背景:咽喉功能不全(VPI)是经口手术的已知并发症,报告发生率为8.1%。与VPI有关的主要因素是软腭的分裂。然而,经口减压导致的死腔可能在功能障碍的发病机理中起关键作用。根据我们的经验,经口减压后几乎一直存在功能上明显的死腔。这可能是由于儿童畸形和术后疤痕,从而配置一个我们可以定义为“鼻咽死腔综合征”的病态实体。“已经提出了腭假体和咽部成形术,尽管这些外科手术在技术上很棘手,并且可能会出现并发症,如OSA症状,打鼾,和鼻咽狭窄。
方法:我们提出了一种毫不费力且微创的手术方法,以通过内窥镜对鼻咽后壁进行脂肪填充来治疗这种情况。要测试程序的功能结果,鼻咽后壁的粘膜下层最初充满了可吸收的材料,即纤维蛋白胶和自体血。结果是最佳的,但在一个月后回归。然后,我们用自体腹部脂肪进行脂肪填充,导致在6个月随访时更稳定的解剖和功能结局。
结果:患者的主诉(鼻窦和口鼻返流)迅速得到显著改善,鼻咽后壁有正确的投影,在发声过程中正确闭合,没有口鼻反流。
结论:经口手术后应正确识别“鼻咽死腔综合征”。它可以通过鼻咽后壁的脂肪填充有效治疗,一个简单的微创手术。
BACKGROUND: Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as \"syndrome of the nasopharyngeal dead space.\" Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis.
METHODS: We proposed an effortless and minimally invasive procedure to treat this condition based on
lipofilling the nasopharynx posterior wall endoscopically. To test the procedure\'s functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by
lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up.
RESULTS: The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux.
CONCLUSIONS: The \"syndrome of the nasopharyngeal dead space\" should be correctly identified after transoral surgery. It can be effectively treated with
lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.