A Case of Scarring Nasopharyngeal Stenosis after Transoral Resection Treated with Y-V Palatopharyngoplasty (Y-V PPP)

Abstract

We report a case of nasopharyngeal stenosis as a late complication of transoral resection and postoperative radiation therapy for oropharyngeal cancer which was successfully treated by Y-V palatopharyngoplasty (Y-V PPP). Y-V plasty is commonly used in plastic surgery for releasing scar contracture. A 60-year-old woman with oropharyngeal cancer (left posterior wall, squamous cell carcinoma, cT2N1M0 stage III) was treated with transoral resection, left selective neck dissection and postoperative radiotherapy (70 Gy/35 Fr). The soft palate and oropharyngeal posterior wall became constricted by cicatrical contracture 11 months after surgery, and she complained of nasal congestion, hyporhinolalia and slurping movement disorder. Since the nasopharyngeal stenosis worsened, at 5 years after the surgery we performed Y-V PPP under general anesthesia. We opened the patient's mouth with a Davis-Meyer mouth opener. Both outer sides of the uvula were incised in a Y shape, and the apex of the V-shaped flap was sutured to the lower end of the Yshaped cut line. Operation time was 89 minutes. After Y-V PPP, nasal congestion hyporhinolalia and slurping movement disorder soon recovered. Her Voice Handicap Index improved from 106 (before surgery) to 21 (4 months after surgery). Nasopharyngeal endoscopy showed good nasopharyngeal closure. No nasopharyngeal reflux occurred during oral intake. Although cases of postoperative nasopharyngeal stenosis may increase as transoral resection becomes more prevalent, the treatment has not yet been developed. Y-V PPP is minimally invasive and technically easy to learn for head and neck surgeons, so it can be one of the treatment options for nasopharyngeal stenosis.