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Pharyngeal Stenosis Following Adenotonsillectomy: A Systematic Review of Etiology, Management, and High Recurrence
Ahmad Alkheder1,2, Molham Alahmad1,2, Adel Azar1,2
1Department of Otorhinolaryngology, Al-Mouwasat University Hospital, Damascus University, Damascus, Syria.
Insights
Pharyngeal stenosis after adenotonsillectomy is rare but severe, often linked to thermal surgical methods. Management requires a multimodal approach due to high recurrence rates, emphasizing prevention through careful surgical technique.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Airway Management
Background:
- Pharyngeal stenosis is a severe complication of adenotonsillectomy.
- This cicatricial airway narrowing causes significant morbidity in children.
- Limited evidence exists on standard management protocols for this rare condition.
Purpose of the Study:
- To synthesize current evidence on pharyngeal stenosis following adenotonsillectomy.
- To analyze epidemiology, etiology, clinical features, management, and outcomes.
- To inform clinical practice and identify research gaps.
Main Methods:
- Systematic review following PRISMA 2020 guidelines.
- Searched PubMed, Web of Science, and Scopus for relevant studies.
- Extracted and analyzed data from 39 studies (166 cases).
Main Results:
- Nasopharyngeal stenosis was most common, with nasal obstruction and snoring as frequent symptoms.
- Thermal surgical techniques, especially electrocautery, were strongly associated.
- 85.2% achieved symptomatic improvement, but recurrence was high (25.4%).
Conclusions:
- Pharyngeal stenosis is a rare, devastating complication linked to thermal techniques, with high recurrence.
- Prevention via meticulous surgical technique is crucial.
- Management demands a personalized, multimodal strategy including surgery, anti-fibrotic agents, and long-term follow-up.
Background:
Adenotonsillectomy is a common pediatric procedure, but pharyngeal stenosis remains one of its most severe complications. This condition, characterized by cicatricial narrowing of the airway, leads to significant morbidity. Given its rarity and the absence of a standard management protocol, a comprehensive synthesis of the evidence is crucial.
Methods:
A systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, Web of Science, and Scopus from inception through December 2025 identified studies reporting pharyngeal stenosis following adenotonsillectomy, tonsillectomy, or adenoidectomy. Data on epidemiology, etiology, clinical features, management, and outcomes were extracted and analyzed.
Results:
The review analyzed 39 studies encompassing 166 cases. The mean age was 14.87 years, with a near-equal sex distribution. The nasopharyngeal was the most common site of stenosis (122 cases). The most frequent symptoms were nasal obstruction and snoring. Thermal techniques, particularly electrocautery, were the most commonly associated surgical method. Over 40 distinct surgical techniques were identified for management. While significant symptomatic improvement was achieved in 85.2% of cases, the overall recurrence rate was high at 25.4%. Analysis of recurrent cases revealed no single superior technique, underscoring the condition's refractory nature. The adjunctive use of anti-fibrotic agents like mitomycin C and steroids was a common feature in modern management strategies.
Conclusion:
Pharyngeal stenosis, though rare, is a devastating complication strongly associated with thermal surgical techniques and characterized by a high recurrence rate. Prevention through meticulous surgical technique is paramount. Successful management requires a personalized, multimodal approach combining surgical release, resurfacing with vascularized flaps, anti-fibrotic agents, and, in select cases, prolonged stenting. Long-term follow-up is essential to monitor for recurrence and manage sequelae effectively.
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