Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations

Navigating Congenital Nasal Obstruction: A Contemporary Surgical Paradigm

An uncommon form of nasal airway obstruction in a newborn with respiratory distress manifestations that needs prompt surgical correction when medical therapy cannot address the problem adequately. In this case study, two newborns were diagnosed with congenital nasal pyriform aperture stenosis (CNPAS) following a CT paranasal sinuses when the infant demonstrated persistent symptoms of upper airway obstruction. The narrowing of the nasal pyriform aperture, with a mean width of 0.65 cm in these newborns, was insufficient to allow breathing through the nostrils. Bedsides flexible endoscopy examinations revealed laryngomalacia in both of these infants. A supraglottoplasty, surgical nasal dilation, and stenting were performed without requiring a sublabial drill out of the pyriform aperture, allowing total resolution of the initial respiratory symptoms. Thus, a successful nasal enlargement was accomplished. During the post-operative follow-up period, no incurrences were observed. Both patients with CNPAS were successfully treated with nasal dilatation and nasal stenting instead of the traditional pyriform aperture bone removal by a sublabial approach. Despite being a small series, it demonstrates that nasal dilatation and stenting may be considered an alternate procedure in selective CNPAS cases because it lowers the risk of open surgery and presumably offers an effective management option.

Congenital nasal pyriform aperture stenosis; our experience of 34 cases

OBJECTIVES

To study our population of patients with congenital nasal pyriform aperture stenosis (CNPAS) in terms of incidence and socioeconomic status; the effect of pyriform aperture size, gestational age, birth weight, and whether congenital abnormalities are associated with surgical requirement.

METHODOLOGY

Retrospective case note review of all patients treated for CNPAS at a single tertiary paediatric referral site was undertaken. Diagnosis was made on the basis of a pyriform aperture of <11 mm on CT scanning; patient demographics were collected to explore risk factors for surgery and surgical outcomes.

RESULTS

34 patients were included in the series, 28 (84%) of whom underwent surgery. 58.8% of subjects had an associated mega central incisor. A smaller pyriform aperture size was seen in neonates requiring surgery (4.87 mm ± 1.24 mm vs 6.55 mm ± 1.41 mm, p = 0.031). There was no difference in gestational age in neonates requiring surgery (p = 0.074). Requirement for surgery was not associated with co-existing congenital anomalies (p = 0.297) or lower birth weight (p = 0.859). Low socioeconomic status was not significantly associated with requiring surgery but a potential link between CNPAS and deprivation was identified (p = 0.0583).

CONCLUSION

These results suggest that a pyriform aperture of less than 6 mm requires surgical intervention. Associated birth anomalies add additional management considerations but in this cohort were not associated with increased need for surgery. A potential association between CNPAS and low socioeconomic status was identified.