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.