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Pyriform aperture stenosis

Pyriform aperture stenosis results from early fusion and hypertrophy of the medial nasal processes.

Epidemiology

Pyriform aperture stenosis is a rare cause of airway obstruction, and its prevalence is unknown.

Associations

Radiologic features 

High-resolution CT

HRCT is the imaging modality of choice. It is performed in planes angled along the hard palate with a section thickness of 1–1.5 mm and should include the maxillary spines. 

Imaging features of pyriform aperture stenosis include a shelf of tissue extending across the nostrils just inside the nares, inward bowing of the maxillary spines, and narrowing of the pyriform aperture.

No standard measurements exist for the normal pyriform aperture; consequently, the diagnosis of aperture stenosis may be difficult.

MRI - Ultrasonography

Associated intracranial anomalies can be excluded in infants with MR imaging or ultrasonography.

Treatment

Treatment of mild cases of pyriform aperture stenosis includes administration of decongestants, which allows time for normal nasal growth. Severe cases may require surgical reconstruction with stent placement, sublabial resection of the anteromedial maxilla, or reconstruction of the anterior nasal passages

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