Oropharyngeal stenosis: a complication of multilevel, single-stage upper airway surgery in children.

OBJECTIVES

To describe oropharyngeal stenosis (OPS), a potential complication of multilevel, single-stage upper airway surgery involving lingual tonsillectomy in children, and to discuss the manner in which OPS may be managed successfully.

DESIGN

Case series with an average follow-up of 12 months.

SETTING

Tertiary care children's hospital.

PATIENTS

Medical charts were reviewed for 104 patients who underwent lingual tonsillectomy over a 30-month period from January 1, 2007, to June 30, 2009.

INTERVENTION

Multilevel, single-stage upper airway surgery, including lingual tonsillectomy.

MAIN OUTCOME MEASURE

Development of OPS noted during office or intraoperative examination.

RESULTS

Forty-nine of 104 patients underwent multilevel, single-stage upper airway procedures that included lingual tonsillectomy. Four of these 49 patients developed OPS, for a complication rate of 8.2%. Three patients required pharyngoplasty (scar release, debulking of fibrotic tissue, and reorientation of the scar) and triamcinolone injections in the operating room. A fourth patient underwent simple scar release in the operating room. No patient who underwent lingual tonsillectomy alone or in combination with an additional procedure at the same level of the upper airway developed OPS.

CONCLUSIONS

Oropharyngeal stenosis is a potential complication of multilevel, single-stage upper airway surgery involving lingual tonsillectomy in children. Although there is pressure to perform multilevel procedures that address each site of upper airway obstruction in 1 sitting, this case series suggests the need for a more conservative, staged approach if lingual tonsillectomy is planned.