Amelioration of acquired nasopharyngeal stenosis, with bilateral Z-pharyngoplasty.
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.
Wan
Derrick C
DC
Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA.
Kumar
Anand
A
Head
Christian S
CS
Katchikian
Hurig
H
Bradley
James P
JP
D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery; D009302:Nasopharyngeal Diseases / Q000209:etiology / Q000601:surgery*; D010614:Pharynx / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome