Related Experiment Video
Updated: Aug 12, 2026
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Acquired nasopharyngeal stenosis: a warning and review
C Giannoni1, M Sulek, E M Friedman
1Department of Otolaryngology, University of Florida, Gainesville, USA.
Insights
Nasopharyngeal stenosis (NPS) after adenoidectomy is challenging to treat, often requiring multiple surgeries. Prevention is the most effective strategy for managing this complication in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Surgical Complications
Background:
- Acquired nasopharyngeal stenosis (NPS) is a rare but serious complication following adenoidectomy and/or tonsillectomy in children.
- This condition can lead to significant morbidity, including airway obstruction and feeding difficulties.
Observation:
- A case series evaluated nine children with newly diagnosed NPS after undergoing adenoidectomy, often with laser techniques.
- Symptoms of nasal obstruction and mouth breathing appeared within 10 weeks post-surgery, with some cases developing obstructive sleep apnea.
- Diagnosis involved thorough history, physical examination, nasopharyngoscopy, and often CT scans.
Findings:
- NPS following adenoidectomy is difficult to correct, with some cases requiring tracheotomy or aggressive medical treatment for associated chronic rhinosinusitis.
- Scarring involved the soft palate, posterior pharyngeal wall, and/or choanae.
- Five children lacked eustachian tube openings, correlating with chronic otitis media with effusion or persistent otorrhea.
Implications:
- Treatment of NPS often necessitates multiple surgical interventions using adapted techniques like lateral pharyngeal flap or transpalatal/endoscopic approaches.
- Prolonged use of nasal stents is crucial for maintaining nasopharyngeal patency.
- Preventing NPS through careful surgical technique is paramount.
Objectives:
To present and discuss the clinical presentation and treatment planning in children with acquired nasopharyngeal stenosis (NPS) following tonsillectomy and adenoidectomy.
Design:
Case series.
Setting:
Tertiary care center.
Patients And Other Participants:
Nine children identified over 2 years (1995-1996) with newly diagnosed NPS were evaluated. Seven of these children underwent adenoidectomy using a potassium titanyl phosphate laser technique at a neighboring facility. These children were aged 15.6 to 62.1 months at the time of original surgery, and all presented with nasal obstruction and mouth breathing beginning within 10 weeks after surgery. In addition, 5 had newly documented obstructive sleep apnea.
Results:
Of the 9 children, 1 required a tracheotomy. After undergoing an adenoidectomy, chronic rhinosinusitis developed and aggressive medical treatment failed in 4 children. Time from symptom onset to diagnosis of NPS ranged from 2 to 34 months. The diagnosis of NPS depends on obtaining a thorough medical history and conducting a physical examination that includes nasopharyngoscopy. Most children underwent a computed tomographic scan prior to repair. The scarring encountered in these patients involved the soft palate and the posterior pharyngeal wall and/or choanae bilaterally. Five children had no identifiable eustachian tube opening into the nasopharynx, and all 5 children had chronic otitis media with effusion or persistent otorrhea.
Conclusions:
Nasopharyngeal stenosis following adenoidectomy and/or tonsillectomy is difficult to correct. Multiple surgeries may be required to relieve the obstruction. Standard operative techniques using the lateral pharyngeal flap and transpalatal or endoscopic intranasal approaches were adapted to the clinical situation. Prolonged use of nasal stents is mandatory to produce a nasopharyngeal opening. Adjunctive treatment may include pressure equalization tubes. However, the best treatment remains prevention.
Related Concept Videos
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:16Tracheostomy Care I: Pre-procedural Steps
Required Equipment
The equipment necessary for tracheostomy care includes:
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...