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Ojha S, Poonia A, Sharma M, Bansal R, Gupta S. Nasal Pyriform Aperture Stenosis in a Newborn: When to Operate. Cureus 2024; 16:e56017. [PMID: 38606260 PMCID: PMC11008318 DOI: 10.7759/cureus.56017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a very rare cause of neonatal respiratory distress and is often missed because of its rarity. It arises from the overgrowth of the nasal process of the maxilla. Maxillofacial CT scan findings of pyriform aperture width <11 mm in a full-term baby, median central incisor, triangular-shaped palate, and median palatal ridge confirm the diagnosis. We describe here a case of CNPAS admitted with respiratory distress that increased further on feeding. An infant feeding tube of size 6 was not negotiable through the nostrils. Resistance was appreciated at the inlet of the nostril. Maxillofacial CT showed pyriform aperture stenosis of 3.4 mm, suggesting CNPAS. The child could not be weaned off a high-flow nasal cannula despite conservative management with decongestants, steroids spray, dilatation, and stenting for 20 days. Subsequently, surgical widening of the nasal aperture by a sublabial approach was done. The child was discharged on the 10th postoperative day on full oral feeds. It is important to suspect CNPAS in neonates with respiratory distress where other common causes have been ruled out, as it can be treated by surgery in cases refractory to conservative management.
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Affiliation(s)
- Sunita Ojha
- Department of Pediatric Surgery, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Anil Poonia
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Maya Sharma
- Department of Otorhinolaryngology, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Rajiv Bansal
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
| | - Supriya Gupta
- Department of Pediatrics, Santokba Durlabhji Memorial Hospital and Research Institute, Jaipur, IND
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Chakravarty PD, Sim F, Slim MAM, Patel N, Wynne DM, Clement WA. Congenital nasal pyriform aperture stenosis; our experience of 34 cases. Int J Pediatr Otorhinolaryngol 2023; 166:111491. [PMID: 36870158 DOI: 10.1016/j.ijporl.2023.111491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 01/26/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
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.
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Affiliation(s)
- Patrick Daragh Chakravarty
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Fiona Sim
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Mohd Afiq Mohd Slim
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - David M Wynne
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - William Andrew Clement
- Department of Otolaryngology - Head and Neck Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
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Naina P, Dahiya V, Irodi A, Varghese AM. Congenital Nasal Pyriform Aperture Stenosis: Same CT Dimensions, Varied Scenarios. Indian J Radiol Imaging 2022; 32:591-593. [DOI: 10.1055/s-0042-1755249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractCongenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress. We report a case series of four infants with similar radiological dimensions but while two needed surgery, two could be managed conservatively. The clinical presentation of the child and the response to conservative treatment, rather than the radiological dimensions were the main predictors for surgical intervention.
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Affiliation(s)
- Picardo Naina
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijeyta Dahiya
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Rodrigues Santos N, Mota R, Gonçalves A, Spratley J, Soares H. Upper Airway Obstruction in a Newborn: A Rare Cause of Respiratory Distress. Cureus 2022; 14:e22126. [PMID: 35291536 PMCID: PMC8918092 DOI: 10.7759/cureus.22126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
Abstract
Newborns are considered obligate nasal breathers until the eighth week of life. Therefore, upper nasal obstruction in a newborn can present as a potentially life-threatening complication. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare form of upper airway obstruction caused by a narrowing without occlusion in the most anterior opening of the bony nasal airways. According to the severity of this stenosis, early onset of respiratory symptoms can arise in the newborn. In this article, we present the case of a male term newborn with no prior relevant family history and uneventful gestation delivered in a eutocic manner with an adequate transition to the extra-uterine environment. On his first day of life, progressive respiratory distress, inability to breastfeed, and impossibility to make nasogastric probe progress through both sides of the nose were observed, leading the newborn to be admitted to a neonatal intensive care unit. During imagiological assessment with perinasal computerized tomography (CT) scan, an almost total occlusion of the pyriform aperture and a solitary median maxillary central incisor (SMMCI) were identified. Additional evaluation with brain magnetic nuclear resonance imaging (MRI) was unremarkable with no midline defects identified. Endocrine laboratory assessment was also normal. The newborn underwent pyriform aperture permeabilization surgery via a sublabial approach with bilateral nasal stent introduction, enabling total resolution of the initial respiratory symptoms. No incurrences were reported during the post-operatory follow-up period. With the present case report, the authors are trying to raise awareness for CNPAS not only as a rare cause of respiratory distress in the newborn but also as a clinical entity that can be associated with midline defects, which require further additional investigation and intervention.
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Lahiff TJ, Sotutu V, Sarachandran S, Speed L, Saddi V. An infrequent cause of neonatal upper airway obstruction: Congenital nasal pyriform aperture stenosis presenting to a remote facility. Pediatr Investig 2021; 5:244-246. [PMID: 34589679 PMCID: PMC8458713 DOI: 10.1002/ped4.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/23/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Congenital nasal pyriform aperture stenosis (CNPAS) is a rare congenital condition of structural nasal obstruction. Respiratory distress, stertor, and poor feeding are often presenting features. CASE PRESENTATION We report a case of a newborn diagnosed with CNPAS at 3 weeks of life. The diagnosis was missed on a nasoendoscopy at day 3 of life but was realised following a facial CT when the infant presented with ongoing symptoms of upper airway obstruction. Nasal dilation was performed successfully. CONCLUSION CNPAS should be considered in any neonate with upper airway obstruction. A normal nasoendoscopy does not exclude the diagnosis.
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Affiliation(s)
- Tahne Joseph Lahiff
- James Cook UniversitySchool of Medicine and DentistryDouglasQLD4811Australia
| | - Viliame Sotutu
- North West Hospital and Health ServicePaediatric DepartmentMount IsaQLDAustralia
| | - Smrdhi Sarachandran
- North West Hospital and Health ServicePaediatric DepartmentMount IsaQLDAustralia
| | - Lucas Speed
- North West Hospital and Health ServicePaediatric DepartmentMount IsaQLDAustralia
| | - Vishal Saddi
- Sydney Children’s Hospital RandwickDepartment of Sleep MedicineSydneyNSWAustralia
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Galluzzi F, Garavello W, Dalfino G, Castelnuovo P, Turri-Zanoni M. Congenital bony nasal cavity stenosis: A review of current trends in diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2021; 144:110670. [PMID: 33706014 DOI: 10.1016/j.ijporl.2021.110670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Congenital bony nasal cavity stenosis is caused by alterations of the normal embryological development of the nasal cavity. Depending on the site of the obstruction, the most important types of stenosis are: choanal atresia and stenosis, congenital nasal pyriform aperture stenosis, congenital midnasal stenosis, arhinia and nasal septum deviation. Although they are uncommon, they could be potentially life-threatening conditions that require early diagnosis and proper treatment. In case of neonatal nasal obstruction, appropriate differential diagnosis with other causes, such as rhinitis and sinonasal masses, are performed by nasal endoscopy and radiological exams. Treatment strategy consisting of medical nasal therapies and endoscopic or open nasal surgery should be tailored according to the types and the degree of the stenosis. When indicated, endoscopic endonasal approach is considered the most effective technique in neonates warranting minimal surgical invasiveness and maximum effect. In order to promote the management of these rare yet clinically relevant neonatal nasal breath disorders, we review the current trends in diagnosis and treatment of congenital bony nasal cavity stenosis.
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Affiliation(s)
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Zatoński T, Pazdro-Zastawny K, Morawska-Kochman M, Biela M, Kołtowska A, Rydzanicz M, Rozensztrauch A, Kosińska J, Dorobisz K, Płoski R, Śmigiel R. Single median maxillary central incisor syndrome and variant in SMO gene associated with SHH pathway. Int J Pediatr Otorhinolaryngol 2020; 134:110038. [PMID: 32335464 DOI: 10.1016/j.ijporl.2020.110038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023]
Abstract
Solitary median maxillary central incisor syndrome (SMMCI) is a rare congenital oronasal-dental midline anomaly. The aim of this paper is a presentation of a patient with SMMCI without other visible dentofacial anomalies, with a potentially new molecular etiology consisting of a gene-gene reaction and conservative therapeutic approach to nasal obstruction. Potentially pathogenic variants in the SMO gene (p.Gly422Glu) and in P2RY13 gene (p.Trp205*) inherited from the probant's father, and in the PLD2 gene (p.Gln319fs), inherited from the mother were found. A multidisciplinary approach is necessary for the management of patients with SMMCI, including a genetic consultation with genetic tests.
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Affiliation(s)
- Tomasz Zatoński
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University Hospital Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Katarzyna Pazdro-Zastawny
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University Hospital Wroclaw, Borowska 213, 50-556, Wroclaw, Poland.
| | - Monika Morawska-Kochman
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University Hospital Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Mateusz Biela
- Department of Pediatrics, Division Propaedeutic of Pediatrics and Rare Disorders, Medical University, Wroclaw, Poland
| | - Anna Kołtowska
- Department of Radiology, Medical University Hospital Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Anna Rozensztrauch
- Department of Pediatrics, Division Propaedeutic of Pediatrics and Rare Disorders, Medical University, Wroclaw, Poland
| | - Joanna Kosińska
- Department of Genetics, Warsaw Medical University, Warsaw, Poland
| | - Karolina Dorobisz
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University Hospital Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Rafał Płoski
- Department of Genetics, Warsaw Medical University, Warsaw, Poland
| | - Robert Śmigiel
- Department of Pediatrics, Division Propaedeutic of Pediatrics and Rare Disorders, Medical University, Wroclaw, Poland
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