Choanal Atresia

This is a congenital condition where blockage of the choanae (posterior nares) results in nasal obstruction. Choanal atresia is thought to be caused by the failure of resolution of the bucco-pharyngeal membrane which is an embryological remnant at the junction of nose and nasopharynx.

Symptoms of severe airway obstruction and cyclical cyanosis are the classic signs of neonatal bilateral atresia. Unilateral atresia may not be detected for years, and patients may present with unilateral nasal discharge or congestion. The clinical evaluation includes a complete physical examination to assess for other congenital anomalies.

A complete nasal examination is performed using a flexible fiberoptic endoscope to assess the deformity. CT scanning is the radiographic procedure of choice in the evaluation of choanal atresia.

Treatment can be divided into emergent and elective definitive categories. Bilateral choanal atresia in a neonate is an emergency that is best initially treated by inserting an oral airway to break the seal formed by the tongue against the palate. This oral airway can be well tolerated for several weeks.

The ideal definitive procedure for choanal atresia restores the normal nasal passage, prevents damage to growing structures important in facial development, is technically safe, requires short operative time, and provides short hospitalization and convalescence.

The endoscopic technique (nasal or retropalatal), with powered instrumentation, offers excellent visualization with great ease in removing the bony choanae. Stenting using special tubes may be performed for a few weeks.

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