Management of midnasal stenosis with infant surgically assisted rapid palatal expansion (i<scp>SARPE</scp>)

Graham, M. Elise; Yamashiro, Duane; Skirko, Jonathan R.

doi:10.1002/lary.27199

Cited by 3 publications

(3 citation statements)

References 13 publications

(23 reference statements)

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“…Surgically assisted rapid palatal advancement (SARPE) achieves palatal distraction through surgical osteotomies and placement of an oral device in patients with crowded maxillary dentition or maxillary hypoplasia. A recent successful application in a case of midnasal stenosis was described by Graham et al [ 22 ], but the authors expressed concern regarding possible long-term risks [ 22 ] such as asymmetric expansion, gingival recession, periodontal bone defects with loss of the central incisors, and osteotomy site infections [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Examples include placement of a Hegar cervical dilator or airway balloon with or without subsequent nasal stenting [ 18 , 19 ]. Rapid maxillary expansion (RME) and surgically assisted rapid palatal advancement have been used to enlarge the nasal space via palatal distraction in infants with CNPAS or midnasal stenosis [ 20 – 22 ]. Here, we present the case of an infant with CNPAS who was treated via combined balloon dilation and placement of an innovative (removable) oral device facilitating rapid palatal expansion; we term this the Neonatal Palatal Expander Plate (NPEP).…”

Section: Introductionmentioning

confidence: 99%

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Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant

et al. 2021

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Background Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that may occur alone or as part of a multi-formative syndrome. Management remains difficult. There is no specific treatment protocol. Traditional surgery would be anachronistic; a non-invasive or minimally invasive therapeutic option is required. However, the rarity of the disease and the infantile context render randomised clinical trials difficult. Case presentation We present the case of a one-month-old Caucasian boy with CNPAS. He presented to the Emergency Department of the Bambino Gesù Pediatric Hospital with nasal obstruction, noisy breathing, feeding difficulties, and suspected sleep apnoea. During hospitalisation, he underwent overnight pulse oximetry, airway endoscopy, and maxillofacial computed tomography (CT); the final diagnosis was CNPAS with moderate obstructive sleep apnoea syndrome. We successfully treated the patient using an innovative strategy that involved collaboration between ear-nose-and-throat surgeons and orthodontists. Conclusions A combination of minimally invasive balloon surgery and placement of a palatal device may successfully treat CNPAS; it may also treat other types of nasal bone stenosis. Future studies may allow the development of practice consensus treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant

et al. 2021

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“…Surgically assisted rapid palatal advancement (SARPE) is a technique of palatal distraction that has been used to provide space for crowded maxillary dentition and in maxillary hypoplasia. A recent and successful application to a midnasal stenosis case was described by Graham et al [22]; they performed surgical dissection until exposing nasal oor before drilling the lateral nasal wall and nally they applied a xed device.…”

Section: Discussionmentioning

confidence: 99%

Balloon Dilatation and Rapid Maxillary Expansion: A Novel, Combined Treatment for Congenital Nasal Pyriform Aperture Stenosis in an Infant

Santarsiero

2021

Preprint

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BackgroundCongenital nasal pyriform aperture stenosis (CNPAS) is a rare condition isolated or inserted in a multi-formative syndrome, which still encounters management difficulties. There are no specific treatment protocols and the use of traditional surgery represents an anachronism since cognitive assumptions and non-invasive or minimally invasive therapeutic innovations would currently be available. However, the rarity of the disease and the infantile context makes RCTs difficult to process. Case presentationWe expose the case of a one-month-old caucasian male infant suffering from CNPAS. The patient presented to the Emergency Department of the Bambino Gesù Pediatric Hospital with a clinical picture characterized by nasal obstruction, noisy breathing, feeding difficulties and suspected sleep apnea. During hospitalization he underwent overnight pulse oximetry, airway endoscopy and maxillofacial CT with a final diagnosis of CNPAS with moderate obstructive sleep apnea. We treated him successfully through an innovative therapeutic strategy that required the collaboration of a team of ENT surgeons and orthodontists.ConclusionsThe combination of minimally invasive balloon surgery and the application of a palatal device may represent a successful strategy for patients with CNPAS, probably also applicable to other types of nasal bone stenosis. Future studies may allow the definition of treatment strategies of these pathologies, we hope in the context of novel practical guidelines.

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Comparison of Surgical Techniques for the Treatment of Congenital Nasal Pyriform Aperture Stenosis: A Systematic Review

Rosi-Schumacher,

DiNardo,

Reese

et al. 2024

Ann Otol Rhinol Laryngol

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Introduction: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that results in neonatal respiratory difficulty. The purpose of this systematic review was to compare surgical outcomes of drilling versus dilation techniques in the treatment of CNPAS. Methods: Pubmed, Embase, and Cochrane Clinical Trials databases were searched for terms “congenital nasal pyriform aperture stenosis” or “pyriform aperture stenosis” from 2010 to 2021. Twenty-five studies were included that evaluated pediatric patients treated surgically for CNPAS with available outcomes data including complications, revisions, and length of stay. Results: A total of 51 patients with CNPAS were pooled from included studies. The median age was 29 days, 56.9% were female, and 54.9% were born full-term. The median pyriform aperture width before surgery was 5.00 mm (IQR = 4.10, 6.45). Forty (78.4%) patients underwent sublabial drilling, while 6 had a dilation procedure performed with hegar cervical dilators, 2 had a balloon dilation, and 3 were dilated with either an acrylic device, endotracheal tube, or bougie. There were no post-operative complications for 76.5% of patients, while a second surgery was required in 9 (17.6%) patients. The median length of stay was 11 days (IQR = 4, 26). No statistically significant difference was observed between sublabial drilling and surgical dilation techniques with respect to complications, need for revision surgery, or length of stay. Conclusion: Current literature is insufficient to determine if drilling or dilation is more effective in the treatment of CNPAS.

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Management of midnasal stenosis with infant surgically assisted rapid palatal expansion (iSARPE)

Cited by 3 publications

References 13 publications

Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant

Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant

Balloon Dilatation and Rapid Maxillary Expansion: A Novel, Combined Treatment for Congenital Nasal Pyriform Aperture Stenosis in an Infant

Comparison of Surgical Techniques for the Treatment of Congenital Nasal Pyriform Aperture Stenosis: A Systematic Review

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