Search

Background: Currently available treatment options for nasopharyngeal stenosis and imperforate nasopharynx in dogs and cats are fraught with complications and failures. Objective: To develop patient-specific nasopharyngeal stents using 3D-printed molds and to assess placement and fit of stents within the nasopharynx. Animals: Six canine cadavers. Methods: Patient-specific nasopharyngeal silicone stents were generated using 3D-printed molds based on CT scans. A placement protocol was developed. Post-placement, goodness of fit within the nasopharynx was evaluated and compared to currently used methods. Mechanical properties of silicone stents were compared to catheter-based and nitinol stents. Results: Development and placement of stents was successful in all six cadavers. Silicone stents offered stiffness (force required for compression, N) and post-load deformation comparable to nitinol stents (1.8–6.2 vs. 1.2–3.3 N and 0.02–0.08 vs. 0.01–0.14 mm, respectively). Patient-specific stents offered superior goodness of fit in the nasopharynx (81–90%) compared to bilateral red rubber catheters (16.2–33.8%). Conclusion: Development and placement of patient-specific stents using 3D printed molds was successful in all six cadavers. The novel stents exhibited similar mechanical properties and superior goodness of fit compared to commercially available stents, potentially offering a better alternative to commercially available stents. Further investigation is needed in animals with nasopharyngeal stenosis to determine efficacy and to assess utility in live patients. [ABSTRACT FROM AUTHOR]

Objectives: Feline nasopharyngeal stenosis (NPS) is an uncommon disease in cats. The aim of this study was to compare the outcome with endoscopic and surgical treatments. Methods: In this retrospective study, medical records were searched for cases of NPS and cases were divided into three groups: endoscopic treatment (balloon dilation); surgical treatment; or no treatment. Data are presented as median and range. Success rates and length of post-procedure corticosteroid treatment were compared between the two treated groups. Results: A total of 21 cases were included: 10 males and 11 females (median age 6.7 years, range 0.5–14.4). Clinical signs at the time of initial presentation included permanent stertor (19/21), increased respiratory efforts (9/21), nasal discharge (9/21) and cough/reverse sneezing (6/21) with a duration in the range of 3–60 months. Diagnosis was based on endoscopy (21 cases) and CT (19 cases). In total, 12 cases were treated with endoscopic balloon dilation; 11 cases demonstrated a complete resolution of clinical signs (two cats had two dilations) and one case showed incomplete improvement after one balloon dilation but was successfully treated surgically. Eight cats were treated surgically (including one cat that was originally treated with balloon dilation), including seven cases with complete resolution of clinical signs and one case with a rostral NPS that failed to respond. Two cats were not treated and are still alive more than 3 years after diagnosis. The success rate was not different between the endoscopic (11/12) and surgically treated cases (7/8) (P = 0.85). The outcome was considered excellent in most of the cases as 18/23 procedures were successful, at least until the medium term, and 15/18 treated cats had no clinical signs of minimal stertor at follow-up. Conclusions and relevance: This preliminary study suggests that minimally invasive endoscopic treatment of NPS has a high success rate and should be attempted in all cases with perforate stenotic membranes. When not achievable, extended palatoplasty can be recommended as a good alternative. [ABSTRACT FROM AUTHOR]

A two-year-old neutered male Turkish Angora cat presented with respiratory signs, including chronic snoring sounds and dyspnea with open-mouth breathing. Nasopharyngeal stenosis (NPS) was diagnosed based on endoscopy and computed tomography (CT). An attempt was made to break down the membrane, causing stenosis in the nasopharynx through balloon dilation using a valvuloplasty balloon dilation catheter (12 mm × 3 cm) and retroflexed endoscope. The balloon size was selected according to the identified diameter of the stenotic site on nasopharyngeal CT images. The balloon was inflated with radiographic contrast medium and maintained for 2 min; the similar procedure was repeated four additional times. The stenotic membrane was excised after balloon dilation. Topical Mitomycin C (MMC) was then administered to the stenotic region. After 2 weeks, an additional MMC application was repeated to prevent recurrence. The cat remained free of clinical signs without recurrence for 12 months after the most recent procedure. In this study, effective treatment results were obtained using a combination of balloon dilation, membrane excision, and topical MMC for membranous nasopharyngeal stenosis in a cat. [ABSTRACT FROM AUTHOR]

The nasopharyngeal disease is common in felines. Nasopharyngeal stenosis is uncommonly a congenital problem, with most cases being secondary to other diseases. An 8‐month‐old male neutered domestic shorthair presented with a chief complaint of chronic nasal congestion, open‐mouth breathing, and discharge. CT was performed, and palatal dysgenesis resulting in complete nasopharyngeal obstruction, secondary nasopharyngitis, and rostral nasal turbinate lysis were found. This was confirmed by an endoscopic evaluation of the nasopharynx region, which demonstrated a lack of connection between the nasopharynx and oropharynx. This is the first CT report documenting congenital palate dysgenesis resulting in complete obstruction of the nasopharynx. [ABSTRACT FROM AUTHOR]

Case summary: A female intact domestic shorthair kitten was evaluated at 8 months of age for bilateral mucopurulent nasal discharge, stertor, open-mouth breathing and difficulty eating. Imperforate nasopharynx (INP) was diagnosed on oronasal examination under anesthesia. An extended palatoplasty was performed and resulted in resolution of the clinical signs. Relevance and novel information: The extended palatoplasty procedure is relatively simple and very similar to the correction of soft palate elongation in brachycephalic dogs. It does not require special equipment and materials; therefore, it represents a viable, more readily available and cost-effective option for the treatment of INP. To the author's knowledge, this is the first case of INP that has been treated with extended palatoplasty. [ABSTRACT FROM AUTHOR]

BackgroundCurrently available treatment options for nasopharyngeal stenosis and imperforate nasopharynx in dogs and cats are fraught with complications and failures.ObjectiveTo develop patient-specific nasopharyngeal stents using 3D-printed molds and to assess placement and fit of stents within the nasopharynx.AnimalsSix canine cadavers.MethodsPatient-specific nasopharyngeal silicone stents were generated using 3D-printed molds based on CT scans. A placement protocol was developed. Post-placement, goodness of fit within the nasopharynx was evaluated and compared to currently used methods. Mechanical properties of silicone stents were compared to catheter-based and nitinol stents.ResultsDevelopment and placement of stents was successful in all six cadavers. Silicone stents offered stiffness (force required for compression, N) and post-load deformation comparable to nitinol stents (1.8–6.2 vs. 1.2–3.3 N and 0.02–0.08 vs. 0.01–0.14 mm, respectively). Patient-specific stents offered superior goodness of fit in the nasopharynx (81–90%) compared to bilateral red rubber catheters (16.2–33.8%).ConclusionDevelopment and placement of patient-specific stents using 3D printed molds was successful in all six cadavers. The novel stents exhibited similar mechanical properties and superior goodness of fit compared to commercially available stents, potentially offering a better alternative to commercially available stents. Further investigation is needed in animals with nasopharyngeal stenosis to determine efficacy and to assess utility in live patients.

Yoga is becoming way of life world over to stay fit and agile both physically and mentally. Sutra neti is an ancient yoga practice in which a thread/tube is passed through nostrils and taken out through mouth and is then moved back and forth. This technique is believed to clean nasal passages and is considered relatively safe. We report a case of nasopharyngeal stenosis caused due to this ancient practice. People and yoga trainers all over the world should be made aware of this complication of sutra neti as it is difficult to treat and has high recurrence rate. [ABSTRACT FROM AUTHOR]

Nasopharyngeal stenosis is a challenging condition characterized by a narrowed nasopharynx, leading to nasal congestion, impaired breathing, and recurrent sinus issues. In this report, we present a unique surgical approach that combines the use of both the Da Vinci Xi robot and a 70-degree nasal endoscope in a patient with a type II stenosis of the nasopharynx. The benefits of improved visualization, maneuverability, and precision of this novel combined approach are highlighted. It also highlights the benefit of using mitomycin C in minimizing the risk of re-stenosis. This previously undescribed technique can not only improve patient outcomes, but it also paves the way for future advancements and broader applications in robotically assisted procedures involving the skull base and oropharynx., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Case Summary: A female intact domestic shorthair kitten was evaluated at 8 months of age for bilateral mucopurulent nasal discharge, stertor, open-mouth breathing and difficulty eating. Imperforate nasopharynx (INP) was diagnosed on oronasal examination under anesthesia. An extended palatoplasty was performed and resulted in resolution of the clinical signs., Relevance and Novel Information: The extended palatoplasty procedure is relatively simple and very similar to the correction of soft palate elongation in brachycephalic dogs. It does not require special equipment and materials; therefore, it represents a viable, more readily available and cost-effective option for the treatment of INP. To the author's knowledge, this is the first case of INP that has been treated with extended palatoplasty., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Two dogs were referred to Veterinary Specialists Aotearoa for evaluation and treatment after sustaining significant head trauma. Case 1 was a 7-month-old, female Staffordshire Bull Terrier who was hit by a car at low speed. Case 2 was a 2-year old, male neutered German Shepherd who sustained a gunshot wound to the head whilst on duty for the New Zealand Police Dog Unit. The dog in Case 1 suffered numerous facial fractures which caused collapse of the ventral nasal meatus and dorsal nasopharyngeal wall. The dog in Case 2 had extensive osseous and soft tissue damage to the nose, nasopharynx and cervical region with severe narrowing of the ventral meatuses, nasopharyngeal meatus and rostral nasopharynx due to multiple fracture fragments and shrapnel pieces. A diagnosis of traumatic nasopharyngeal stenosis was made in each case by computed tomography. Mechanical balloon dilation was used to treat the stenosis in both dogs. The balloon dilations were performed using a 12-mm balloon dilation catheter inserted in an antegrade fashion. In the first dog, the procedure was performed blind and was repeated three times with 5- and 9-day intervals between dilations. In the second dog, the procedure was performed under endoscopic guidance and again, was repeated three times with a 7-day interval between dilations. Clinical success was reported in both patients following treatment and the second dog also underwent a follow-up computed tomography scan which confirmed resolution of the stenosis. Traumatic nasopharyngeal stenosis that was successfully treated with balloon dilation. Findings suggest that balloon dilation may be an effective technique for the treatment of traumatic nasopharyngeal stenosis in dogs. Multiple dilation procedures are likely required, but the procedure can ultimately result in long term clinical resolution. Abbreviations: CT: Computed tomography; VSA: Veterinary Specialists Aotearoa [ABSTRACT FROM AUTHOR]

Abstract Background Nasopharyngeal stenosis (NPS) is a rare condition defined as the obstruction of the communication between the oropharynx and nasopharynx owing to scar contracture of the soft palate, tonsillar pillars, and posterior pharyngeal wall. NPS could be primary (attributed to a disease process such as rhinoscleroma) or secondary caused by prior surgery. In this study, we discuss the clinical manifestation of the acquired nasopharyngeal stenosis (NPS) and to investigate if there is a relation between the grade of the acquired NPS and the severity of obstructive sleep apnea (OSA) and patients’ symptoms. So, this cross-sectional study was conducted on patients who had post-surgical NPS of different grades. Then, the severity of snoring ± OSA and VAS of symptoms in those patients was assessed in different grades of the NPS, and the results were also statistically compared. Results Within the included 22 patients, there were no statistical differences between grade 1 and in grade 2 as regards age (p = 0.0619) or sex (p = 0.21137). The mean AHI was significantly more (p = 0.004) in grade 2 NPS than grade 1 NPS. The VAS of difficult nasal breathing and dysphagia were significantly worse (p < 0.0001) in grade 2 NPS than in grade 1, while the VAS of snoring did not differ significantly (p = 0.3466) between grade 1 and grade 2 NPS. Conclusion Grade 2 NPS leads to significantly more severe AHI, dysphagia, and difficult nasal breathing than grade 1 NPS. But the difference in the grade of NPS did not cause differences in the snoring intensity.

Respiratory disease is common in guinea pigs (Cavia porcellus). As obligate nasal breathers, disease of the upper airway can result in significant dyspnea. Nasopharyngeal stenosis is defined as a luminal narrowing of the nasopharynx, which extends from the choana to the caudal margin of the soft palate. This condition can be acquired or congenital and has been diagnosed in other species. However, nasopharyngeal stenosis has not been previously described in guinea pigs. Four guinea pigs were presented with chronic, recurrent upper respiratory signs including stertor, oculonasal discharge, tachypnea, and dyspnea. All four animals had signs suggestive of upper respiratory tract disease on examination. Nasopharyngeal stenosis was identified at the rostral aspect of the nasopharynx at the level of the choana via computed tomography (CT) in all cases. Otitis media was also present in three of the four cases. Antibiotic therapy was instituted for all animals. Two of the four guinea pigs were treated with prednisolone and two were treated with meloxicam to control associated inflammation. One animal died 2 months after diagnosis due to complications from severe otitis media. One individual was euthanized due to progressive disease after a year and a half of treatment. One guinea pig was lost to follow up after 6 months. The remaining guinea pig was alive at the time this case series was written (11 months after initial diagnosis) but continues to have signs of upper airway disease. Nasopharyngeal stenosis is an important differential diagnosis for persistent upper respiratory signs in guinea pigs. CT was diagnostic in all cases, identifying nasopharyngeal stenosis at the level of the choana, and allowed identification of comorbidities (otitis media and rhinitis). Medical management resulted in survival times from 2 months to a year and a half following diagnosis. Further investigation into minimally invasive interventions such as balloon dilation and stent placement are warranted for future cases. [ABSTRACT FROM AUTHOR]

• Purastat is a novel haemostatic agent used effectively in nasal procedures in the prevention of epistaxis and adhesions. • This study describes the use of PuraStat following division of nasopharyngeal stenosis to reduce the risk of restenosis. • On last follow-up the patient experienced excellent resolution of symptoms with no evidence of readhesion. • The authors propose that PuraStat may be used in other surgical interventions to prevent mucosal adhesion formation. Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy. A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted. [ABSTRACT FROM AUTHOR]

Introduction: Choanal atresia is a rare congenital anomaly in humans and animals, characterized by the absence of communication of one or both nasal cavities with the nasopharynx. The severity of clinical signs depends on the presence of unilateral versus bilateral stenosis as well as comorbidities. With bilateral atresia, respiration may be severely compromised particularly during sleep, as airflow can only occur when breathing through the open mouth. Various therapeutic modalities have been described in people and adopted for animals. All treatments may be associated with complications, the most important being post-therapeutic scar formation with re-stenosis. This report describes a 10-month-old British Shorthair cat with chronic unilateral serosal nasal discharge that changed to mucopurulent discharge. When acute neurological signs developed, the cat was presented to the veterinary hospital. A diagnosis of primary, membranous right sided choanal atresia was achieved via computed tomography (CT) and nasopharyngeal (posterior) rhinoscopy. Secondary changes included destructive rhinitis with progression to the CNS with a subdural empyema and meningoencephalitis. Retinal changes and aspiration bronchopneumonia were suspected additional complications. After recovery from the secondary infections, the membranous obstruction was perforated and dilated using a valvuloplasty balloon by an orthograde transnasal approach under endoscopic guidance from a retroflexed nasopharyngeal view. To prevent re-stenosis, a foley catheter was placed as a transient stent for 6 days. The cat recovered uneventfully and was asymptomatic after the stent removal. Endoscopic re-examination after 5 months confirmed a persistent opening and patency of the generated right choanal passage. The cat remains asymptomatic 10 months after the procedure. Transnasal endoscopic balloon dilation and transient stenting of choanal atresia is a minimally invasive and relatively simple procedure with potentially sustained success.

Highlights • An unusual case of nasopharyngeal stenosis following severe erosive oral lichen planus is described. • Initial surgical management was complicated by recurrent nasopharyngeal stenosis due to the intense underlying inflammatory disease process. • 'Nasal flossing' is described as a novel technique that can be used as an adjunct to prevent recurrence of nasopharyngeal stenosis and has relevance to a broad range of oral and nose and throat physicians. Abstract Introduction We describe a case of severe erosive oral lichen planus that led to nasopharyngeal stenosis. This is a rare clinical presentation that was ultimately, successfully treated by surgery combined with post-operative 'nasal flossing': a novel therapeutic intervention. Presentation of case A 76-year-old male suffering from a rare case of severe oral lichen planus that was resistant to conservative measures is described. Initial surgery was complicated by recurrence of nasopharyngeal stenosis. Definitive surgery required revision of nasopharyngeal stenosis release combined with a course of post- operative 'nasal flossing'. The technique for 'nasal flossing' is described and demonstrated in photographs. The patient remained asymptomatic at 3 years using this combined approach, with restoration of olfaction, taste perception and voice quality, significantly enhancing quality of life. Discussion Erosive oral lichen planus is a rare but important presentation in oral medicine. We found 'nasal flossing' to be a successful treatment to maintain nasopharyngeal patency following surgical repair of this uncommon condition. We are not aware that this combined approach has previously been described in the published literature. Conclusions Severe erosive oral lichen planus can lead to nasopharyngeal stenosis. Nasopharyngeal stenosis in these patients may be refractive to conventional surgical approaches. 'Nasal flossing' is demonstrated to be both practical and acceptable as a surgical adjunct in these difficult to treat cases of recurrent nasopharyngeal stenosis. This report has relevance for all those practicing oral and maxillofacial surgery, ear nose and throat surgery and oral medicine. [ABSTRACT FROM AUTHOR]

Objective: Intranasal substance abuse with cocaine or opioids can result in complications involving the midline nasal and oral structures. When the defect involves the velopharyngeal musculature, this leads to velopharyngeal dysfunction (VPD). This article aims to illustrate this clinical entity through a series of four patients and a review of the literature.Methods: A series of four cases of VPD due to intranasal narcotic use and their management are discussed. A comprehensive search in PubMed was conducted for cases of VPD associated with intranasal drug use in the English-language literature.Results: Four female patients presented with symptoms of VPD, including worsening nasal regurgitation, poor speech intelligibility, and hypernasal speech. One patient presented with nasopharyngeal stenosis. All patients admitted to intranasal cocaine, methamphetamine, and/or prescription narcotics use prior to the onset of symptoms. The diagnosis was confirmed with abnormal velopharyngeal musculature seen on nasopharyngoscopy. Both conservative and surgical treatment options were proposed. A literature review identified nine cases of VPD. Erosion of the velum was seen in all cases. Reported treatments included obturator prosthetic, local flap, and free flap. Ancillary investigations were not consistently pursued to rule out other etiologies to VPD.Conclusion: Intranasal illicit drug use can result in destructive changes leading to VPD. This is the largest case series to date of this difficult clinical problem. Management principles including options for conservative and surgical interventions are summarized.Level Of Evidence: 4 Laryngoscope, 128:2721-2725, 2018. [ABSTRACT FROM AUTHOR]

Objective Rarely the tonsillar pillars and the soft palate became adherent to the posterior nasopharyngeal wall by strong fibrous tissue due to excessive dissection and cauterization during surgery leading to nasopharyngeal stenosis. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to explore our results of modifying the basic technique to accommodate those patients with combined nasopharyngeal stenosis and tonsillar pillars adhesions in one stage. Study Design: Case series. Methods This study was conducted on 10 patients with combined nasopharyngeal stenosis and tonsillar pillars adhesions after adenotonsillectomy. They were subjected to treatment by palatal eversion through dividing the soft palate in the midline to separate each pillar from the pharyngeal wall in continuation with each half of soft palate and removal of the fibrous tissue causing stenosis. This was followed by eversion and fixation of the two palatal divisions on either side to allow complete epithelialization of the stenotic area. Postoperative follow-up was done for one year by the flexible nasopharyngoscopy, perceptual speech analysis, and polysomnography. Results The flexible nasopharyngosopic examination of the 10 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 10 cases. No obstructive episodes were recorded in polysomnograms. Conclusions Palatal eversion is a promising technique in the treatment of post-adenotonsillectomy of combined nasopharyngeal stenosis and tonsillar pillars adhesion. It is recommended to be used on a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. The level of evidence: 4 (case series). [ABSTRACT FROM AUTHOR]

Background Scleroma is a rare, chronic, granulomatous infectious disease of the respiratory tract mucosa which begins in the nose and spreads to the respiratory tract and adjoining structures. We report on the extensions and the management of 134 cases of scleroma in the Highlands region of Papua New Guinea. Methods The charts and treatment records of 134 scleroma cases were retrospectively reviewed from 1995 to 2013. The staging, extensions, treatment and results of treatment were reviewed and analysed. Results Of the 134 cases, 72 (53.7%) were females and the age ranged from 6 to 65 years. The disease was confined to the nose and nasopharynx in 71 (53.0%) cases. Extension of the disease from the nose to the Eustachian tube occurred in nine (6.7%) cases and into the middle ear in four (3.0%) cases. Further extensions to the larynx and trachea were seen in 17 (12.7%) cases each and the bronchus in three (2.2%) cases. Primary laryngoscleroma without involvement of the nose and nasopharyngeal stenosis without laryngeal involvement were managed in 11 (8.2%) and nine (6.7%) cases respectively. Others cases treated were ethmoid scleroma with proptosis and scleroma involving the upper lip in one (0.75%) case each. Ninety-nine (74.9%) patients were treated medically while 35 (26.1%) patients required surgery. Cure were achieved in 83 (61.9%) cases treated medically and 26 (19.4%) had successful surgical outcome. Conclusion Scleroma begins in the nose and when not arrested, extends causing obstruction to the airway and cosmetic deformity which requires surgical intervention. [ABSTRACT FROM AUTHOR]

A sixty-eight years old female patient with complete nasopharyngeal stenosis without any determined etiology is presented. She had complete nasal obstruction as well as obstructive sleep apnea syndrome. She was operated and dense, thick, avascular fibrotic tissues were excised and reconstructed with local flaps and skin graft. Only partial opening was achieved in the long term follow-up.

Introduction: Nasopharyngeal stenosis (NPS) is a rare and morbid complication following radiation therapy for nasopharyngeal carcinoma. This review provides an update on management and prognosis., Methods: A comprehensive PubMed review using the terms "nasopharyngeal stenosis," "choanal stenosis," and "acquired choanal stenosis" was performed., Results: Fourteen studies identified 59 patients who developed NPS after radiotherapy for NPC. 51 patients underwent endoscopic nasopharyngeal stenosis excision by cold technique (80-100% success). The remaining 8 underwent carbon dioxide (CO 2 ) laser excision with balloon dilation (40-60% success). Adjuvant therapies included postoperative topical nasal steroids in 35 patients. The need for revision was 62% in the balloon dilation group, vs 17% in the excision group (p-value <0.01)., Conclusion: When NPS occurs after radiation, primary excision of scarring is the most effective method of management with less need for revision surgery relative to balloon dilation., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Abstract: Objective: The treatment of nasopharyngeal stenosis is challenging because of a high incidence of recurrence after surgical correction. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to assess the efficacy of palatal eversion as a new technique for treatment of nasopharyngeal stenosis after adenotonsillectomy. Study Design: Case series. Methods: This study was conducted on 12 patients with nasopharyngeal stenosis after adenotonsillectomy were subjected to treatment by palatal eversion by dividing the soft palate in the midline and removal of the fibrous tissue causing stenosis followed by evertion and fixation of the two palatal division on either side for six weeks to allow complete epithelialization of the stenotic area followed by another operation to reunion the soft palate in the midline. Post-operative follow up was done for one year by flexible nasopharyngoscopy, perceptual speech analysis and polysomnography. Results: Flexible nasopharyngosopic examination of the 12 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 12 cases. No obstructive episodes were recorded in polysomnograms. Conclusions: Palatal eversion is a promising technique in treatment of post-adenotonsillectomy nasopharyngeal stenosis and it is recommended to be used in a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. Level of evidence: 4 (case series). [Copyright &y& Elsevier]

Objectives/Hypothesis: Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO2 laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results. Study Design: Retrospective review of case series. Methods: An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO2 laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation. Results: Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months. Conclusions: Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation. [ABSTRACT FROM AUTHOR]

Objective: A series of nasopharyngeal appliance designs is presented that represents our evolving experience over a 20-year period in the adjunctive use of prosthetic stents in the surgical correction of nasopharyngeal stenosis. Design: Retrospective assessment of effectiveness of two nasopharyngeal stenosis hollow stent designs in a consecutive series of patients for relief of nasal obstructive symptoms. Setting: Tertiary academic medical center, Craniofacial Program at Children's Hospital. Patients: Four patients with nasopharyngeal stenosis were treated with a preoperatively fabricated stent made from a clasped palatal appliance onto which hollow acrylic conduits were extended through surgically re-created pharyngeal ports. A subsequent set of four patients with nasopharyngeal stenosis were treated with intraoperatively-fashioned silastic grommets, as opposed to palatal appliances. Interventions: Postoperative intraoral stenting of nasopharyngeal ports. Main Outcome Measures: Maintenance of pharyngeal port opening after 1 year, improvement in nasal airway obstructive symptoms. Results: The palatal appliance stents were less well tolerated and had a lower maintenance of port patency after device removal (4 of 8, 50%). The silastic grommets provided better retention into the ports and increased patient tolerance, as well as better 1-year port maintenance (6 of 8, 75%). Conclusions: The grommet stent appliance offers numerous advantages over a conventional dental-clasped appliance for prosthetic nasopharyngeal stenting, including obviation of extensive preoperative preparation, ease of insertion and removal, and exchange of air during the stenting period, Improved nasopharyngeal patency with this device may be due to greater patient tolerance and subsequent longer use. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 55-year-old female with 2 years of bilateral nasal obstruction, facial pressure, oral dryness, and nasal drainage. Examinations revealed extensive synechiae between the nasal septum and turbinates, near complete nasopharyngeal stenosis, and soft tissue along nasal floor, and the diagnosis of Sjögren syndrome was confirmed. The patient underwent endoscopic repair of nasopharyngeal stenosis, division of nasal synechiae and postoperative oral steroids.

A sixty-eight years old female patient with complete nasopharyngeal stenosis without any determined etiology is presented. She had complete nasal obstruction as well as obstructive sleep apnea syndrome. She was operated and dense, thick, avascular fibrotic tissues were excised and reconstructed with local flaps and skin graft. Only partial opening was achieved in the long term follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons. [Copyright &y& Elsevier]