Douglas Sidell1, Dinesh K Chhetri. 1. Division of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA. dsidell@mednet.ucla.edu
Abstract
OBJECTIVES/HYPOTHESIS: Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results. STUDY DESIGN: Retrospective review of case series. METHODS: An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation. RESULTS: Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months. CONCLUSIONS: Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.
OBJECTIVES/HYPOTHESIS: Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results. STUDY DESIGN: Retrospective review of case series. METHODS: An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation. RESULTS: Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months. CONCLUSIONS: Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.