Management of Total Nasopharyngeal Stenosis following UPPP

Stepnick, David W.

doi:10.1177/014556139307200119

Cited by 31 publications

(18 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 In more severe cases of stenosis, aggressive strategies have included the use of radial forearm and jejunal free flaps to treat recurrent stenosis after conventional flaps have failed. 1,8 Only limited experiences with such approaches, however, have been reported in the literature. And while theoretically bringing more healthy, unoperated tissue into the site of stenosis, frequent postoperative scarring has been observed requiring additional surgical revisions.…”

Section: Discussionmentioning

confidence: 99%

“…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. Nevertheless, as most patients tend to be young and symptoms may potentially progress, intervention is typically necessary.…”

mentioning

confidence: 99%

“…10,11 More severe forms of nasopharyngeal stenosis, however, must be approached surgically, using Z-plasty repair, pharyngeal flaps, or free tissue transfer. [2][3][4]8,[12][13][14][15] The study below reports our surgical outcome from a bilateral Z-pharyngoplasty procedure used to relieve significant pharyngeal stenosis from surgical scarring. In addition, we review outcomes of other various surgical techniques.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

Wan¹,

Kumar²,

Head³

et al. 2010

Annals of Plastic Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

Wan¹,

Kumar²,

Head³

et al. 2010

Annals of Plastic Surgery

View full text Add to dashboard Cite

show abstract

“…Even with optimal planning and surgical technique, many patients require repeat operations to obtain satisfactory results. Stepnick [8] reported recurrent scarring and stenosis within 6 weeks of treating nasopharyngeal stenosis with the placement of a free flap and a local laterally based flap is not always successful and depends on the presence of healthy pharyngeal tissue to rotate onto the stenosed surface [9].…”

Section: Introductionmentioning

confidence: 99%

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

Abu-Samra

Eladl

2012

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The objective of this study is to describe a simple surgical procedure for management of acquired total nasopharyngeal obstruction in adults. Five patients were diagnosed as having complete nasopharyngeal obstruction over a 3-year period. Three patients previously underwent uvulopalatoplasty, while for the remaining two it was due to pharyngoscleroma. In all the patients, nasopharyngeal obstruction was at the level of the inferior edge of the soft palate. Two of the post-uvulopalatoplasty patients had recurrent obstruction after scar excision and topical application of mitomycin-C without stenting. All the patients were treated surgically by creation of a new anatomical nasopharyngeal isthmus and stenting it by nasopharyngeal airway for 6 months. All the patients experienced satisfactory results and good tolerability to airway placement. The nasopharyngeal airway can counteract the inevitable scar contraction of the new nasopharyngeal isthmus after surgical correction and maintain its patency.

show abstract

“…Delayed complications include return of snoring, worsening of sleep apnea including central apneas, and nasopharyngeal stenosis. Nasopharyngeal stenosis has been described infrequently in small case series [2][3][4][5] and is regarded as a rare complication of UPPP. 6,7 We define nasopharyngeal stenosis as a rare complication of attempted surgical treatment for OSA or snoring that results in scar tissue formation and subsequent narrowing at the junction of the oropharynx and nasopharynx producing specific clinical sequelae.…”

mentioning

confidence: 99%

Resolution of Severe Sleep-Disordered Breathing with a Nasopharyngeal Obturator in 2 Cases of Nasopharyngeal Stenosis Complicating Uvulopalatopharyngoplasty

DeAngelo

Mysliwiec

2004

Sleep Breath

View full text Add to dashboard Cite

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by episodic decrements in airflow due to upper airway obstruction. Uvulopalatopharyngoplasty (UPPP) is a potential therapy for OSAHS. Nasopharyngeal stenosis is a rare complication of UPPP that worsens OSAHS. We report two patients referred for OSAHS worsened by nasopharyngeal stenosis complicating UPPP. Both patients were treated with carbon dioxide laser release of adhesions and placement of a nasopharyngeal obturator. Follow-up polysomnograms demonstrated resolution of OSAHS correlating with subjective resolution of symptoms. Nasopharyngeal stenosis complicating UPPP can be successfully treated with scar removal and nasopharyngeal stenting. Polysomnographic demonstration of the effectiveness of this therapy has not previously been reported. Future questions include duration of nasopharyngeal stenting and timing of follow-up polysomnography.

show abstract

Management of Total Nasopharyngeal Stenosis following UPPP

Cited by 31 publications

References 4 publications

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

Amelioration of Acquired Nasopharyngeal Stenosis, with Bilateral Z-Pharyngoplasty

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

Resolution of Severe Sleep-Disordered Breathing with a Nasopharyngeal Obturator in 2 Cases of Nasopharyngeal Stenosis Complicating Uvulopalatopharyngoplasty

Contact Info

Product

Resources

About