Congenital Stridor and Desaturations – the long Path to a Diagnosis of Stenosis of the nasal vestibule (a Case Presentation and Review of Literature)

Introduction:

We demonstrate the case of a new born girl with massive postnatal in- and expiratory stridor and desaturation during sucking and crying. After a three month search, excluding a tracheomalacia, choanal atresia or cardial cause, we diagnosed a stenosis of the nasal vestibule. Since the nose was passable by instruments, initially a stenosis of the upper airway was not considered and ENT consultation delayed. Prior to our consultation a conservative therapeutic approach had been unsuccessful.

Method:

After a thorough PubMed research of literature we found approximately 80 cases with the diagnosis of a congential osseous stenosis of the nasal vestibule.

Results:

Besides various conservative therapies surigcal procedures like repeated dilatations, stent placements as well as sublabial osseous resection are discussed in literature. Complications to all therapeutic measures such as re-stenosis, perforation of the septum and adhesions must be kept in mind.

In our case, dilatation and stent placement successfully corrected the respiratory insufficiency. One week after the stent placement, the girl was discharged from the ward. Feeding was secured with an oral gastric tube. The stent was removed after six weeks. We did not observe any re-stenosis or desaturations and the feeding, respectively suction ability normalised.

Conclusion:

In our experience, a small surgical procedure should be pursued to resolve the stenosis of the nasal vestibule. Larger surgeries should only be considered with repeated stenosis and persistent symptomes.

Publication History

Publication Date:
23 April 2019 (online)