Awake Blue Laser Excision and Balloon Dilation of Oropharyngeal Stenosis in High-Risk Patients

Oropharyngeal stenosis is a rare condition that can develop following head and neck cancer treatment, leading to progressive dyspnea, dysphagia, and dysphonia. Patients with symptomatic dyspnea may benefit from endoscopic surgery. However, head and neck cancer survivors can have severe trismus, limited neck extension, and altered laryngeal landmarks, which make rigid endoscopic surgery under general anesthesia high-risk or potentially not feasible without a tracheostomy tube. We describe an awake approach for the management of oropharyngeal stenosis for 2 head and neck cancer survivors with high-risk airways. Briefly, under monitored anesthesia care in the operating room, a flexible channeled nasolaryngoscope was utilized to perform awake blue light laser excision of stenosis followed by balloon dilation. Postoperatively, both patients reported symptomatic improvement, and objective increases in airway patency were noted at clinic follow-up. This operative technique represents a feasible, well-tolerated approach for high-risk airway patients with oropharyngeal stenosis.