September 2026

OTOLARYNGOLOGY

CASE STUDY: AWAKE IN-OFFICE TECHNIQUE FOR HIGH-RISK OROPHARYNGEAL STENOSIS

Featuring: Andrew P. Stein, MD
Oropharyngeal stenosis often causes progressive dyspnea, dysphagia and dysphonia. But for cancer survivors with severe trismus, limited neck extension or altered laryngeal landmarks, standard endoscopic repair under general anesthesia can be high-risk or simply not possible without a tracheostomy.

A new case report from Northwestern Medicine, co-authored by Otolaryngologist Andrew P. Stein, MD, offers a workaround: performing the repair entirely awake.

Study Details
Two head and neck cancer survivors with high-risk airways — an 80-year-old man with post-chemoradiation neck fibrosis and severe trismus, and a 32-year-old woman with prior difficult intubation — underwent awake blue light laser excision of their stenosis followed by balloon dilation. The entire procedure was done under monitored anesthesia care (not general anesthesia) using a flexible transnasal endoscope, with the patient breathing spontaneously throughout and back-up airway equipment on standby rather than a tracheostomy tray.

Findings
Both patients tolerated the procedure well and reported meaningful symptom improvement in breathing (and, for one patient, voice and swallowing), with objective gains in airway patency confirmed on follow-up endoscopy. As expected with airway stenosis, some restenosis occurred over time; one patient needed repeat procedures at 11 and 21 months. However, recurrence timelines were comparable to those seen with traditional general-anesthesia approaches.

Clinical Impact
For patients who are poor candidates for rigid endoscopy or intubation due to altered anatomy from prior cancer treatment, this awake approach may offer a durable, well-tolerated alternative that avoids tracheostomy and the risks of general anesthesia, and it can be repeated as needed for recurrence, including in complex scenarios like pregnancy.

​While this is a small, two-patient series, it offers insights for outside-of-the-box approaches to managing airway stenosis in anatomically challenging cases.
Andrew P. Stein, MD, Assistant Professor of Otolaryngology - Head and Neck Surgery

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