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.