Shenoy Vijendra S, Samanth Rakshitha, Parvathareddy Navya, Apoorva K V
Dept of ENT and Head & neck surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):2352-2354. doi: 10.1007/s12070-023-03694-5. Epub 2023 Mar 20.
Introduction: Oronasopharyngeal stricture is a rare sequel of oropharyngeal surgical procedure which can cause swallowing difficulty, dyspnea, sleep related breathing disorders, incompetence at the velopharynx due to soft palatal adherence. Case: Here we present a case of nine-year-old girl who presented to us with complains of nasal obstruction since 3 months and symptoms of sleep disordered breathing. She underwent adenotonsillectomy 5 years ago and coblator assisted palatoplasty and stricture release 4 months ago. On examination adenoid facies was noted, postpalatoplasty and tonsillectomy status with stricture between the anterior and posterior tonsillar pillars. Soft palate was stuck to posterior pharyngeal wall. Computed tomography scan was done which depicted homogenously enhancing soft tissue density causing complete nasopharyngeal airway obstruction. Oronasopharyngeal stricture release was performed under general anesthesia. Infant feeding tube was inserted through the nasal cavity and introduced through the oropharynx into exterior and was tied externally which was removed on postoperative day 5. Child is on regular follow up since 5 months and asymptomatic. Discussion: Oropharyngeal stricture is reported as a rare sequela of adenotonsillectomy. Many surgical techniques have been reported for release of similar oropharyngeal and nasopharyngeal stricture patterns such as triamcinolone injection, manual dilation method, plasma hook method, division and skin grafting, local flaps like pharyngeal or palatal mucosal flaps, and free flap techniques. Conclusion: Utmost care must be taken during the surgical procedure of oropharynx to prevent collateral damage to mucosal surfaces which can result in such devastating complications.
The online version contains supplementary material available at 10.1007/s12070-023-03694-5.
引言：口鼻咽狭窄是口咽外科手术罕见的后遗症，可导致吞咽困难、呼吸困难、睡眠相关呼吸障碍、由于软腭粘连导致的腭咽功能不全。病例：在此，我们报告一例9岁女孩，自3个月前出现鼻塞及睡眠呼吸障碍症状。她5年前接受了腺样体扁桃体切除术，4个月前接受了等离子辅助腭成形术及狭窄松解术。检查发现腺样体面容，腭成形术和扁桃体切除术后状态，扁桃体前后柱之间有狭窄。软腭粘连于咽后壁。进行了计算机断层扫描，显示均匀强化的软组织密度导致完全性鼻咽气道阻塞。在全身麻醉下进行口鼻咽狭窄松解术。将婴儿喂养管经鼻腔插入，经口咽引出至体外并在外部固定，术后第5天取出。患儿自5个月以来定期随访，无症状。讨论：口咽狭窄被报道为腺样体扁桃体切除术后罕见的后遗症。已报道了多种用于松解类似口咽和鼻咽狭窄模式的手术技术，如曲安奈德注射、手动扩张法、等离子钩法、切开及植皮、局部皮瓣如咽或腭黏膜瓣以及游离皮瓣技术。结论：在口咽手术过程中必须极其小心，以防止对黏膜表面造成附带损伤，这可能导致此类毁灭性并发症。
在线版本包含可在10.1007/s12070-023-03694-5获取的补充材料。
