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

Abstract

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.

Oral self-inflicted accidental trauma in patients with neurological disorders: a case report of dental management in infants with cerebellar hypoplasia

“…Dental impressions should be taken to customize the device for each individual's anatomy. In general, oral devices that are fixed within the oral cavity, and in particular devices such as the type described in this article, are best used in the comatose or semicomatose patient population because of the potential for the device to stimulate a gag reflex or agitation secondary to the inability to fully move the tongue [26]. Removable devices allow for better hygiene but require patient collaboration with therapy; in the specific case of the paediatric patient, the real collaboration lies with the caregiver.…”

“…Antibiotic therapy [16] To prevent superinfections Tricyclic antidepressants/neurotransmitter agonist-antagonist/anticonvulsants [17] To treat dopaminergic dysfunction and/or serotonin system dysfunction but with the disadvantage to induce the patients in a state of chronic stupor Intraoral devices (hard acrylic resin plates, thermoplastic plates, or mouth guards) [18] First remedy for the management of self-inflicted injuries Botulinum toxin an injections (BTX-A) [19][20][21] Has shown promising results as a safe and effective treatment for self-induced trauma, resulting in decreased muscle strength and less frequent action, also if injected directly in masseter muscle Surgical-resorptive approach in severe and refractory cases [22] To prevent chronic injuries or to restore already self-inflicted deep injuries improve their function, and decrease the risk of hypertrophic scar formation [25,26]. Extraction of the entire dentition is an extreme but effective method to prevent mutilation.…”

Use of an Orthodontic and Otolaryngological Approach in an Infant with Holoprosencephaly

“…After the surgery, given the presence of the characteristic palatal deformity, a decision was made to increase the respiratory space by applying a device. On the same day, a neonatal palatal expander plate (NPEP) [13] was built by a dental technician and positioned in the upper arch (Figure 2). The device was a mucous anchoring plate made of acrylic resin, which was extended buccally with flanges to ensure good retention [13].…”

“…On the same day, a neonatal palatal expander plate (NPEP) [13] was built by a dental technician and positioned in the upper arch (Figure 2). The device was a mucous anchoring plate made of acrylic resin, which was extended buccally with flanges to ensure good retention [13]. A screw was placed at the center of device, to correspond with the palate median suture.…”

“…Today, less invasive approaches involve balloon dilation of the pyriform opening, with or without nasal stent placement [12]. A recent paper reported the use of this new minimally invasive method (balloon dilatation) to achieve nasal patency, accompanied by the use of intraoral devices to promote and stabilize the dilatation [13]. The objective of this report is to present a clinical case of holoprosencephaly complicated by stenosis of the pyriform opening with acute respiratory failure and to propose a combined multidisciplinary otorhinolaryngology-orthodontic approach.…”