<scp>CPAS</scp>: Surgical approach with combined sublabial bone resection and inferior turbinate reduction without stents

Merea, Valeria Silva; Lee, Andrew H Y; Peron, Didier L.; Waldman, Erik H.; Grunstein, Eli

doi:10.1002/lary.25001

Cited by 15 publications

(6 citation statements)

References 9 publications

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“…This is the first report of a case of CNPAS in which both inferior turbinate reduction and postoperative stents were utilized. Furthermore, in previously published studies, postoperative nasal stents were left in place for 5 days to a maximum of 4 weeks (Visvanathan and Wynne 2012; Gonik et al 2015; Merea et al 2015). In this patient, we trialed different types of nasal stents for periods of time while the patient was admitted to the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, one case reported the use of bilateral intranasal mometasone furoate stents, traditionally used following sinus surgery to maintain patency and locally deliver steroid medication, as an alternative to traditional stents, in order to decrease the risk of plugging and nasal alar necrosis (Smith et al, 2017). Inferior turbinate reduction (Merea et al, 2015) has been reported in combination with the above techniques to increase the patency of the nasal cavity. Nasal dilation of CNPAS has also been described in the literature (Wine et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Conservative management utilizes nasal suctioning, decongestants, humidification, oropharyngeal airways, anti-reflux medications, and feeding modifications (Collins et al, 2013). Surgical management includes transnasal dilations, widening of the bony pyriform aperture via sublabial and submucosal approaches, and the use of stents and inferior turbinate reduction (Visvanathan and Wynne 2012; Gonik et al 2015; Merea et al 2015; Moreddu et al 2016). This case report describes a complicated case of CNPAS with both pyriform aperture and nasal cavity narrowing.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Complicated Case of Congenital Nasal Pyriform Aperture Stenosis: Use of a Long-term Unilateral Nasal Stent

Awad

Maresh

2019

The Cleft Palate-Craniofacial Journal

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This case describes a full-term baby with pyriform aperture stenosis who failed intranasal dexamethasone and reflux therapy. She underwent repair via a sublabial approach and inferior turbinate reduction. Symptoms initially improved but she was unable to be weaned from intranasal steroids. Three subsequent surgeries ensued, including lysis of synechiae, further turbinate reduction, and placement of custom nasal stents, which failed as they became clogged frequently and were easily dislodged, leading to increased intranasal manipulation and postprocedural inflammation. She was eventually fitted and discharged with a large, unilateral stent. After 8 weeks, the stent was removed; she was tolerating full oral feeds. This case highlights the limitations of surgical repair and describes nontraditional uses of stenting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Complicated Case of Congenital Nasal Pyriform Aperture Stenosis: Use of a Long-term Unilateral Nasal Stent

Awad

Maresh

2019

The Cleft Palate-Craniofacial Journal

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“…9 Further, it has also been proposed to perform inferior turbinate reduction rather than stenting at the time of repair. 10 This method could stent open the internal nasal valve and deliver steroids directly to the inferior turbinate. We could also envision using these stents in revision/refractory cases.…”

Section: Discussionmentioning

confidence: 99%

Pyriform Aperture Stenosis: A Novel Approach to Stenting

Smith

Kull

Thottam

et al. 2017

Ann Otol Rhinol Laryngol

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“…Patients with stents should be closely followed up due to a risk of restenosis when removed early or tissue necrosis when removed too late. 4 , 6 Merea et al 11 published a series of six patients who underwent the classic sublabial procedure associated with bilateral inferior turbinectomy without stenting. These researchers reported successful follow-up, with no cases of restenosis or septal perforations.…”

Section: Discussionmentioning

confidence: 99%

Newborn Nasal Obstruction due to Congenital Nasal Pyriform Aperture Stenosis

Serrano

Pfeilsticker

Silva

et al. 2016

Allergy�Rhinol (Providence)

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Introduction:Nasal obstruction is an important condition that can lead to severe respiratory distress in newborns. There are several differential diagnoses, and one of them is congenital nasal pyriform aperture stenosis (CNPAS). CNPAS is a rare case of respiratory distress caused by excessive growth of the nasal process of the maxilla and leads to narrowing of the anterior third of the nasal cavity. Diagnosis, associated anomalies, and treatment strategies are reviewed by the following presentation of two cases.Case Presentation:We report two cases of infants diagnosed with CNPAS. The patients in the first case had no concomitant comorbidities, and the outcome was successful after surgical correction of stenosis. The patient in the second case had an associated holoprosencephaly, and although surgical correction and nasal cavity patency, the patient remains dependent on tracheostomy due to dysphagia and neurologic impairment.Discussion:Airway obstruction affects 1 in 5000 children, and CNPAS is a diagnosis frequently forgotten and even unknown to neonatal and pediatric intensivists. Newborns are obligate nasal breathers, and, nasal obstruction, therefore, can lead to severe respiratory distress. CNPAS is not only rare but, many times, is not easily recognized. It is important to bear in mind the diagnostic criteria when evaluating infants with nasal obstruction. Conservative treatment should be prioritized, but surgical treatment is required in severe cases with failure to thrive and persistent respiratory distress. Respiratory distress and dysphagia may persist to some degree despite correction of the stenotic pyriform aperture due to associated narrowing of the entire nasal cavity and association with other anomalies.Final Comments:CNPAS is a rare condition and may be lethal in newborns. Differential diagnosis of nasal obstruction must be remembered to recognize this anomaly, and the otolaryngologist must be familiarized with this condition and its diagnosis. Precise surgical treatment in severe cases have high rates of success in children without other comorbidities.

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CPAS: Surgical approach with combined sublabial bone resection and inferior turbinate reduction without stents

Abstract: 4.

Cited by 15 publications

References 9 publications

A Complicated Case of Congenital Nasal Pyriform Aperture Stenosis: Use of a Long-term Unilateral Nasal Stent

A Complicated Case of Congenital Nasal Pyriform Aperture Stenosis: Use of a Long-term Unilateral Nasal Stent

Pyriform Aperture Stenosis: A Novel Approach to Stenting

Newborn Nasal Obstruction due to Congenital Nasal Pyriform Aperture Stenosis

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