"Thai Noodle": A Novel Technique for Post Radiation Choanal Stenosis

Abstract

The aim of this retrospective study is to describe a novel endoscopic technique to treat post radiation choanal stenosis. We describe a novel "Thai noodle" silastic splint, which is tailor-made, increases compliance, reduces pain and recurrence. A retrospective study over a period of 2 years was done to evaluate the results of our "Thai noodle" technique, which included 4 patients who had previously been treated with conventional endoscopic release and commercially available nasal airway splint. All patients were followed up for a period of 1 year. All 4 patients, which included 3 females and 1 male, were treated with our novel technique. All the patients remained symptom free and none required further intervention. The Thai noodle technique customises the splint for every patient, which along with an adequately done posterior septectomy increases patient comfort and reduces recurrence which is seen with conventional airway splints.

Keywords: Choanal stenosis; Nasopharyngeal carcinoma; Post radiation.

Fig. 1

CT scan of paranasal sinuses (Axial view) showing post radiation choanal stenosis

Fig. 2

Thai noodle technique operative steps. a) Infiltration of fibrotic bands with lignocaine and adrenaline (1:2,00,000) b) Incision taken on the fibrotic segment using 90-degree insulated ball point probe (used in otology) and monopoly cautery c) Releasing fibrotic bands using Heymann’s turbinectomy scissors d) Removal excessive tissue and creation of neochoana using microdebrider

Fig. 3

(a) Introduction of Thai Noodle splint into the nasal cavity. (b) Thai Noodle splint covering the raw area of posterior end of septum and separating it from the nasopharynx. (c) Splint secured to the septum using non absorbable suture. (d) “Thai Noodle” splint is fashioned from a thin silastic sheet according to the measurement of the nasal cavity taken using the linen surgical tie