Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma.
Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.
Department of Otorhinolaryngology, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia.
Jalal
J
Hussein
Teck Soon
TS
Tan
Aun Wee
AW
Chong
Prepageran
P
Narayanan
Rahmat
R
Omar
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D002277:Carcinoma / Q000532:radiotherapy; D002921:Cicatrix / Q000503:physiopathology / Q000601:surgery; D003251:Constriction, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy; D009305:Nasopharynx / Q000503:physiopathology* / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects*; D015607:Stents; D014057:Tomography, X-Ray Computed; D055158:Velopharyngeal Sphincter / Q000503:physiopathology* / Q000601:surgery
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin