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Post-adenotonsillectomy pharyngeal stenosis in children - a systematic review
Michael Van Thillo1, Margot Van Daele2, Alberto Maria Saibene3
1Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
Insights
Pharyngeal stenosis is a rare complication after pediatric tonsillectomy. Reconstructive surgery offers more durable outcomes than minimally invasive treatments for this condition.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Complications
Background:
- Pharyngeal stenosis is a rare, severe late complication of pediatric tonsillectomy, adenoidectomy, or adenotonsillectomy.
- Its low incidence leads to underrecognition and poor characterization.
- This systematic review addresses the limited understanding of post-surgical pharyngeal stenosis in children.
Purpose of the Study:
- To systematically review literature on pediatric pharyngeal stenosis following (adeno)tonsillectomy.
- To analyze patient and surgical factors, management, outcomes, and prevention strategies.
- To synthesize evidence on this rare but serious complication.
Main Methods:
- Systematic review adhering to PRISMA 2020 guidelines.
- Searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library.
- Included 26 studies with 109 pediatric patients; data extraction and quality assessment by two independent reviewers.
Main Results:
- Pharyngeal stenosis caused significant morbidity, including airway obstruction, dysphagia, and speech issues, often appearing years post-surgery.
- Management varied from dilation to complex reconstruction.
- Minimally invasive approaches had high recurrence rates; reconstructive flap techniques showed durable outcomes.
Conclusions:
- Pharyngeal stenosis is a rare, serious complication of pediatric (adeno)tonsillectomy.
- Increased awareness, meticulous surgery, and careful follow-up are crucial for early detection and prevention.
- Standardized reporting and collaboration are needed for evidence-based management.
Purpose:
Pharyngeal stenosis is a rare but potentially severe late complication following pediatric tonsillectomy, adenoidectomy, or adenotonsillectomy. Due to its low incidence, this condition is poorly characterized and may be underrecognized. The aim of this systematic review was to synthesize the available literature on post-(adeno)tonsillectomy pharyngeal stenosis in children, focusing on patient and surgical characteristics, management strategies, outcomes, and potential risk and preventive factors.
Methods:
A PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library systematic review was conducted according to PRISMA 2020 guidelines for studies reporting pharyngeal, nasopharyngeal, or oropharyngeal stenosis following adenoidectomy, tonsillectomy, or adenotonsillectomy in children. Data extraction and quality assessment were performed independently by two independent reviewers.
Results:
Twenty-six studies comprising 109 pediatric patients were included. All studies were case reports or small case series. Pharyngeal stenosis was associated with significant morbidity, including airway obstruction, dysphagia, and speech disturbances, often presenting weeks to years after surgery. Management strategies varied widely, ranging from dilation and scar division to complex reconstructive procedures. Minimally invasive treatments frequently resulted in recurrence, whereas reconstructive flap techniques were more often associated with durable outcomes.
Conclusion:
Pharyngeal stenosis is a rare but serious late complication of pediatric (adeno)tonsillectomy. Increased awareness, meticulous surgical technique, and careful postoperative follow-up are essential to facilitate early recognition and prevention. Standardized reporting and multicenter collaboration are needed to improve evidence-based management.
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