Post-adenotonsillectomy pharyngeal stenosis in children - a systematic review

Purpose: Pharyngeal stenosis is a rare but potentially severe late complication following pediatric tonsillectomy, adenoidectomy, or adenotonsillectomy. Due to its low incidence, this condition is poorly characterized and may be underrecognized. The aim of this systematic review was to synthesize the available literature on post-(adeno) tonsillectomy pharyngeal stenosis in children, focusing on patient and surgical characteristics, management strategies, outcomes, and potential risk and preventive factors. Methods: A PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library systematic review was conducted according to PRISMA 2020 guidelines for studies reporting pharyngeal, nasopharyngeal, or oropharyngeal stenosis following adenoidectomy, tonsillectomy, or adenotonsillectomy in children. Data extraction and quality assessment were performed independently by two independent reviewers. Results: Twenty-six studies comprising 109 pediatric patients were included. All studies were case reports or small case series. Pharyngeal stenosis was associated with significant morbidity, including airway obstruction, dysphagia, and speech disturbances, often presenting weeks to years after surgery. Management strategies varied widely, ranging from dilation and scar division to complex reconstructive procedures. Minimally invasive treatments frequently resulted in recurrence, whereas reconstructive flap techniques were more often associated with durable outcomes. Conclusion: Pharyngeal stenosis is a rare but serious late complication of pediatric (adeno)tonsillectomy. Increased awareness, meticulous surgical technique, and careful postoperative follow-up are essential to facilitate early recognition and prevention. Standardized reporting and multicenter collaboration are needed to improve evidence-based management.