Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by episodic decrements in airflow due to upper airway obstruction producing arousals, oxyhemoglobin desaturation, and daytime somnolence. Fujita et al.1 first introduced uvulopalatopharyngoplasty (UPPP) as a therapy for OSAHS in 1981. Nasopharyngeal stenosis is a rare complication of UPPP that worsens OSAHS. A paucity of literature describing its therapy exists.CASE: A 31-year old man was referred for OSAHS worsened by nasopharyngeal stenosis complicating UPPP. Post-operative complaints included velopharyngeal incompetence, distorted speech resonance, and worsening of daytime somnolence. Polysomnography demonstrated severe sleep disordered breathing with severe desaturations. He underwent CO2 laser release of adhesions and placement of a nasopharyngeal obturator. Follow-up polysomnogram demonstrated resolution of OSAHS correlating with subjective resolution of daytime somnolence.DISCUSSION: The reported efficacy of surgical therapy for OSAHS varies between 50-60%.2 There are limited reports of severe complications of UPPP with the incidence of nasopharyngeal stenosis estimated at less than 1%.3 Reported therapeutic modalities include CO2 laser release of adhesions and nasopharyngeal obturator placement, used in conjunction or separately.3 Successful treatment has been based on subjective improvement and post-operative lumen size without mention of sleep disordered breathing. Optimal duration of obturator placement is unknown and a post-intervention polysomnogram has not been reported.
Nasopharyngeal stenosis complicating UPPP can be successfully treated with scar removal and nasopharyngeal stenting. Polysomnographic demonstration of the effectiveness of this therapy has not been previously reported. Important questions for future research include duration of nasopharyngeal stenting and timing of follow-up polysomnography.
A.J. DeAngelo, None.