Wan Derrick C, Kumar Anand, Head Christian S, Katchikian Hurig, Bradley James P
Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA 90095, USA.
Ann Plast Surg. 2010 Jun;64(6):747-50. doi: 10.1097/SAP.0b013e3181a73009.
Nasopharyngeal stenosis as a postoperative complication following pharyngeal surgery (tonsillectomy/adenoidectomy) is rare and may be difficult to treat. All patients with severe nasopharyngeal stenosis treated at UCLA with a bilateral Z-pharyngoplasty procedure from 1999 to 2006 were studied (n = 6). Degree of pharyngeal stenosis preoperatively and following a bilateral Z-pharyngoplasty was graded 0-4 based on (1) symptomatology (snoring, hyponasal speech, difficulty with nasal breathing, difficulty breathing during exercise, obstructive sleep apnea, daytime fatigue, anosmia, rhinorrea, dysphagia, or difficulty in blowing nose) and (2) measurement of stricture at the time of direct nasolaryngoscopy. Nasopharyngeal stenosis after pharyngeal surgery (adenotonsillectomy--67%, uvuloplasty--17%, pharyngoplasty--17%) failed to be alleviated by a mean of 2.3 procedures (kenalog injection or scar excision) and required corrective bilateral Z-pharyngoplasty a mean of 9.2 months after the original surgery. Symptomatic grading of the nasopharyngeal stenosis improved from a mean score of 3.3 (severe stenosis) preoperatively to a score of 0.2 (minimal to no stenosis) in follow-up. Endoscopic stricture measurement improved from 6.1 x 6.3 mm preoperatively to 28.1 x 39.3 mm in follow-up. Bilateral Z-pharyngoplasty was effective in alleviating severe postsurgical nasopharyngeal stenosis.
作为咽手术（扁桃体切除术/腺样体切除术）术后并发症的鼻咽狭窄较为罕见，且可能难以治疗。对1999年至2006年在加州大学洛杉矶分校接受双侧Z形咽成形术治疗的所有重度鼻咽狭窄患者（n = 6）进行了研究。根据（1）症状（打鼾、鼻音过重、鼻呼吸困难、运动时呼吸困难、阻塞性睡眠呼吸暂停、日间疲劳、嗅觉丧失、鼻漏、吞咽困难或擤鼻困难）和（2）直接鼻喉镜检查时狭窄的测量，术前及双侧Z形咽成形术后的咽狭窄程度分为0 - 4级。咽手术（腺样体扁桃体切除术——67%，悬雍垂成形术——17%，咽成形术——17%）后的鼻咽狭窄平均经2.3次手术（曲安奈德注射或瘢痕切除）未能缓解，在原手术平均9.2个月后需要进行双侧Z形咽成形术矫正。鼻咽狭窄的症状分级从术前平均3.3分（重度狭窄）改善至随访时的0.2分（轻度至无狭窄）。内镜下狭窄测量从术前的6.1×6.3毫米改善至随访时的28.1×39.3毫米。双侧Z形咽成形术在缓解严重的术后鼻咽狭窄方面有效。
