Plastic surgery of scarred tissues of the oropharynx and nasopharynx in childhood, resulting from the use of a surgical laser

Background. Radiofrequency ablation and laser surgery have become common procedures in otorhinolaryngology in recent years. Radiofrequency ablation techniques are now well established, with clear indications and contraindications for radiofrequency interventions in adults. However, postoperative complications pose a greater threat and danger to the patient’s health than the underlying disease for which the surgery is performed, especially in children. The aim of the study is to describe the technique of restoration of anatomical structures of the nasopharynx and oropharynx lost as a result of laser-assisted surgical intervention in children.
Clinical case. A 9-year-old patient referred to our center with complaints of nasal breathing difficulties, nasal voice, hearing loss in both ears, snoring, and breathing pauses during sleep. Upon consultation with otolaryngologists in his place of residence, he was diagnosed with hypertrophy of the adenoids and palatine tonsils. Laser-assisted adenotomy, tonsillotomy, and tympanostomy were performed repeatedly, but after each surgical operation, the condition deteriorated further. After consultation in our center, the patient was diagnosed with cicatricial obliteration of the nasopharynx, and surgical treatment was recommended. Examination of the oropharynx revealed that the palatoglossal arches were adherent to remnants of lymphoid tissue of the palatine tonsils, the posterior arches were not visible due to scarring, the pharynx was asymmetrical, the soft palate was immobile due to complete obliteration of the posterior pharyngeal wall, and the uvula was displaced to the right due to cicatricial obliteration. Rhinoscopy revealed an almost complete absence of nasal breathing. In November 2023, the patient underwent surgery, which resulted in the formation of a connection between the nasal cavity and the pharynx.
Conclusion. Timely detection and thorough correction of cicatricial deformity of the soft palate and nasopharynx allowed the patient to restore many vital body functions, the main ones being breathing and swallowing.
Keywords: obliteration, nasopharynx, soft palate, surgical laser, radiofrequency surgery, adenotomy, scar tissue, breathing difficulties, postoperative complications, congenital cleft palate
Conflicts of interest. The authors have no conflicts of interest to declare.
Financing. The study received no funding.