Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

Abstract

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.

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

“…Therefore, careful technique, judicious use of electrocautery, and adequate preoperative evaluation are essential in preventing nasopharyngeal stenosis. Nasopharyngeal stenosis is a very difficult complication to fix; however, palatal eversion and bilateral Z-pharyngoplasty have been shown to be effective treatments [58,59].…”

“…In 2016, a case was published where a young girl suffered an internal carotid artery (ICA) dissection and subsequent cerebral infarction resulting in hemiplegia and global aphasia found to be due to an ICA loop later confirmed on angiogram [60]. Other very rare events described in the literature include temporomandibular joint dysfunction, vertebral osteomyelitis [58,61,62], and cerebrospinal fluid (CSF) leak from the use of a microdebrider leading to pneumocephalus and meningitis [63].…”

Transoral robotic surgery for pharyngeal stenosis

“…Conversely, while balloon dilation is an acceptable, minimally invasive technique that is commonly used, several treatments under general anesthesia may be necessary. Z‐plasty is a technique that has been used with some success in patients with nasopharyngeal stenosis via scar lysis with mucosal reapproximation and preservation of the vascular supply , but limitations of visualization and space for instrumentation pose great challenges in the vast majority of these cases. In our patient group, surgical exposure was very limited, therefore TORS allowed the application of a sound, single‐stage surgical technique that would have been difficult via other techniques.…”

‘A good shepherd, but with obstructive sleep apnoea syndrome’: traditional uvulectomy case series and literature review

“…Despite no conclusive evidence that our patients’ obstructive sleep apnoea was caused by traditional uvulectomy, it most probably played a role. It is known that nasopharyngeal stenosis can cause obstructive sleep apnoea 33 …”