Multimodality Management of Nasopharyngeal Stenosis After Uvulopalatopha­ryngoplasty

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Introduction

Nasopharyngeal stenosis (NPS) after uvulopalatopharyngoplasty (UPPP) is a serious problem. More palatal procedures are being performed, leading to an increased incidence of NPS, but little has been written about this severe complication and its management.

Historically, adult NPS was a consequence of maxillofacial trauma or severe infection such as syphilis. Now NPS is seen as a complication of surgery such as tonsillectomy and adenoidectomy in the pediatric population, and UPPP in the adult population with obstructive sleep apnea. Rhinoscleroma, lupus, diphtheria, tuberculosis, acid burn, scarlet fever, and aggressive velopharyngeal repair can also cause NPS.

The complication of severe NPS after UPPP is well understood. Most cases are problems of surgical technique. The management of intraoperative or postoperative bleeding with nasopharyngeal packing and electrocautery is an important cause of NPS. Adenoidectomy in conjunction with UPPP carries an increased risk of NPS. Other technical errors include excessive excision and cauterization of the posterior tonsillar pillars or undermining the posterior and lateral pharyngeal walls. Wound dehiscence, infection, necrosis, and scarring in keloid-forming patients are some other causes of acquired NPS. Also, the use of KTP (potassium titanyl phosphate) laser to perform adenoidectomy is associated with an extremely high incidence of NPS.

The management of NPS is difficult, and reoperation using conventional methods results in only short-term improvement in symptoms with restenosis.