Combined retrograde and anterograde hypopharyngeal puncture and dilatation in a child with complete hypopharyngeal stenosis.
The management of complete hypopharyngeal stenosis is a complex task, and various methods of re-creating a lumen and maintaining its patency have been described in both the adult and pediatric literature. We present our experience using a modification of the combined anterograde-retrograde endoscopic technique for managing a 15-year-old child who developed complete hypopharyngeal and upper esophageal obliteration following successful treatment of a parapharyngeal rhabdomyosarcoma. During an 18-month period following initial cannulation of the aerodigestive tract, we performed 17 dilatations using a double-balloon technique that combined anterograde and retrograde approaches to the stenosis. Initially, Kenalog injections and topical Mitomycin-C were used as adjunctive treatments. We observed no major complications following dilatations. At 33 months follow-up the patient was asymptomatic, tolerating a near normal diet, had not required dilation for more than 18 months, and no longer required a gastrostomy tube.
Zur
Karen B
KB
Division of Pediatric Otolaryngology/Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2018 Cincinnati, OH 45229-3039, USA.
Putnam
Philip E
PE
Rutter
Michael J
MJ
D000287:Administration, Topical; D000293:Adolescent; D000477:Alkylating Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D006801:Humans; D007013:Hypopharynx; D015552:Injections, Intralesional; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use; D010608:Pharyngeal Diseases / Q000150:complications / Q000209:etiology / Q000628:therapy*; D011677:Punctures; D012208:Rhabdomyosarcoma / Q000150:complications; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
D000477:Alkylating Agents; D000893:Anti-Inflammatory Agents; D016685:Mitomycin; D014222:Triamcinolone Acetonide