Perth Children’s Hospital, University of Western Australia, AustraliaFulltext PDF
Congenital Nasal Piriform Aperture Stenosis (CNPAS) is a rare cause of nasal obstruction in infants, characterized by narrowing of the nasal maxillary processes to <11 mm. For patients who fail conservative management, surgery has traditionally been via sublabial approach to drill-out the nasal aperture, with nasal stenting for up to 1 month. Radiological evidence shows that the entire length of the nasal cavity is narrowed in these patients which is not addressed by drill-out procedures. The first report of balloon dilation to treat CNPAS was in 2014 and the author has employed this technique since 2017. Including the present series of 4 patients there have been 10 patients with CNPAS managed by dilation alone, of whom 6 required a single dilation procedure, 3 required a single repeat dilation, and 1 who required an open drill-out procedure after repeated dilation. Three out of 9 patients successfully treated with dilation alone had a stent placed postdilation. Balloon dilation is technically easier to perform than open drill-out, is associated with fewer complications, rapid recovery, and reduced length of hospitalization. Correcting the entire length of the nasal cavity could have long term benefits on development of nasal structures and the need for additional surgery later in life. The requirement for stents after balloon dilation remains undefined. Balloon dilation represents a new treatment paradigm for patients with CNPAS and could be used as the first-line treatment in patients requiring surgery. There is still a role for drill-out procedures in patients who fail repeated dilation.
Congenital nasal piriform aperture stenosis; Pyriform stenosis; Balloon dilation
Vijayasekaran S. Congenital Nasal Piriform Aperture Stenosis – A New Paradigm for Surgical Management. Am J Otolaryngol Head Neck Surg. 2023; 6(5): 1244.