Acquired Nasopharyngeal Stenosis Correction Using a Modified Palatal Flaps Technique in Obstructive Sleep Apnea (OSA) Patients

Abstract

Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8-67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the Department of Otolaryngology, Morgagni Pierantoni Hospital, Forlì, Italy. Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique.

Keywords: OSA; nasal obstruction; nasopharyngeal stenosis; pharyngeal surgery.

Figure 1

Pre-operative vision of nasopharyngeal stenosis from a nasopahryngeal (A) and oral (B) perspective. a—posterior pharyngeal wall, b—soft palate, c—tongue.

Figure 2

Surgical steps: dissection of muscular layer (A), splitting of nasopharyngeal mucosal flap (B), suture of the muscular layer to the oral mucosal layer (C), eversion of the left and right palatal flaps anteriorly and laterally (D). a’—nasopharyngeal mucosa inner face, a’’—nasopharyngeal mucosa external face, b—muscular layer, c—oral mucosal layer, d—tongue.

Figure 3

Post-operative control at 6 months from a nasopharyngeal view (A) and from an oral view (B). a—posterior pharyngeal wall, b—soft palate, c—tongue, d—epiglottis.