1
Introduction
Oropharyngeal stenosis (OPS) is a narrowing of the oropharynx as a result of adhesions from the base of tongue to the anterior tonsillar pillars and inferior tonsillar fossa . OPS is a rare complication of oropharyngeal surgery and can cause dysphagia, sleep disordered breathing, velopharyngeal incompetence due to tethering of the soft palate, and dyspnea. Whereas OPS occurred historically following oropharyngeal infection, the advent of antibiotic treatment for common infectious agents in the early 20th century has made OPS an extremely rare condition . OPS has been associated with multilevel, single-stage upper airway surgery involving lingual tonsillectomy and in conjunction with nasopharyngeal stenosis .
OPS is mentioned historically anecdotally after simple adenotonsillectomy but to our knowledge this is the first case report of a patient who developed OPS following routine adenotonsillectomy with no other risk factors. She underwent successful surgical repair which included scar division and palatal scar lengthening with local advancement flap. This case report highlights OPS as a rare complication following primary adenotonsillectomy and discusses current strategies to manage OPS.
2
Case report
Written consent was attained as recommended by institutional IRB guidelines. A 17-year-old female with no other significant medical history underwent adenotonsillectomy for chronic tonsillitis using a bipolar vascular sealing system (LigaSure). She had a normal perioperative course except for severe postoperative pain lasting several weeks. She then developed tethering of her tongue within the post-operative period and her surgeon attempted an unsuccessful manual separation of scar bands noted in oropharynx. Four months postoperatively, she presented to our clinic with complaints of persistent oropharyngeal pain, tethered tongue with restricted mobility, trismus, nasopharyngeal reflux with fluids, and hypernasal speech. On examination she had a firm, well-matured scar involving soft palate laterally and between the palatoglossal and palatopharyngeal arches resulting in tethering of the lateral tongue bilaterally ( Fig. 1 ). The patient attempted oral physical therapy but had minimal improvement.
Therefore, she underwent scar division and palatal scar lengthening with local advancement flap reconstruction. The palatal scar was divided horizontally and reapproximated in the vertical plane, thereby lengthening the soft palate ( Fig. 2 ). Local advancement flaps were used to primarily close the incisions. The lateral scars between the palatoglossal and palatopharyngeal arches were excised and wounds were closed primarily. She had an unremarkable postoperative course. She was encouraged to continue oral stretching exercises to prevent repeat scar formation. At her two-week ( Fig. 3 ) and three-month postoperative visits, the patient reported complete resolution of oropharyngeal pain, tongue tethering, velopharyngeal incompetence, and dysphagia.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
