Nasopharyngeal Stenosis 101 for Craniofacial Teams: A Systematic Review on a Rare Condition

Abstract

Objective: Acquired nasopharyngeal stenosis (NPS) is a rare condition affecting breathing, speech, and quality of life. We present a literature review and representative cases to identify best practices for the management of NPS and determine what factors may contribute to disease recurrence. Design: A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases searched included PubMed, Embase, and Cochrane using the keywords: “nasopharyngeal stenosis,” “velopharyngeal stenosis,” “total nasopharyngeal stenosis,” “complete nasopharyngeal stenosis,” “nasopharyngeal obstruction,” “velopharyngeal obstruction.” Results: Of 355 potential articles, 58 were subjected to qualitative analysis that included 385 patients. Decreased nasal breathing, snoring, daytime somnolence, and voice changes were the most common presenting symptoms, and nasoendoscopy was the diagnostic tool of choice. Iatrogenic surgical etiologies account for 88% of cases, but rare etiologies do exist. Delayed symptomology, diagnosis, and treatment are common. Refractory NPS resulted in 13% of patients. The use of bilateral local tissue arrangement for initial repair was found to be associated with decreased rates of refractory restenosis (P < .001). Best practices emphasized avoiding exposure of raw mucosa when removing stenotic tissue, given the propensity for restenosis. Conclusion: Despite the various treatment modalities developed for this condition, NPS remains extremely challenging to treat regardless of etiology, as evidenced by high rates of recurrence.