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Published on: November 30, 2010
Congenital Pyriform Aperture Stenosis: Not All Patients Require Open Repair
Eelam Adil1,2, Sarah Francisco1, Reza Rahbar1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Congenital nasal pyriform aperture stenosis (CNPAS) management is shifting towards less invasive options. Balloon dilation offers a successful, minimally invasive approach for CNPAS, often avoiding complex surgical revisions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Devices
Background:
- Congenital nasal pyriform aperture stenosis (CNPAS) presents a challenge in pediatric airway management.
- Associated conditions include central mega incisor and holoprosencephaly.
Purpose of the Study:
- To evaluate and compare management strategies for CNPAS.
- Assess the efficacy of medical therapy, balloon dilation, and open surgical repair.
Main Methods:
- Retrospective case series of 15 CNPAS patients managed between 2015 and 2023.
- Data collected on medical history, interventions, and patient outcomes.
Main Results:
- 8 patients (53.3%) achieved successful outcomes with medical therapy or single balloon dilation.
- Open sublabial repair had a higher revision rate (4/5) due to synechiae.
- Balloon dilation showed lower operative time (mean 27 min) compared to open repair (mean 104 min).
Conclusions:
- Minimally invasive approaches, particularly balloon dilation, are effective for CNPAS.
- Balloon dilation should be considered in the CNPAS management algorithm due to its success and reduced operative time.
- Open surgical repair may lead to complications like synechiae requiring further intervention.
Objective:
Evaluate the management options for congenital nasal pyriform aperture stenosis (CNPAS).
Study Design:
Case series.
Setting:
Tertiary referral children's hospital.
Methods:
The medical records of CNPAS patients managed from January 2015 to 2023 were reviewed for medical history, management, and outcomes.
Results:
Fifteen patients met inclusion criteria. Six patients (40.0%) had a central mega incisor and 4 (26.7%) had holoprosencephaly. Three (20%) patients were managed with medications alone. Mean PA width was similar between patients managed medically versus those managed surgically (mean width 6.2 ± 0.15 mm vs 6.1 ± 0.38 mm). Median age at first procedure was 50 (range 8-263) days. Seven (46.7%) underwent an initial balloon nasal dilation and 5 (33.3%) underwent an open sublabial repair. Operative time was lower in the balloon dilation group (mean 27 vs 104 minutes). Five patients had a single balloon dilation and 2 required revision procedures: 1 underwent a second balloon dilation, and 1 patient underwent a subsequent open sublabial procedure. Four patients with an initial open sublabial approach returned to the operating room for nasal balloon dilation or debridement due to nasal synechiae.
Conclusion:
There has been general shift towards minimally invasive surgery. In our series, 8 (53.3%) patients were managed successfully with medical therapy or a single nasal balloon dilation procedure. Of those who underwent an open surgical repair, most (4/5) required a revision procedure due to synechiae. Given the relative success and lower operative time of balloon dilation, this option should be considered in the management algorithm for CNPAS.
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