Hussein Jalal, Tan Teck Soon, Chong Aun Wee, Narayanan Prepageran, Omar Rahmat
Department of Otorhinolaryngology, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia.
Auris Nasus Larynx. 2013 Jun;40(3):323-6. doi: 10.1016/j.anl.2012.05.004. Epub 2012 May 30.
Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.
后鼻孔狭窄是鼻咽癌放疗后一种公认的晚期并发症。然而，鼻咽癌放疗后腭咽狭窄较为罕见。我们在此报告一例鼻咽癌放疗患者出现双侧后鼻孔狭窄和腭咽狭窄的病例。一名58岁女性因鼻塞一年就诊于我们的耳鼻喉科门诊。她12年前被诊断为鼻咽癌并接受了放疗。临床检查发现双侧后鼻孔狭窄和腭咽狭窄。由于复发率高，后鼻孔狭窄和腭咽狭窄的治疗具有挑战性，患者通常需要多次手术。该患者在全身麻醉下接受了经鼻内镜下腭咽瘢痕组织切除术及使用Surgitron®扩大后鼻孔，术中在手术创面局部应用丝裂霉素-C并进行双侧支架置入。支架留置两周，术后3年腭咽孔径和后鼻孔仍保持通畅。如本病例所示，放疗后可发生腭咽狭窄，不应被忽视。经鼻内镜下腭咽瘢痕组织切除术、使用Surgitron®扩大后鼻孔狭窄，随后应用丝裂霉素-C和支架置入的联合治疗方法已被证明是一种有效的选择。
