Hi Dmarcov,
I went through the results that I found using the search referred to
in the clarification question above and feel that I've found nine that
are on topic for you. I'm including the citations and abstracts
below. These articles were found in PubMed MEDLINE (www.pubmed.gov)
using a search for "nasopharyngeal stenosis" (thank you to pinkfreud).
That gave me a broad results list with 51 articles, which I then went
through by hand. I could have limited them by adding limits for
adult, English, and a date, but with such few results I didn't feel I
needed to. Instead I pulled out ones that seemed to fit your broad
criteria - and stopped with the 1993 article under a general "10 year"
rule. The results in PubMed go back to the mid-1950s, if you're
interested.
If you'd like to see the results list, here is a URL that should work:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=pubmed&term="nasopharyngeal+stenosis"
Many of the articles in the overal results involve research a: on cats
and dogs, b: in pediatric cases, c: look at nasopharyngeal stenosis as
a side effect of uvulopalatoplastic surgery (or some other surgery of
the nose and throat, including tonsillectomies), and/or d: are not in
English. If you'd be interested in that research as well, please let
me know.
Here are the nine articles I think you'll find helpful:
1: Sleep & breathing. 2004 Feb;8(1):49-55.
Resolution of severe sleep-disordered breathing with a nasopharyngeal obturator
in 2 cases of nasopharyngeal stenosis complicating uvulopalatopharyngoplasty.
DeAngelo A, Mysliwiec V.
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by episodic
decrements in airflow due to upper airway obstruction. Uvulopalatopharyngoplasty
(UPPP) is a potential therapy for OSAHS. Nasopharyngeal stenosis is a rare
complication of UPPP that worsens OSAHS. We report two patients referred for
OSAHS worsened by nasopharyngeal stenosis complicating UPPP. Both patients were
treated with carbon dioxide laser release of adhesions and placement of a
nasopharyngeal obturator. Follow-up polysomnograms demonstrated resolution of
OSAHS correlating with subjective resolution of symptoms. Nasopharyngeal
stenosis complicating UPPP can be successfully treated with scar removal and
nasopharyngeal stenting. Polysomnographic demonstration of the effectiveness of
this therapy has not previously been reported. Future questions include duration
of nasopharyngeal stenting and timing of follow-up polysomnography.
2: Sleep Medicine. 2002 Mar;3(2):151-3.
Prosthetic therapy in the management of nasopharyngeal stenosis following
uvulopalatopharyngoplasty for obstructive sleep apnea.
Kashyap R, Yonkers AJ, Sheridan PJ.
3: Otolaryngology--head and neck surgery. 2000 Dec;123(6):692-5.
Management of nasopharyngeal stenosis after uvulopalatoplasty.
Krespi YP, Kacker A.
OBJECTIVE: The objective of this study is to evaluate the management of
nasopharyngeal stenosis (NPS) with the CO(2) laser and a customized
nasopharyngeal obturator. Study Design: An 8-year retrospective study based at a
tertiary care teaching hospital consisting of 18 patients with NPS after
uvulopalatoplasty treated over an 8-year period with the CO(2) laser and a
nasopharyngeal obturator. Patients with grade I stenosis were treated in the
office and did not require a nasopharyngeal obturator. More severe cases (grades
II and III) were treated in the operating room and required a nasopharyngeal
obturator. RESULTS: Eighteen patients with NPS, stages I to III, were treated
with a CO(2) laser with or without a nasopharyngeal obturator with good results.
CONCLUSION: The repair of NPS with a CO(2) laser and a nasopharyngeal obturator
in severe cases helps in restoring nasopharyngeal patency. SIGNIFICANCE: This
technique provided a reliable method of correcting postuvulopalatoplasty NPS.
4: American journal of rhinology. 2000 May-Jun;14(3):199-204.
Bivalved palatal transposition flaps for the correction of acquired
nasopharyngeal stenosis.
Toh E, Pearl AW, Genden EM, Lawson W, Urken ML.
Nasopharyngeal stenosis is almost universally an iatrogenic problem resulting
from surgical trauma after adenotonsillectomy or uvulopalatopharyngoplasty
(UPPP). In addition, laser-assisted uvulopalatopharyngoplasty for the treatment
of snoring may lead to the development of cicatricial scarring and stenosis at
the level of the velopharynx. The most common mechanisms implicated in the
development of acquired nasopharyngeal stenosis are the overzealous removal of
inferolateral adenoid tissue and excessive excision of the palatopharyngeal
arches. Symptoms generally relate to a disturbance in respiration, olfaction,
voice quality, and deglutition, and are often poorly tolerated. Surgical options
for the correction of this challenging problem include steroid injections, scar
lysis, skin grafts, Z-plasty repair, and the use of various local mucosal flaps.
We report the successful use of bivalved palatal transposition flaps performed
through the transoral route for the correction of severe acquired nasopharyngeal
stenosis following UPPP in two patients. Both patients developed delayed
nasopharyngeal stenosis following their initial surgery and subsequently failed
several attempts at surgical correction of the stenosis, including laser lysis
of the scarred soft palate. Using this technique of repair, both patients
achieved satisfactory resolution of their symptoms, including comfortable nasal
breathing and normal speech. We have found that this is a simple and effective
technique for the correction of severe nasopharyngeal stenosis.
5: Journal of Prosthetic Dentistry. 1999 May;81(5):507-9.
Treatment of nasopharyngeal stenosis with a conformer prosthesis: a clinical
report.
Schaefer KS, Taylor TD.
6: Archives of otolaryngology--head & neck surgery. 1998 Feb;124(2):163-7.
Acquired nasopharyngeal stenosis: a warning and review.
Giannoni C, Sulek M, Friedman EM, Duncan NO 3rd.
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.
7: Rhinology. 1995 Dec;33(4):240-3.
Acquired nasopharyngeal obstruction and "Metsovo lung".
Shevas AT, Kastanioudakis IG, Constantopoulos SH, Assimakopoulos DA.
Acquired nasopharyngeal obstruction is a rare lesion today. Formerly it was the
result of infections, but today it is more commonly seen as an unusual
complication of surgical trauma. This article reports the first case, as we know
it from the international literature, of nasopharyngeal obstruction which cannot
be attributed to the already known causes and which occurred in a woman with
"Metsovo lung" (i.e., occupational exposure to the asbestos-containing mineral
tremolite). The ascertainment in the future of other cases like this will
confirm the correlation between nasopharyngeal stenosis and Metsovo lung for
which we have not any doubts.
8: Ear, Nose & Throat Journal. 1993 Jan;72(1):86-90.
Management of total nasopharyngeal stenosis following UPPP.
Stepnick DW.
UPPP has emerged over the past decade as a surgical procedure to improve or
possibly eliminate Obstructive Sleep Apnea. The procedure itself is not
uniformly successful and the technique continues to undergo evolution. Most
complications occur in the acute post-operative period and are not unusual. Late
complications are seen much less frequently: less than 100 cases of severe
nasopharyngeal stenosis have been reported. Several authors have previously
identified this problem and have published "avoidance strategies" and we
recommend that the UPPP surgeon be well aware of these pitfalls and the ways to
avoid them. Stenosis repair using pharyngeal flaps should be the primary
technique used to correct this problem. The radial forearm free flap provides
the surgeon with another technique for repair of acquired nasopharyngeal
stenosis in problem cases in which pharyngeal flap procedures have failed. As
with any surgery, the surgeon must have a thorough understanding of the wound
healing process.
9: Journal of Prosthetic Dentistry. 1992 Feb;67(2):141-3.
Contribution of prosthetic therapy in the management of nasopharyngeal stenosis
following uvulopalatopharyngoplasty.
Riski JE, Mason RM, Serafin D.
I also found the following two articles that may be of interest, using
the "related articles" option in PubMed (note that they are older):
1: Laryngoscope. 1995 Sep;105(9 Pt 1):914-8.
Treatment of nasopharyngeal inlet stenosis following uvulopalatopharyngoplasty
with the CO2 laser.
Van Duyne J, Coleman JA Jr.
This report looks at outpatient treatment of nasopharyngeal inlet stenosis, a
more commonly seen postoperative complication of uvulopalatopharyngoplasty
(UPPP). It does not study the effectiveness of the UPPP for treatment of
obstructive sleep apnea syndrome (OSAS). The authors evaluated six patients who
had a UPPP for OSAS, all of whom developed stenosis in the nasopharyngeal inlet
ranging from 14 mm to complete closure. Two patients had failed rotation flap
repairs. The carbon dioxide laser was used to treat these patients in the office
under a local anesthesia in a staged manner. We now have patients from 3 months
to 12 months follow-up who have had stenosis treated successfully. We believe
that the postoperative complication of nasopharyngeal inlet stenosis after UPPP
can be treated in a safe and cost-effective manner in the office setting.
2: Laryngoscope. 1987 Mar;97(3 Pt 1):309-14.
Nasopharyngeal complications following uvulopalatopharyngoplasty.
Katsantonis GP, Friedman WH, Krebs FJ 3rd, Walsh JK.
This report presents our experience with nasopharyngeal complications of UPPP in
85 patients undergoing the procedure from May, 1982 to January, 1985. Three
patients developed nasopharyngeal stenosis and one patient developed permanent
velopharyngeal insufficiency. Surgical management in two patients with
nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one
patient still has a moderate stenosis following two surgical procedures. The
patient with velopharyngeal insufficiency underwent Teflon paste injection in
the posterior pharyngeal wall. This resulted in complete alleviation of his
nasal regurgitation.
I hope these articles help you with your research. If you need
further information along these lines, please let me know!
Librariankt |
Clarification of Answer by
librariankt-ga
on
05 Apr 2004 22:35 PDT
Hi again - How about these seven articles? I weeded them out by
requiring "complication*" be in the title/abstract. The numbering is
a little wonky because I took out duplicates from the list I gave you
before... - Librariankt
1: Archives of otolaryngology--head & neck surgery. 2002 Oct;128(10):1196-7.
Nasopharyngectomy after failure of 2 courses of radiation therapy.
Ibrahim HZ, Moir MS, Fee WW.
BACKGROUND: Recurrence of nasopharyngeal carcinoma after initial therapy has
been reported to range between 18% and 54%. As an alternative to surgical
salvage, patients with recurrent nasopharyngeal carcinoma are offered a second
course of radiation therapy. If this second course fails, patients may be
candidates for surgical resection. OBJECTIVE: To identify the effectiveness and
morbidity of surgical resection of recurrent nasopharyngeal carcinoma in
patients who have received 2 cycles of external beam radiation. DESIGN AND
SETTING: Retrospective survey of 6 patients in a university-based practice who
underwent resection of recurrent nasopharyngeal carcinoma after 2 courses of
radiation therapy. PATIENTS: Our study group comprised 4 women and 2 men aged
between 35 and 67 years. All patients underwent 2 courses of radiation with a
mean total dose of 11 500 rad (115 Gy) (range, 9500-13 200 rad [95-132 Gy])
delivered to the nasopharynx prior to resection. The mean duration between the
second course of radiation and resection is 21 months (range, 8-52 months). The
mean follow-up period is 7.2 years (range, 4.2-11.5 years). INTERVENTION:
Nasopharyngectomy after failure of 2 courses of radiation therapy. MAIN OUTCOME
MEASURES: Postoperative clinical outcome and morbidity. RESULTS: Five years
after resection, 1 patient died of disease. The remaining 5 patients (83%) are
alive with no evidence of disease. Osteomyelitis is the most common
complication, affecting 5 patients. Three of the 5 patients with osteomyelitis
required operative debridement of the nasopharynx and split-thickness skin
grafting. Other complications include oronasal fistula (2 patients), chronic
otitis media (2 patients), and nasopharyngeal stenosis (1 patient). CONCLUSION:
Although poor wound healing is evident, the overall 5-year survival of 83% is
encouraging.
2: Laryngoscope. 2002 Aug;112(8 Pt 2):35-6.
Complications of adenotonsillectomy.
Johnson LB, Elluru RG, Myer CM 3rd.
OBJECTIVE: To review the immediate, short-term, and long-term complications of
adenotonsillectomy. STUDY DESIGN: Review. METHODS: Complications of
adenotonsillectomy and methods for preventing and treating them were reviewed.
RESULTS: The most common complications of adenotonsillectomy, such as bleeding,
generally occur in the immediate perioperative period but can develop up to 2
weeks postoperatively. Long-term complications, such as nasopharyngeal stenosis,
may appear months to years after surgery. These more unusual sequelae result
from scar contracture and maturation. CONCLUSION: Although rare, complications
associated with adenotonsillectomy can be taxing for patients and health care
resources. The most common complications, namely, anesthesia risks, pain,
otalgia, and bleeding, should be discussed with patients' caregivers.
3: Acta Oto-rhino-laryngologica Belgica. 2002;56(2):163-75.
Side effects and complications of velopharyngeal surgery.
Goffart Y.
Although velopharyngeal surgery is generally safe, complications are not
uncommon. This article reviews the major complications occurring in the
postoperative period and the severe late complications such as velopharyngeal
incompetence and nasopharyngeal stenosis. Most of these complications can be
prevented by a careful operative technique and preoperative evaluation. We also
emphasise the frequency of minor modifications of voice, swallowing, taste and
velopharyngeal function.
4: Ear, Nose & Throat Journal. 1999 Nov;78(11):846-50.
Operative techniques of uvulopalatopharyngoplasty.
Fairbanks DN.
Uvulopalatopharyngoplasty is, for the most part, both safe and effective as a
surgical treatment for obstructive sleep apnea and severe snoring. Most
complications can be avoided with proper surgical technique. Palatal dysfunction
can be avoided if the shortening of the soft palate in the midline (uvula) area
is minimized. Nasopharyngeal stenosis can be avoided with minimization of the
posterior pillar resection and by avoidance of pharyngeal undermining. The
effectiveness of surgery can be improved by placing emphasis 1) on opening the
nasopharynx widely in the lateral port areas and 2) on tissue removal deep in
the inferior tonsillar poles (and hypopharynx) with mucosal advancement and
suturing.
5: International journal of pediatric otorhinolaryngology. 1998 Jul
10;44(2):149-53.
Safety of powered instrumentation for adenoidectomy.
Heras HA, Koltai PJ.
A recent study established the utility of an endoscopic shaver for adenoidectomy
in children by the transoral approach and showed that power assisted
adenoidectomy (PAA) was significantly faster with a trend toward decreased blood
loss. The purpose of this study was to demonstrate the safety of power assisted
adenoidectomy in a large cohort of patients. A retrospective review was
performed of 329 patients who had adenoidectomy by powered instrumentation.
Postoperative complications were documented and compared with a similar group
that had curette adenoidectomy. Complications watched for included prolonged
recovery, postoperative hemorrhage, readmission for dehydration, velopharyngeal
insufficiency, and nasopharyngeal stenosis. No postoperative complications were
seen in the power assisted adenoidectomy group. This review confirms the safety
of power assisted adenoidectomy.
7: Otolaryngology -- Head & Neck Surgery. 1998 Jan;118(1):61-8.
Complications of tonsillectomy and adenoidectomy.
Randall DA, Hoffer ME.
Adenotonsillectomy is generally safe surgery, but surgeons should be cognizant
of potential complications and be prepared to manage them. Postoperative
hemorrhage usually responds to local measures or cautery but can be
life-threatening. Preoperative screening of coagulation profiles appears
unnecessary. Anesthetic risks have declined with modern techniques, but airway
risks, aspiration, and pulmonary edema are possible. Nasopharyngeal valving may
be altered by velopharyngeal incompetence or nasopharyngeal stenosis. Sore
throat, otalgia, fever, dehydration, and uvular edema are more common
postoperative complaints. Less common complications include atlantoaxial
subluxation, mandible condyle fracture, infection, eustachian tube injury, and
psychological trauma. The prevalence, management, and strategies for avoidance
of these are discussed.
8: Journal of Otolaryngology. 1997 Feb;26(1):36-43.
Ablative adenoidectomy: a new technique using simultaneous
liquefaction/aspiration.
Wright ED, Manoukian JJ, Shapiro RS.
OBJECTIVE: This study was performed to critically evaluate a new cautery
technique for adenoidectomy that combines indirect visualization with complete
hemostasis, ultimately permitting the surgeon to tailor the procedure to the
patient's specific needs. DESIGN: This prospective study of 138 consecutive
adenoidectomy patients of the senior author was carried out at the Montreal
Children's Hospital over 17 months. Concurrent adenoidectomy patients of another
senior otolaryngologist in our institution as well as cases of the senior author
using the conventional cold curettage technique served as controls. METHOD: Data
were collected preoperatively with respect to indication for surgery and
radiologic findings. Operative findings including duration of surgery,
concurrent procedures, position of adenoid hypertrophy, and blood loss were also
recorded. Postoperative complications such as hemorrhage, infection,
dehydration, as well as the incidence of velopharyngeal insufficiency and
nasopharyngeal stenosis were also recorded up to 1 year from the date of
surgery. The operative technique involves indirect visualization of the
nasopharynx with a laryngeal mirror combined with cautery-liquefaction and
suction ablation of the adenoid tissue. RESULTS: Our results demonstrate a
significant reduction in blood loss as well as a reduction in operative time.
There was a low incidence of postoperative infection, no patients required a
return to the operating room for hemostasis, and there were no cases of
recurrent adenoid hypertrophy. There was no detectable difference in the
incidence of postoperative complications. CONCLUSION: We conclude that this
technique is safe and time-efficient, with the advantages of excellent
visualization and essentially no operative blood loss.
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