J Otolaryngol Ophthalmol Shandong Univ ›› 2017, Vol. 31 ›› Issue (6): 58-61.doi: 10.6040/j.issn.1673-3770.0.2017.436

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Treatment of pharyngeal stenosis following uvulopalatopharyngoplasty with coblation.

HUO Hong, LI Wuyi, WANG Jian, YANG Dahai, JIN Xiaofeng, TIAN Xu, NIU Yanyan.   

  1. Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2017-10-20 Online:2017-12-16 Published:2017-12-16

Abstract: Objective Pharyngeal stenosis as a postoperative complication following uvulopalatopharyngoplasty(UPPP)with coblation is rare and may be difficult to treat. This report explores the causes of pharyngeal stenosis and presents our experience in successfully treating it. Methods From November 2010 to August 2016, eight patients with pharyngeal stenosis(five cases of nasopharyngeal stenosis and three of combined nasopharyngeal and oropharyngeal stenosis)secondary to UPPP with coblation presenting to Peking Union Medical College Hospital were studied. All patients with grade Ⅲ nasopharyngeal stenosis and different levels of difficulty in nasal breathing, mouth breathing, and blowing of the nose, as well as hyponasal speech, snoring, apnea, anosmia, and dysphagia. They underwent scar resection surgery for nasopharyngeal stenosis, horizontal-to-vertical pharyngoplasty for oropharyngeal stenosis, and local pharyngeal-flap rotation. Nasopharyngeal hollow stents were maintained in situ for >6 months postoperatively. Results Over a follow-up period of 1-4.5 years, amelioration of all symptoms was observed in seven cases, and the nasopharyngeal diameter was maintained at about 2 cm. No case of velopharyngeal insufficiency was noted. One patient required retreatment after restenosis. Conclusion Improper operation with coblation can cause severe postoperative pharyngeal stenosis. Scar resection, local flap rotation, horizontal-to-vertical pharyngoplasty, and prolonged use of nasopharyngeal hollow stents are reliable methods for correction of pharyngeal stenosis following UPPP surgery.

Key words: Pharyngeal stenosis, Uvulopalatopharyngoplasty, Coblation, Postoperative complications

CLC Number: 

  • R766.7
[1] 李五一,陈兴明,倪道凤,等.悬雍垂腭咽成形术后鼻咽瘢痕狭窄的治疗[J].中华耳鼻咽喉头颈外科杂志, 2007,42(2):100-103. LI Wuyi, CHEN Xingming, NI Daofeng, et al. Management of nasopharyngeal stenosis following uvulopalatopharyngoplasty[J]. Chin J Otorhinolaryngol Head Neck Surg, 2007, 42(2):100-103.
[2] Krespi YP, Kacker A. Management of nasopharyngeal stenosis after uvulopalatoplasty[J].Otolaryngol Head Neck Surg, 2000, 123(6):692-695.
[3] Katsantonis GP, Friedman WH, Krebs FJ III, et al. Nasopharyngeal complications following uvulopalatopharyngoplasty[J]. Laryngoscope, 1987, 97(3 pt 1):309-314.
[4] 李五一,张连山,倪道凤,等.悬雍垂腭咽成形术后重度鼻咽狭窄的发生原因与处理[J].临床耳鼻咽喉科杂志, 2000, 14(2):53-54. LI Wuyi, ZHANG Lianshan, NI Daofeng, et al. Nasopharyngeal stenosis following uvulopalatopharyngoplasty[J].J Clinical Otorhinolaryngol, 2000, 14(2):53-54.
[5] Muderris T, Sevil E, Bercin S, et al. Oropharygeal stenosis after transoral robotic lingual tonsillectomy[J]. J Craniofacial Surgery, 2015, 26(3):853-855.
[6 ] Prager JD, Hopkins BS, Propst EJ, et al. Oropharyngeal stenosis: a complication of multilevel, single-stage upper airway surgery in children[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(11):1111-1115.
[7] Chheda NN, Postma GN. Balloon dilation of an acquired nasopharyngeal stenosis[J]. Otolaryngol Head Neck Surg, 2009, 140(6):939-941.
[8] McLaughlin KE, Jacobs IN, Todd NW, et al. Management of nasopharyngeal and oropharyngeal stenosis in children[J]. Laryngoscope, 1997, 107(10):1322-1331.
[9] Cotton RT.Nasopharyngeal stenosis[J]. Arch Otolaryngol, 1985, 111(3):146-148.
[10] Wan DC, Kumar A, Head CS, et al. Amelioration of acquired nasopharyngeal stenosis, with bilateral Z-pharyngoplasty[J]. Ann Plast Surg, 2010, 64(6):747-750.
[11] Nangole FW, Khainga SO. FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis[J].Plast Surg Int, 2014: 276058. doi: 10.1155/2014/276058.
[12] Abdel-Fattah G. Palatal eversion for the treatment of combined nasopharyngeal stenosis and tonsillar pillars adhesion[J]. Int J Pediatr Otorhinolaryngol, 2016,90:227-230.
[13] Stepnick DW. Management of total nasopharyngeal stenosis following UPPP[J]. Ear Nose Throat J, 1993, 72(1):86-90.
[14] Jones LM, Guillory VL, Mair EA. Total nasopharyngeal stenosis: treatment with laser excision, nasopharyngeal obturators, and topical mitomycin-c[J]. Otolaryngol Head Neck Surg, 2005, 133(5):795-798.
[15] Baptista P, Carlos G, Salvinelli F, et al. Acquired nasopharyngeal stenosis: surgical treatment for this unusual complication after chemoradiation for nasopharyngeal carcinoma[J]. Otolaryngol Head Neck Surg, 2007, 137(6):959-961.
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