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Congenital nasal pyriform aperture stenosis: feeding evaluation and management

Babar Sultan1, Maureen A Lefton-Greif, David J Brown

  • 1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.

International Journal of Pediatric Otorhinolaryngology
|June 12, 2009
PubMed

Insights

Feeding difficulties are common in infants with congenital nasal pyriform aperture stenosis (CNPAS). Supplemental feeding may be necessary, and comprehensive swallowing evaluations are recommended for optimal outcomes.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Gastroenterology
  • Speech-Language Pathology

Background:

  • Congenital nasal pyriform aperture stenosis (CNPAS) can cause significant feeding and respiratory issues in infants.
  • Feeding difficulties in CNPAS are under-recognized compared to other nasal obstructions like choanal atresia.

Purpose of the Study:

  • To investigate the prevalence and characteristics of feeding difficulties in infants diagnosed with CNPAS.
  • To evaluate the effectiveness of interventions and the long-term feeding prognosis for infants with CNPAS.

Main Methods:

  • Case series of four infants with CNPAS presenting with feeding and respiratory challenges.
  • Utilized nasal steroids, nasal saline, and surgical repair as treatments.
  • Conducted upper gastrointestinal tract contrast studies, bedside swallow evaluations, and videofluoroscopic swallow studies (VFSS).

Main Results:

  • Three out of four infants experienced feeding difficulties, including nasal congestion and desaturations during oral feeding.
  • One infant showed trace aspiration; three required supplemental feeding in the first year.
  • Successful oral feeding was achieved by 16 months in three patients with normal brain MRIs.

Conclusions:

  • Feeding problems are a significant concern in infants with CNPAS, often requiring supplemental support beyond airway management.
  • Comprehensive feeding and swallowing assessments, including VFSS, are crucial for infants with CNPAS.
  • Prognosis for oral feeding is generally good, influenced by airway obstruction severity and comorbidities.
Abstract

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