Acquired Nasopharyngeal Stenosis Correction Using a Modified Palatal Flaps Technique in Obstructive Sleep Apnea (OSA) Patients

Abstract

Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8-67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the . Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique.

Relation between grades of acquired nasopharyngeal stenosis and severity of obstructive sleep apnea symptoms

“…Severe cases of NPS (grade 3) were not detected in the current study because they are much far less encountered than other grades [16,18].…”

“…In the current study, 3 cases of the included NPS were caused by adenotonsillectomy. This could be attributed to some risk factors such as excessive mucosal removal, keloid tendency, existence of concomitant nasopharyngeal inflammation, and an extreme surgical electrocautery use [18].…”

“…Due to the high recurrence rates noted in the NPS management, many treatment modalities are now available. The surgical options reported in literature include the usage of either soft palate or pharyngeal wall flaps [15,16,[18][19][20] after excision of the scarred tissue. But, the NPS is prone to high recurrence incidence in spite of adequate planning and proper techniques [18].…”

Partial Nasopharyngeal Stenosis: Presentation of an Unusual Case

“…In this, a varied technique to bivalved palatal transposition flaps was used. This study also described promising results with none of the patients showing follow-up complications [6]. A study in Kenya documented the successful treatment of NPS using a facial artery Musculo mucosal flap as an alternative [7].…”

Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment

“…There are many surgical procedures proposed for the treatment of OSA. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls [ 18 , 19 , 20 , 21 ]. In this scenario, barbed reposition pharyngoplasty (BRP), devised by Vicini et al [ 22 ], showed excellent outcomes at short- and long-term follow-up [ 23 , 24 ].…”