How I manage nasopharyngeal stenosis

Aetiology

Nasopharyngeal stenosis (NPS) is a narrowing within the nasopharynx caudal to the choanae. It can be seen as a congenital abnormality (similar to choanal atresia) but most commonly occurs following aspiration rhinitis resulting as a complication of general anaesthesia (other causes can include trauma, recent surgery, inflammatory rhinitis and space occupying lesion). Clinical signs associated with this include both inspiratory and expiratory stertor along with recurrent nasal discharge/infection. Obligate mouth breathing will be seen in cases of complete obstruction. Very few reports are published regarding the management of NPS in dogs. Traditional surgical options for NPS are associated with relatively high recurrence rates and so minimally invasive fluoroscopic assisted procedures are the current recommendation.

Interventional options for NPS include balloon dilation alone, temporary (6 weeks) placement of silicone/rubber tubing or metallic stent placement following balloon dilation. Options for NPS stents include balloon expandable stents and self-expanding stents. These metallic stents can either be covered (stronger but risk of migration and chronic infection are higher) or uncovered. Covered stents should be secured through the palate with either sutures or T-fasteners. [...]