Congenital nasal pyriform aperture stenosis: is there a role for nasal dilation?

IMPORTANCE

Congenital nasal pyriform aperture stenosis (CNPAS) may require sublabial drill-out of the pyriform aperture when symptoms are severe or refractory to medical therapy. Less invasive nasal dilation decreases potential morbidity to neonates with severe CNPAS.

OBJECTIVE

To determine the outcome of patients with CNPAS who underwent nasal dilation alone without other surgical therapy.

DESIGN, SETTING, AND

PARTICIPANTS

A retrospective case series at a tertiary pediatric hospital involving neonates with CNPAS.

INTERVENTIONS: Nasal dilation using Hegar cervical dilators in neonates with severe CNPAS.

MAIN OUTCOMES AND MEASURES: Avoidance of sublabial pyriform aperture drill-out and length of stay in the hospital after treatment.

RESULTS

Four patients (median age, 15 days) had respiratory distress and feeding difficulties. Nasal stenosis was suspected, and maxillofacial computed tomography scans revealed a mean pyriform aperture width of 4.5 mm. Medical therapy was initiated, but symptoms persisted. Direct laryngoscopy, rigid bronchoscopy, and nasal endoscopy with nasal dilation to at least 4 mm were performed in 4 patients without postoperative stenting. Mean length of stay after treatment was 4 days. Two patients underwent repeat nasal dilation on postoperative days 18 and 23. All 4 patients remained free of nasal disease in a median follow-up of 4.5 months.

CONCLUSIONS AND RELEVANCE: Four patients with severe CNPAS were successfully treated with nasal dilation without pyriform aperture bone removal or nasal stenting. This series, while small, suggests that nasal dilation may be a therapeutic option for severe CNPAS that decreases the risks of open surgery and subsequent stent use.