Formation of scar tissue between the tonsillar pillars, the inferior part of the tonsillar fossa and the base of the tongue. It is a rare complication of upper airway surgery as lingual tonsillectomy, cleft soft palate surgery or uvuloplasty for sleep obstructive apneas. It can also be observed after ulcerated lesions in this area: burn, infection or Behçet disease. The symptoms vary according to the residual pharyngeal diameter: dysphagia, obstructive apneas, dyspnea during exercice.

This should be kept in mind in the presence of respiratory or feeding difficulties in a patient who has benefited from oropharyngeal surgery, especially if he has some tendency to cheloids.

Anesthetic implications: 

oral intubation can be impossible; difficulties to insert a supraglottic device; ventilation by mask can possibly be difficult. Nasotracheal intubation is indicated. Ideally, the stenosis should be removed surgically before any elective intubation.

References:

-        Prager JD, Hopkins BS, Propst EJ, Shott SR, Cotton RT.
Oropharyngeal stenosis: a complication of multilevel, single-stage upper airway surgery in children.
Arch Otolaryngol Head Neck Surg 2010; 136:1111-5.

-        Boles KS, Casler JD, Porter SB. 
Oropharyngeal stenosis leading to an unanticipated difficult airway in a patient after uvulopalatopharyngoplasty: a case report and review of the literature.
A&A Practice 2018; 11: 124-7.        

Updated: September 2018