Novel Technique

The LaryngoscopeVolume 121, Issue S4 p. S240-S240 Triological Society 2011 Combined Sections Meeting Posters C02 Laser ablation and Balloon Dilation for Acquired Nasopharyngeal Stenosis: A Novel Technique Douglas Sidell MD, Douglas Sidell MD Division of Head and Neck Surgery, David Geffen School of medicine at UCLASearch for more papers by this authorDinesh K. Chhetri MD, Dinesh K. Chhetri MD Division of Head and Neck Surgery, David Geffen School of medicine at UCLASearch for more papers by this author Douglas Sidell MD, Douglas Sidell MD Division of Head and Neck Surgery, David Geffen School of medicine at UCLASearch for more papers by this authorDinesh K. Chhetri MD, Dinesh K. Chhetri MD Division of Head and Neck Surgery, David Geffen School of medicine at UCLASearch for more papers by this author First published: 28 June 2011 https://doi.org/10.1002/lary.22126AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume121, IssueS4Supplement: Triological Society 2011 Combined Sections Meeting Posters2011Pages S240-S240 RelatedInformation

Acquired Nasopharyngeal Stenosis in a Patient with Sarcoidosis

The LaryngoscopeVolume 120, Issue S3 p. S4-S4 Poster Presentations from the 2010 Triological Society Combined Section Meetings Acquired Nasopharyngeal Stenosis in a Patient with Sarcoidosis JR Brodsky, JR Brodsky Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this authorSA Tatum, SA Tatum Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this authorRT Kelley, RT Kelley Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this author JR Brodsky, JR Brodsky Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this authorSA Tatum, SA Tatum Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this authorRT Kelley, RT Kelley Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse NY 13210Search for more papers by this author First published: 14 December 2010 https://doi.org/10.1002/lary.21173Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume120, IssueS3Supplement: Poster Presentations from the Triological Society's 2010 Annual MeetingOctober 2010Pages S4-S4 RelatedInformation

Taste Impairment following Tonsillectomy and Adenoidectomy: An Unusual Complication

Tonsillectomy and adenoidectomy is a relatively safe procedure, but it is nevertheless associated with certain complications. Some of these include throat pain, otalgia, dehydration, hemorrhage, nasopharyngeal stenosis, velopharyngeal insufficiency, burns, soft-tissue injury, dentomandibular trauma, atlantoaxial subluxation, and respiratory compromise. One unusual complication is altered taste. To the best of the author's knowledge, only 29 cases of altered taste associated with palatine tonsillectomy have been previously reported in the literature since 1966. In this article, the author reports a new case and discusses the features of this unlikely complication.

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

Nasopharyngeal stenosis as a postoperative complication following pharyngeal surgery (tonsillectomy/adenoidectomy) is rare and may be difficult to treat. All patients with severe nasopharyngeal stenosis treated at UCLA with a bilateral Z-pharyngoplasty procedure from 1999 to 2006 were studied (n = 6). Degree of pharyngeal stenosis preoperatively and following a bilateral Z-pharyngoplasty was graded 0-4 based on (1) symptomatology (snoring, hyponasal speech, difficulty with nasal breathing, difficulty breathing during exercise, obstructive sleep apnea, daytime fatigue, anosmia, rhinorrea, dysphagia, or difficulty in blowing nose) and (2) measurement of stricture at the time of direct nasolaryngoscopy. Nasopharyngeal stenosis after pharyngeal surgery (adenotonsillectomy--67%, uvuloplasty--17%, pharyngoplasty--17%) failed to be alleviated by a mean of 2.3 procedures (kenalog injection or scar excision) and required corrective bilateral Z-pharyngoplasty a mean of 9.2 months after the original surgery. Symptomatic grading of the nasopharyngeal stenosis improved from a mean score of 3.3 (severe stenosis) preoperatively to a score of 0.2 (minimal to no stenosis) in follow-up. Endoscopic stricture measurement improved from 6.1 x 6.3 mm preoperatively to 28.1 x 39.3 mm in follow-up. Bilateral Z-pharyngoplasty was effective in alleviating severe postsurgical nasopharyngeal stenosis.

Common Postoperative Complications in Otolaryngology Presenting to the Pediatric Emergency Department

Postoperative complications in pediatric otolaryngology often present to the emergency department. Posttonsillectomy hemorrhage is a feared complication due to its lethal potential and should be managed in conjunction with an otolaryngologist. Physicians should possess and awareness of procedures that have been used in an emergent setting. Postoperative pain management options are discussed including acetaminophen, acetaminophen with codeine, and nonsteroidal anti-inflammatory drugs. Rare postadenoidectomy complications such as nasopharyngeal stenosis and Grisel syndrome are discussed. Tympanostomy tubes are the most common surgery in children, and the proper treatment of posttympanostomy tube otorrhea is discussed.

Complications of adenotonsillectomy.

To review the immediate, short-term, and long-term complications of adenotonsillectomy. Review. Complications of adenotonsillectomy and methods for preventing and treating them were reviewed. The most common complications of adenotonsillectomy, such as bleeding, generally occur in the immediate perioperative period but can develop up to 2 weeks postoperatively. Long-term complications, such as nasopharyngeal stenosis, may appear months to years after surgery. These more unusual sequelae result from scar contracture and maturation. Although rare, complications associated with adenotonsillectomy can be taxing for patients and health care resources. The most common complications, namely, anesthesia risks, pain, otalgia, and bleeding, should be discussed with patients' caregivers.

Obstructive sleep apnea hypopnea syndrome: surgical complications and strategy for avoidance

To analyze the surgical complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and discuss the risk factors and preliminary strategies for prevention of complications. From September 1998 to March 2007, 653 OSAHS patients confirmed by polysomnography were treated by different surgical approaches according to their obstructive sites, which included uvulopalatopharyngoplasty (UPPP) in 586 cases, nasal surgery in 104 cases/times, hyoid suspension surgery in 53 cases/times, respectively or at the same time. Local anesthesia was used in 294 cases and general anesthesia in 359 cases. Two hundreds and seventeen cases were treated by continuous positive airway pressure (CPAP) 3 to 7 days pre-operation and 2 to 3 days post-operation. Perioperative complications were found in 57 OSAHS cases (93 times), the incidence of peri-operative complications was 8.7% (57/653), including respiratory problems in 19 cases/times and 1 death occurred during inducing stage in general anesthesia. Profuse bleeding was encountered in 9 cases/times during operation and primary and secondary bleeding in 27 cases/times, cardiopathy and hypertension crisis in 31 cases/times and cerebral stroke and hemiplegia in 1 case, reactive somnolence in 3 cases/times and reactive hyperglycemia in 3 cases/times. Data were analyzed by the multivariate logistic regression model. The results showed that the complications were significantly reduced after CPAP treatment during peri-operative stage and increased accompanied with patients' hypertension, choice of general anesthesia, BMI and AHI. All patients were followed-up more than 1 year. After UPPP, 23.9% cases (140/586) had sensation of foreign body in pharynx and alleviated in 6 to 12 months. Scar tissues in oropharynx in 7 cases, nasopharyngeal stenosis in 1 case, atrophy rhinitides and atrophy pharyngitis in 3 cases, nasopharyngeal un-closure and long-term nasopharyngeal reflex in 3 cases. Conclusions Peri-operative complications are more common in obese and severe OSAHS patients, especially when they accompanied with hypertension. The corresponding strategies should be taken to reduce complications in OSAHS surgery, which include controlling the hypertension effectively, performing CPAP treatment actively, cooperating with interdisciplinary doctors, monitoring closely after operation. It is important to reduce surgical sequelae through improving surgical skills and not enlarging the surgical scale blindly.

A retrospective study of chronic nasal disease in 75 dogs

Chronic nasal disease is a common problem in dogs. To determine the aetiology, a retrospective study in 75 dogs with persistent and chronic nasal disease was done. All dogs were evaluated by means of survey nasal radiographs, antegrade and retrograde rhinoscopy, bacterial and fungal cultures, and histopathology. A definitive diagnosis was made in 74/75 cases (98.6%). Nasal neoplasia was the most common diagnosis (46.7%), median age 108 months, followed by lympho-plasmacytic rhinitis (20%), median age 112 months, and fungal rhinitis (10.7%), median age 53.5 months. Other diagnoses included nasal foreign body (5.3%), median age 51 months, and primary bacterial rhinitis (6.7%), median age 116.5 months. Rare aetiologies identified were nasal polyps, granulomatous rhinitis, oro-nasal fistula and naso-pharyngeal stenosis. This study showed that by using a structured combination of survey radiography, rhinoscopy, cultures and histopathology, a diagnosis could be made in dogs with chronic nasal disease.

Balloon dilation of an acquired nasopharyngeal stenosis

Balloon dilation of an acquired nasopharyngeal stenosis

Velopharyngeal stenosis, a late complication of radiotherapy

Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons.

Management of pharyngeal stenosis following tonsillectomy with local injection of steroids: Case report and literature review

Summary Objective: Tonsillectomy is a common surgical procedure in pediatric ENT. Pharyngeal stenosis is a late complication with an insidious onset and seems to occur largely in cases with suboptimal surgical technique or in a particular clinical scenario. We report the case of a 9-year-old child which presented a severe pharyngeal stenosis 4 months after a tonsillectomy for obstructive sleep apnea syndrome (OSAS). Method: Case report and literature review. Results: The boy presented with a severe recurrence of OSAS, dysphagia, and recent weight loss. The parents reported frequent vomiting after the initial procedure. Sleep monitoring showed numerous episodes of apnea and desaturation. Examination and endoscopy under general anesthesia confirmed the presence of a large, fibrous stenosis of the pharyngeal isthmus. Due to the pharyngeal stenosis, the control of the airway was difficult and required an uneasy fiberoptic intubation. The management of the lesions required several endoscopies and surgical procedures: LASER, stenting, pharyngeal flaps, use of mitomycine . Only repeated injections of corticosteroids in the fibrous area eventually allowed healing of the scarring. Pharyngeal stenosis is an unusual complication after tonsillectomy. We report a detailed review of the literature dealing with this complication and its management. There are only limited series and the exact incidence is unknown. Conclusion: Nasopharyngeal stenosis post-tonsillectomy is a rare but serious complication. Early detection of recurrence of the obstructive syndrome several weeks after the surgery is essential. A minimum follow-up of 10 months is required after surgery. Local triamcinolone acetonide injections can be used as first line therapy. Prevention of this complication can be achieved by surgical expertise and by preserving the anatomical structures, avoiding the use of a LASER and excessive electro coagulation. In cases with an associated significant gastro-esophageal reflux, systematic post-operative treatment with a proton pump inhibitor is recommended.

Use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats: six cases (2005–2007)

To determine outcome associated with use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats. Retrospective case series. 3 dogs and 3 cats. All 6 animals had severe inspiratory stertor at initial examination. Two animals had no orifice present at the stenosis. Nasopharyngeal stenosis was diagnosed and stent size determined by use of computed tomography. A percutaneous transluminal angioplasty balloon premounted with a balloon-expandable metallic stent was placed over a guidewire, advanced through the stenotic lesion under fluoroscopic and rhinoscopic guidance, and dilated to restore patency. All animals had immediate resolution of clinical signs after stent placement. The procedure took a median of 38 minutes (range, 22 to 70 minutes). One animal with a stenosis located far caudally needed the tip of the stent resected because of hairball entrapment and exaggerated swallowing. Both animals without an orifice in the stenosis had tissue in-growth requiring a covered stent. All animals were reexamined 6 to 12 weeks after treatment via rhinoscopy, radiography, computed tomography, or a combination of techniques. All animals lacked signs of discomfort; 5 of 6 were breathing normally 12 to 28 months after the procedure. Transnasal balloon-expandable metallic stent placement may represent a rapid, safe, noninvasive, and effective treatment in animals with nasopharyngeal stenosis. If the stenosis is extremely caudal in the nasopharynx, serial balloon dilatation might be considered prior to stent placement. A covered stent should be considered initially if the stenosis is completely closed.