Combined retrograde and anterograde hypopharyngeal puncture and dilatation in a child with complete hypopharyngeal stenosis

SummaryThe management of complete hypopharyngeal stenosis is a complex task, and various methods of re-creating a lumen and maintaining its patency have been described in both the adult and pediatric literature. We present our experience using a modification of the combined anterograde–retrograde endoscopic technique for managing a 15-year-old child who developed complete hypopharyngeal and upper esophageal obliteration following successful treatment of a parapharyngeal rhabdomyosarcoma. During an 18-month period following initial cannulation of the aerodigestive tract, we performed 17 dilatations using a double-balloon technique that combined anterograde and retrograde approaches to the stenosis. Initially, Kenalog injections and topical Mitomycin-C were used as adjunctive treatments. We observed no major complications following dilatations. At 33 months follow-up the patient was asymptomatic, tolerating a near normal diet, had not required dilation for more than 18 months, and no longer required a gastrostomy tube.