Pharyngeal Stenosis Following Adenotonsillectomy: A Systematic Review of Etiology, Management, and High Recurrence Rates

Background: Adenotonsillectomy is a common pediatric procedure, but pharyngeal stenosis remains one of its most severe complications. This condition, characterized by cicatricial narrowing of the airway, leads to significant morbidity. Given its rarity and the absence of a standard management protocol, a comprehensive synthesis of the evidence is crucial. Methods: A systematic review was conducted following PRISMA 2020 guidelines. A comprehensive search of PubMed, Web of Science, and Scopus from inception through December 2025 identified studies reporting pharyngeal stenosis following adenotonsillectomy, tonsillectomy, or adenoidectomy. Data on epidemiology, etiology, clinical features, management, and outcomes were extracted and analyzed. Results: The review analyzed 39 studies encompassing 166 cases. The mean age was 14.87 years, with a near-equal sex distribution. The nasopharyngeal was the most common site of stenosis (122 cases). The most frequent symptoms were nasal obstruction and snoring. Thermal techniques, particularly electrocautery, were the most commonly associated surgical method. Over 40 distinct surgical techniques were identified for management. While significant symptomatic improvement was achieved in 85.2% of cases, the overall recurrence rate was high at 25.4%. Analysis of recurrent cases revealed no single superior technique, underscoring the condition’s refractory nature. The adjunctive use of anti-fibrotic agents like mitomycin C and steroids was a common feature in modern management strategies. Conclusion: Pharyngeal stenosis, though rare, is a devastating complication strongly associated with thermal surgical techniques and characterized by a high recurrence rate. Prevention through meticulous surgical technique is paramount. Successful management requires a personalized, multimodal approach combining surgical release, resurfacing with vascularized flaps, anti-fibrotic agents, and, in select cases, prolonged stenting. Long-term follow-up is essential to monitor for recurrence and manage sequelae effectively.