Management of nasopharyngeal stenosis post-tonsillectomy using the Madame Butterfly technique: A case report with novel approach

Abstract

Background: Nasopharyngeal stenosis (NPS) is an uncommon but significant complication that arise following tonsillectomy in adults, leading to manifestations including obstructive sleep apnea and dysphagia. This condition is often rare, underscoring the need for awareness and effective management strategies.

Case presentation: We present a case involving a 48-year-old female who developed nasopharyngeal stenosis (NPS) 15 months after undergoing a tonsillectomy. Her medical history was unremarkable, with no identifiable predisposing factors. She experienced respiratory distress, snoring, and dysphagia due to significant nasopharyngeal obstruction caused by fibrotic adhesions. The Madame Butterfly flap technique was employed, facilitating effective reconstruction while minimizing complications typically associated with skin grafts.

Discussion: The existing literature on NPS in adults is limited, particularly regarding standardized management protocols. Current treatment modalities exhibit considerable variability; however, few have undergone rigorous investigation within adult populations. The Madame Butterfly technique is particularly noteworthy for its ability to achieve both functional and aesthetic repair without the drawbacks associated with traditional grafting methods. This case underscores the necessity for comparative studies involving larger sample sizes to determine optimal management strategies for NPS.

Conclusion: This case exemplifies the successful implementation of the Madame Butterfly technique in managing NPS following tonsillectomy, with no recurrence observed during a six-month follow-up period. Given the rarity of NPS and the lack of established protocols, there is an urgent need for updated postoperative guidelines to mitigate this complication. Future research should prioritize the development of standardized management approaches to improve surgical outcomes for patients affected by NPS.

Keywords: Adhesion; Butterfly technique; Madame procedure; Post-tonsillectomy complications; Tonsillectomy.

Fig. 1

The adhesive lesion was diagnosed via nasoendoscopy following a thorough physical examination of the nasopharyngeal space. (Please refer to our instructive full video). The adhesive lesion was diagnosed via nasoendoscopy following a thorough physical examination of the nasopharyngeal space. (Please refer to our instructive full video).

Fig. 2

The margins for Madame butterfly flap were designed (please refer to our video). The margins for Madame butterfly flap were designed (please refer to our video).

Fig. 3

Final stage where uncuffed ETTs and Silastic sheets were inserted onto nostrils and fixed for two weeks.