Bivalved Palatal Transposition Flaps for the Correction of Acquired Nasopharyngeal Stenosis

Abstract

Nasopharyngeal stenosis is almost universally an iatrogenic problem resulting from surgical trauma after adenotonsillectomy or uvulopalatopharyngoplasty (UPPP). In addition, laser-assisted uvulopalatopharyngoplasty for the treatment of snoring may lead to the development of cicatricial scarring and stenosis at the level of the velopharynx. The most common mechanisms implicated in the development of acquired nasopharyngeal stenosis are the overzealous removal of inferolateral adenoid tissue and excessive excision of the palatopharyngeal arches. Symptoms generally relate to a disturbance in respiration, olfaction, voice quality, and deglutition, and are often poorly tolerated. Surgical options for the correction of this challenging problem include steroid injections, scar lysis, skin grafts, Z-plasty repair, and the use of various local mucosal flaps. We report the successful use of bivalved palatal transposition flaps performed through the transoral route for the correction of severe acquired nasopharyngeal stenosis following UPPP in two patients. Both patients developed delayed nasopharyngeal stenosis following their initial surgery and subsequently failed several attempts at surgical correction of the stenosis, including laser lysis of the scarred soft palate. Using this technique of repair, both patients achieved satisfactory resolution of their symptoms, including comfortable nasal breathing and normal speech. We have found that this is a simple and effective technique for the correction of severe nasopharyngeal stenosis.

Stenting the nasopharyngeal isthmus by nasopharyngeal airway after correction of acquired total nasopharyngeal obstruction: surgical procedure and results

“…Local flaps either from the soft palate as described by Toh et al [17], or from the posterior pharyngeal wall as described by Cotton [1], were elevated in the submucosal plan to cover the denuded surface after excision of the scar tissue to promote mucosal healing by primary intension, but it is not always successful and depends on the presence of healthy tissue to rotate onto the stenosed surface [9]. Restenosis is the major challenge.…”

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

“…5 Several etiologic factors have been reported in the development of postoperative nasaopharyngeal stenosis, including devascularization and/or destruction of mucosa, surgery in the presence of pharyngitis, and a keloid diathesis. 2,4,6 Subsequent cicatrical scar contraction results in various degrees of fusion between the soft palate and posterolateral pharynx. Secondary or acquired nasopharyngeal stenosis can present with a range of symptoms depending on the severity of obstruction.…”

“…1 In the preantibiotic era, this was commonly a sequelae of pharyngeal inflammation secondary to syphilitic infection resulting in fusion of the soft palate and tonsillar pillars with the posterior pharyngeal wall. 1,2 Antiquated treatment of syphilis with various caustic chemicals such as topical nitric acid further contributed to scarring of the mouth, pharynx, and palate. 3,4 Following the advent of penicillin, however, most cases of nasopharyngeal stenosis are now associated with postoperative complications following uvulopalatopharyngoplasty, tonsillectomy, or adenoidectomy.…”

“…Patients with mild stenosis often report a degree of dysphagia, difficulty with nose blowing, and hyponasal speech. 2 More severe stenosis can result in obstructive sleep apnea, rhinorrea, otitis media, and anosmia. 2,6 Most commonly, these symptoms develop 3 to 6 weeks following initial surgery.…”

“…2 More severe stenosis can result in obstructive sleep apnea, rhinorrea, otitis media, and anosmia. 2,6 Most commonly, these symptoms develop 3 to 6 weeks following initial surgery. 7,8 The decision to treat nasopharyngeal stenosis must be carefully balanced with the severity of symptoms.…”