Department of Otolaryngology-Head and Neck Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
Ann Otol Rhinol Laryngol. 2024 Jul;133(7):639-646. doi: 10.1177/00034894241242179. Epub 2024 Mar 28.
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that results in neonatal respiratory difficulty. The purpose of this systematic review was to compare surgical outcomes of drilling versus dilation techniques in the treatment of CNPAS.
Pubmed, Embase, and Cochrane Clinical Trials databases were searched for terms "congenital nasal pyriform aperture stenosis" or "pyriform aperture stenosis" from 2010 to 2021. Twenty-five studies were included that evaluated pediatric patients treated surgically for CNPAS with available outcomes data including complications, revisions, and length of stay.
A total of 51 patients with CNPAS were pooled from included studies. The median age was 29 days, 56.9% were female, and 54.9% were born full-term. The median pyriform aperture width before surgery was 5.00 mm (IQR = 4.10, 6.45). Forty (78.4%) patients underwent sublabial drilling, while 6 had a dilation procedure performed with hegar cervical dilators, 2 had a balloon dilation, and 3 were dilated with either an acrylic device, endotracheal tube, or bougie. There were no post-operative complications for 76.5% of patients, while a second surgery was required in 9 (17.6%) patients. The median length of stay was 11 days (IQR = 4, 26). No statistically significant difference was observed between sublabial drilling and surgical dilation techniques with respect to complications, need for revision surgery, or length of stay.
Current literature is insufficient to determine if drilling or dilation is more effective in the treatment of CNPAS.
先天性鼻前梨状孔狭窄（CNPAS）是一种导致新生儿呼吸窘迫的罕见疾病。本系统评价的目的是比较钻孔与扩张技术治疗 CNPAS 的手术效果。
从 2010 年至 2021 年，在 Pubmed、Embase 和 Cochrane 临床试验数据库中使用“先天性鼻前梨状孔狭窄”或“梨状孔狭窄”等术语进行搜索。纳入了 25 项研究，这些研究评估了接受手术治疗的小儿 CNPAS 患者的结局数据，包括并发症、翻修和住院时间。
共有 51 例 CNPAS 患者纳入研究。中位年龄为 29 天，56.9%为女性，54.9%为足月出生。手术前梨状孔宽度的中位数为 5.00 mm（IQR = 4.10，6.45）。40（78.4%）例患者行下唇下钻孔，6 例行 Hegar 宫颈扩张器扩张，2 例行球囊扩张，3 例行丙烯酸器械、气管内导管或探条扩张。76.5%的患者无术后并发症，9（17.6%）例患者需要再次手术。中位住院时间为 11 天（IQR = 4，26）。下唇下钻孔与手术扩张技术在并发症、翻修手术的需求或住院时间方面无统计学差异。
目前的文献不足以确定钻孔或扩张技术在治疗 CNPAS 方面更有效。
