Etiology
Trauma or Surgery
Severe burns in the pharynx, resulting in extensive mucosal necrosis and ulceration, may lead to scar-induced stenosis or even atresia after healing. Excessive damage to mucosa and soft tissues during pharyngeal surgeries can also cause postoperative scar-related stenosis.
Specific Infections
Conditions such as tuberculosis, syphilis, scleroma, and leprosy can lead to pharyngeal stenosis.
Congenital Abnormalities
These often involve congenital nasopharyngeal atresia, which commonly coexists with posterior choanal atresia.
Rheumatologic Disorders
Diseases such as Behçet's syndrome, characterized by extensive ulceration and adhesion formation, can result in pharyngeal stenosis.
Clinical Manifestations
For cases of nasopharyngeal stenosis or atresia, symptoms may include difficulty in nasal breathing, mouth breathing, hyponasal speech, retained nasal secretions that are difficult to expel, reduced olfactory ability, and, if the eustachian tube is blocked, hearing impairment or secondary otitis media.
For oropharyngeal and hypopharyngeal stenosis, symptoms may include difficulty swallowing and eating, impaired breathing, and unclear articulation. Patients with long-term stenosis may exhibit signs of malnutrition.
Diagnosis
A diagnosis can generally be established through medical history inquiries, visual examination of the pharynx, indirect nasopharyngoscopy or laryngoscopy, fiberoptic/electronic nasopharyngolaryngoscopy, and imaging studies. X-ray imaging and iodized oil contrast studies can help determine the extent and severity of the atresia. For suspected specific infections, serological, microbiological, and pathological tests are necessary. For suspected Behçet's syndrome, serological testing related to rheumatic diseases should be conducted.
Treatment
For pharyngeal stenosis or atresia caused by specific infections or Behçet's syndrome, the underlying condition should be treated first, followed by reconstructive surgery once the disease stabilizes. Depending on the location and severity of the stenosis, treatment may involve reconstructive techniques such as mucosal flap repair, tongue tissue flap repair, soft palate flap repair, or local pedicled skin flap repair.