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.
ChangYCChengYKTsaiMH.A new stenting technique to manage nasopharyngeal stenosis. J Otolaryngol. 2006;35(06):430-431. doi:10.2310/7070.2006.0067
2.
WanDCKumarAHeadCSKatchikianHBradleyJP.Amelioration of acquired nasopharyngeal stenosis, with bilateral Z-pharyngoplasty. Ann Plast Surg. 2010;64(6):747-750. doi:10.1097/SAP.0b013e3181a73009
3.
JonesLMGuilloryVLMairEA.Total nasopharyngeal stenosis: treatment with laser excision, nasopharyngeal obturators, and topical mitomycin-c. Otolaryngol Head Neck Surg. 2005;133(5):795-798. doi:10.1016/j.otohns.2005.07.005
4.
ShepardPMHouserSM.Choanal stenosis: an unusual late complication of radiation therapy for nasopharyngeal carcinoma. Am J Rhinol. 2005;19(1):105-108.
5.
MadgyDNBelenkyWDunkleyBShinharS.A simple surgical technique using the plasma hook for correcting acquired nasopharyngeal stenosis. Laryngoscope. 2005;115(2):370-372. doi:10.1097/01.mlg.0000154748.01680.7d
6.
ShevasATKastanioudakisIGConstantopoulosSHAssimakopoulosDA.Acquired nasopharyngeal obstruction and “Metsovo lung”. Rhinology. 1995;33(4):240-243.
7.
GiannoniCSulekMFriedmanEMDuncanNO.Acquired nasopharyngeal stenosis: a warning and review. Arch Otolaryngol Head Neck Surg. 1998;124(2):163-167. doi:10.1001/archotol.124.2.163
Abdel-FattahG.Palatal eversion for the treatment of combined nasopharyngeal stenosis and tonsillar pillars adhesion. Int J Pediatr Otorhinolaryngol. 2016;90:227-230. doi:10.1016/j.ijporl.2016.09.028
10.
Abdel-FattahG.Palatal eversion: a new technique in treatment of nasopharyngeal stenosis. Int J Pediatr Otorhinolaryngol. 2012;76(6):879-882. doi:10.1016/j.ijporl.2012.02.064
11.
FairbanksDN.Uvulopalatopharyngoplasty complications and avoidance strategies. Otolaryngol Head Neck Surg. 1990;102(3):239-245. doi:10.1177/019459989010200306
12.
KatsantonisGPFriedmanWHKrebsFJWalshJK.Nasopharyngeal complications following uvulopalatopharyngoplasty. Laryngoscope. 1987;97(3 Pt 1):309-314.
PageMJMcKenzieJEBossuytPM, et alThe PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
15.
YanJJGuoSSLinDF, et alDevelopment and validation of a normal tissue complication probability model for acquired nasal cavity stenosis and atresia after radical radiotherapy for nasopharyngeal carcinoma. Radiother Oncol. 2021;160:9-17. doi:10.1016/j.radonc.2021.03.040
16.
GucluDUnluENOgulH. Membranous nasopharyngeal stenosis: Case report. Ear Nose Throat J. 2022; doi: 10.1177/01455613221142737. Epub ahead of print. PMID: 36417305.
17.
KrespiYPKackerA.Management of nasopharyngeal stenosis after uvulopalatoplasty. Otolaryngol Head Neck Surg. 2000;123(6):692-695. doi:10.1067/mhn.2000.110962
18.
TiwanaHVirkRSGautamV.The ancient practice of sutra neti leading to velopharyngeal stenosis: case report. J Laryngol Otol. 2019;133(8):730-732. doi:10.1017/S0022215119001142
19.
KorkmazHSelcukOTTatarECSaylamGOzdekA.Complete nasopharyngeal stenosis: presentation of a rare case. Eurasian J Med. 2012;44(3):185-187. doi:10.5152/eajm.2012.44
20.
BrodskyJRTatumSAKelleyRT.Acquired nasopharyngeal stenosis in a patient with sarcoidosis. J Laryngol Otol. 2012;126(11):1182-1185. doi:10.1017/S0022215112001776
21.
YouPChowLDworschak-StokanAHuseinM.Velopharyngeal dysfunction from intranasal substance abuse: case series and review of literature. Laryngoscope. 2018;128(12):2721-2725. doi:10.1002/lary.27240
22.
HwangJCGillASSquiresLDSteeleTO.Sjögren’s syndrome sequelae: nasal synechiae and nasopharyngeal stenosis. Ear Nose Throat J. 2021;100(10_suppl):1095S-1097S. doi:10.1177/0145561320936965
23.
HansonRDOlsenKDRogersRS.Upper aerodigestive tract manifestations of cicatricial pemphigoid. Ann Otol Rhinol Laryngol. 1988;97(5 Pt 1):493-499. doi:10.1177/000348948809700511
24.
McLaughlinKEJacobsINToddNWGussackGSCarlsonG.Management of nasopharyngeal and oropharyngeal stenosis in children. Laryngoscope. 1997;107(10):1322-1331. doi:10.1097/00005537-199710000-00006
25.
EppleyBLSadoveAMHennonDvan AalstJA.Treatment of nasopharyngeal stenosis by prosthetic hollow stents: clinical experience in eight patients. Cleft Palate Craniofac J. 2006;43(3):374-378. doi:10.1597/04-055.1
26.
StepnickDW.Management of total nasopharyngeal stenosis following UPPP. Ear Nose Throat J. 1993;72(1):86-90.
27.
BennhoffDF.Current management of nasopharyngeal stenosis: indications for Z-plasty. Laryngoscope. 1979;89(10 Pt 1):1585-1592. doi:10.1002/lary.5540891006
KashyapRYonkersAJSheridanPJ.Prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty for obstructive sleep apnea. Sleep Med. 2002;3(2):151-153. doi:10.1016/s1389-9457(01)00170-8
30.
DeAngeloAMysliwiecV.Resolution of severe sleep-disordered breathing with a nasopharyngeal obturator in 2 cases of nasopharyngeal stenosis complicating uvulopalatopharyngoplasty. Sleep Breath. 2004;8(1):49-55. doi:10.1007/s11325-004-0049-8
31.
McDonaldTJDevineKDHaylesAB.Nasopharyngeal stenosis following tonsillectomy and adenoidectomy. Report of six cases and their repair. Arch Otolaryngol. 1973;98(1):38-41. doi:10.1001/archotol.1973.00780020042010
GhorayebBY.Cicatricial velopharyngeal stenosis. Arch Otolaryngol Head Neck Surg. 1988;114(2):192-194. doi:10.1001/archotol.1988.01860140090028
34.
HenryLRGalTJMairEA.Does increased electrocautery during adenoidectomy lead to neck pain?Otolaryngol Head Neck Surg. 2005;133(4):556-561. doi:10.1016/j.otohns.2005.07.008
35.
BaptistaPCarlosGVSalvinelliFPonz-SarviseMCasaleM.Acquired nasopharyngeal stenosis: surgical treatment for this unusual complication after chemoradiation for nasopharyngeal carcinoma. Otolaryngol Head Neck Surg. 2007;137(6):959-961. doi:10.1016/j.otohns.2007.08.021X
36.
RiskiJEMasonRMSerafinD.Contribution of prosthetic therapy in the management of nasopharyngeal stenosis following uvulopalatopharyngoplasty. J Prosthet Dent. 1992;67(2):141-143. doi:10.1016/0022-3913(92)90443-e
37.
Van DuyneJColemanJA. Treatment of nasopharyngeal inlet stenosis following uvulopalatopharyngoplasty with the CO2 laser. Laryngoscope. 1995;105(9 Pt 1):914-918. doi:10.1288/00005537-199509000-00008
38.
ChhedaNNPostmaGN.Balloon dilation of an acquired nasopharyngeal stenosis. Otolaryngol Head Neck Surg. 2009;140(6):939-941. doi:10.1016/j.otohns.2009.02.030
39.
SchaeferKSTaylorTD.Treatment of nasopharyngeal stenosis with a conformer prosthesis: a clinical report. J Prosthet Dent. 1999;81(5):507-509. doi:10.1016/S0022-3913(99)70202-7
40.
TohEPearlAWGendenEMLawsonWUrkenML.Bivalved palatal transposition flaps for the correction of acquired nasopharyngeal stenosis. Am J Rhinol. 2000;14(3):199-204. doi:10.2500/105065800782102708
41.
LeeSCTangIPSinghAKumarSSSinghS.Velopharyngeal stenosis, a late complication of radiotherapy. Auris Nasus Larynx. 2009;36(6):709-711. doi:10.1016/j.anl.2009.02.002
FinkelsteinYSteinGOphirDBergerRBergerG.Laser-assisted uvulopalatoplasty for the management of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2002;128(4):429-434. doi:10.1001/archotol.128.4.429
44.
IbrahimHZMoirMSFeeWW.Nasopharyngectomy after failure of 2 courses of radiation therapy. Arch Otolaryngol Head Neck Surg. 2002;128(10):1196-1197. doi:10.1001/archotol.128.10.1196
45.
CammarotoGStringaLMCerritelliL, et alAcquired nasopharyngeal stenosis correction using a modified palatal flaps technique in obstructive sleep apnea (OSA) patients. Int J Environ Res Public Health. 2020;17(6):2048. doi:10.3390/ijerph17062048
46.
NishimonMOchiaiHWatanabeS, et alChemotherapy-induced nasopharyngeal stenosis treated with bilateral facial artery musculomucosal flaps. Plast Reconstr Surg Glob Open. 2020;8(8):e3041. doi:10.1097/GOX.0000000000003041
47.
WongEHoJSmithMSritharanNRiffatFSmithMC.Use of purastat, a novel haemostatic matrix based on self-assembling peptides in the prevention of nasopharyngeal adhesion formation. Int J Surg Case Rep. 2020;70:227-229. doi:10.1016/j.ijscr.2020.04.027
48.
HenryABiddlestoneJMcCaulJ.‘Nasal flossing’: A case report of nasopharyngeal stenosis due to severe erosive lichen planus and a novel therapeutic intervention. Int J Surg Case Rep. 2019;54:99-102. doi:10.1016/j.ijscr.2018.11.002
49.
NitassiSKissiMRkainIBenbouzidAOujilalAEssakalliL.Nasopharyngeal stenosis: a rare radiotherapy complication. Indian J Otolaryngol Head Neck Surg. 2019;71(S1):29-31. doi:10.1007/s12070-015-0954-0
50.
SidellDChhetriDK.CO2 laser ablation and balloon dilation for acquired nasopharyngeal stenosis: a novel technique. Laryngoscope. 2011;121(7):1486-1489. doi:10.1002/lary.21843
51.
Abu-SamraMEladlH.Stenting the nasopharyngeal isthmus by nasopharyngeal airway after correction of acquired total nasopharyngeal obstruction: surgical procedure and results. Eur Arch Otorhinolaryngol. 2012;269(8):1993-1997. doi:10.1007/s00405-012-1970-2
52.
IgweCSharmaRRobertsDHopkinsC. Use of balloon dilatation as an adjunctive treatment for complete nasopharyngeal stenosis: a technical innovation. Clin Otolaryngol. 2012;37(1):88-89. doi:10.1111/j.1749-4486.2012.02430.x
53.
HusseinJTanTSChongAWNarayananPOmarR.Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma. Auris Nasus Larynx. 2013;40(3):323-326. doi:10.1016/j.anl.2012.05.004
54.
CranfordJKadakiaSBerzofskyC.Palatopharyngoplasty for treatment of nasopharyngeal stenosis secondary to extra-laryngeal tuberculosis. Am J Otolaryngol. 2016;37(6):559-562. doi:10.1016/j.amjoto.2016.06.002
55.
ViciniCD’AgostinoGMeccarielloGDe VirgilioAMontevecchiF.Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis. Clin Otolaryngol. 2017;42(6):1432-1434. doi:10.1111/coa.12633
56.
ShemeshRAlonEEGluckIYakirevitchA.Endoscopic surgery for delayed sinonasal complications of radiation therapy for nasopharyngeal carcinoma: a subjective outcome. Int J Radiat Oncol Biol Phys. 2018;100(5):1222-1227. doi:10.1016/j.ijrobp.2018.01.014
57.
Abdel-AzizMEl-TahanAREl-FoulyMKamelAAbdel-WahidA.Treatment of post-adenotonsillectomy velopharyngeal stenosis with bivalved uvular flaps. Int J Pediatr Otorhinolaryngol. 2019;126:109600. doi:10.1016/j.ijporl.2019.109600
58.
CheungVWManoukianJJ.Two cases of nasopharyngeal stenosis after multiple adenoidectomies. J Otolaryngol Head Neck Surg. 2009;38(3):E98-E99.
59.
ManninoEARubinsteinBJDobratzEJ.Facial artery musculomucosal flap for nasopharyngeal and oropharyngeal reconstruction. Facial Plast Surg Aesthet Med. 2020;22(6):449-455. doi:10.1089/fpsam.2019.0001
60.
MackentyJE.Nasopharyngeal Atresia. Arch Otolaryngol Head Neck Surg. 1927;6(1):1-27. doi:10.1001/archotol.1927.00610010009001
61.
FairbanksDN.Operative techniques of uvulopalatopharyngoplasty. Ear Nose Throat J. 1999;78(11):846-850. doi:10.1177/014556139907801108
62.
EesaMHendawyEEl-AnwarMW.Modified Z-palatoplasty for correction of acquired nasopharyngeal stenosis following palatal surgery: a case series. Cleft Palate Craniofac J. 2022;59(6):774-778. Epub 2021 Jun 22. doi:10.1177/10556656211021702
63.
LeeKCLadizinskiBFedermanDG.Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge. Mayo Clin Proc. 2012;87(6):581-586. doi:10.1016/j.mayocp.2012.03.010
64.
KuPKTongMCTsangSSvan HasseltA.Acquired posterior choanal stenosis and atresia: management of this unusual complication after radiotherapy for nasopharyngeal carcinoma. Am J Otolaryngol. 2001;22(4):225-229. doi:10.1053/ajot.2001.24816
65.
KuPKTongMCvan HasseltA.Application of holmium yttrium aluminium garnet (YAG) laser in treatment of acquired posterior choanal atresia following radiotherapy for nasopharyngeal carcinoma. J Laryngol Otol. 2007;121(2):138-142. doi:10.1017/S0022215106003720
66.
WoolfRMBroadbentTR.Nasopharyngeal stenosis following tonsillectomy and adenoidectomy. Plast Reconstr Surg. 1970;45(4):352-355. doi:10.1097/00006534-197004000-00007
67.
KazanjianVHHolmesEM.Stenosis of the nasopharynx and its correction. Arch Otolaryngol Head Neck Surg. 1946;44(3):261-273. doi:10.1001/archotol.1946.00680060280002
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