Otolaryngologic Manifestations and Management in Stevens-johnson Syndrome and Toxic Epidermal Necrolysis: A Scoping Review

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions with frequent otolaryngologic involvement; however, ENT-specific manifestations and outcomes have never been systematically synthesized. We present a comprehensive scoping review to systematically map the spectrum of acute and long-term manifestations and modern management strategies of patients with ENT involvement.

Methods: Following PRISMA-ScR guidelines, a literature search was performed in Embase, Web of Science Core Collection, PubMed, and Cochrane Library for primary peer-reviewed, English-language studies with a biopsy-confirmed diagnosis of SJS or TEN reporting otolaryngologic manifestations. Non-primary research and pre-2000s studies were excluded to reflect modern therapeutic practice. Two independent reviewers performed title and abstract screening, full-text reviews, and data extraction. Discrepancies were resolved via third-party review by the senior author.

Results: A systematic literature search resulted in 2,239 unique studies and yielded 567 studies that met inclusion criteria for data extraction. First otolaryngologic manifestations appeared at a mean 4 days from symptom onset, most frequently involving the oral cavity (93%), nasal cavity (37%), pharynx (34%), and larynx (31%). In the acute phase, tracheostomy was required in 16%. Of those with documented long-term sequelae (e.g., xerostomia – 40%, tongue depapillation – 25%, oral cavity or hypopharyngeal webs/synechiae – 29%), 78% required at least one outpatient surgical procedure.

Conclusions: Otolaryngologic involvement in SJS/TEN presents early, involves multiple mucosal surfaces, and may be followed by substantial delayed stenotic and functional sequelae. Because comprehensive otolaryngologic assessment was uncommon, the true incidence of acute and long-term findings are likely underreported. Our findings support early otolaryngology consultation, proactive mucosal care, and interval airway/swallow surveillance as part of standardized multidisciplinary care.