Introduction
Nasopharyngeal stenosis (NPS) is a rare condition of obstruction of the
communication between the nasopharynx and oropharynx due to concentric
scar contracture of the tonsillar pillars, soft palate, and posterior
pharyngeal wall. Mostof NPS nowadays are secondary to
adenotonsillectomy, uvulopalatopharyngoplasty (UPPP), or radiotherapy
for nasopharyngeal carcinoma1. Symptoms of NPS vary
from nasal obstruction, difficulty in nose blowing to snoring, hyponasal
speech, obstructive sleep apnea (OSA), daytime fatigue, anosmia,
rhinorrhea, and dysphagia2. With increasing use of
electrocautery and different palatal surgeries techniques,NPS incidence
also increases3.Definitive treatment is often very
difficult and may induce more scarring and restenosis. Nonetheless, not
much has been written about this challenging complication and unique and
standardized management has not yet been presented. Some articles
discussed and presented diagrams of flaps that are difficult to
understand and would appear to be difficult to reproduce and create,
while others presented the idea of stenting4 that
would appear very difficult to fit for a long time into this irregular,
very mobile area. Z-palatoplasty (ZPP)5was first
described in 2001 for snoring and OSA but their Z-plasty requires intact
anterior and posterior pillars and is meant for patients with intact
tonsils. In 2004, Friedman et al described a modified ZPP especially in
tonsillectomized patients6. Both techniques were
dedicated for primary treatment of snoring and OSA. Now, the ZPP role
has been diminished due to emergence of many lateral wall adressing
techniques. We thought to use a modified form of ZPP as a salvage
treatment for post-surgical NPS mainly after UPPP. Our aim was to
evaluate the efficacy and safety of a new modified ZPP, describing its
steps and results.