Gonik Nathan J, Cheng Jeffrey, Lesser Martin, Shikowitz Mark J, Smith Lee P
Albert Einstein College of Medicine - Department of Otorhinolaryngology, Bronx, NY, United States; Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, United States.
Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, United States; Hofstra North Shore LIJ School of Medicine - Department of Otolaryngology, Hempstead, NY, United States.
Int J Pediatr Otorhinolaryngol. 2015 Feb;79(2):235-9. doi: 10.1016/j.ijporl.2014.12.016. Epub 2014 Dec 22.
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of respiratory distress in neonates that may necessitate early surgical intervention. Restenosis and granulation are postoperative concerns that may prompt a return to the operating room. Reoperation places children at increased risk of perioperative complications and prolonged hospital stays. We are presenting a review of our institutional experience of 16 patients treated for CNPAS over a 14 year period and a systematic review with pooled data analysis to determine the effect of craniofacial and neurologic anomalies on surgical success.
Retrospective chart review of all cases of CNPAS treated at our tertiary children's hospital between 1999 and 2013. Systematic review of English language literature was conducted adhering to the PRISMA statement to determine the effect of neurologic anomalies and craniofacial dysmorphism (CFD) on surgical failure for CNPAS treatment. Univariate and exact multiple logistic regression were used for analysis of an individual patient data analysis.
10 patients had surgery and 6 were treated medically. Average pyriform apertures were 5.71±1.72mm for the surgical group and 4.83±1.26mm for the medical group (p=0.38). 31% had neurological impairments. 31% had craniofacial dysmorphisms (CFD). 2 patients developed restenosis and 1 required tracheotomy. Both of these patients had other CFDs. Literature review captured 63 surgical patients and 9 failures in 6 series of CNPAS. 4.6% of patients without CFD and 36.8% of patients with CFD required surgical revision (p=0.023, OR13.8).
When repairing CNPAS, co-morbidities must be considered. Impaired respiration, central neurologic deficits and extensive craniofacial anomalies may require additional surgeries or an alternative approach.
先天性鼻梨状孔狭窄（CNPAS）是新生儿呼吸窘迫的罕见原因，可能需要早期手术干预。再狭窄和肉芽形成是术后需要关注的问题，可能促使患者再次接受手术。再次手术会增加儿童围手术期并发症的风险，并延长住院时间。我们回顾了我院14年间治疗的16例CNPAS患者的机构经验，并进行了系统回顾和汇总数据分析，以确定颅面和神经异常对手术成功的影响。
对1999年至2013年间在我院三级儿童医院治疗的所有CNPAS病例进行回顾性病历审查。按照PRISMA声明对英文文献进行系统回顾，以确定神经异常和颅面畸形（CFD）对CNPAS治疗手术失败的影响。采用单因素和精确多元逻辑回归分析个体患者数据。
10例患者接受了手术治疗，6例接受了保守治疗。手术组梨状孔平均直径为5.71±1.72mm，保守治疗组为4.83±1.26mm（p = 0.38）。31%的患者有神经功能障碍。31%的患者有颅面畸形（CFD）。2例患者出现再狭窄，1例需要气管切开术。这两名患者均有其他CFD。文献回顾纳入了6组CNPAS的63例手术患者和9例失败病例。无CFD的患者中有4.6%需要手术翻修，有CFD的患者中有36.8%需要手术翻修（p = 0.023，OR 13.8）。
修复CNPAS时，必须考虑合并症。呼吸功能受损、中枢神经功能缺损和广泛的颅面畸形可能需要额外的手术或替代方法。
