Congenital bilateral choanal atresia- Endonasal endoscopic surgery- Report of two cases

Kamrul Hasan Tarafder,Md Habibur Rahman,Mohammad Idrish Ali,Rokeya Begum,Sheikh Hasanur Rahman

doi:10.3329/bjo.v24i1.45347

Abstract

Congenital choanal atresia (CCA) is the development failure of the nasal cavity to communicate with nasopharynx. It is an uncommon congenital anomaly of nose with an incidence of approximately 1 in 5000-7000 live births. Choanal atresia is caused by failure of resorption of the nasobuccal membrane during embryonic development. Choanal atresia has a significant association with CHARGE syndrome. Surgical intervention is recommended in the first weeks of life in bilateral cases because this is a life threatening condition. Two cases of congenital bilateral choanla atresia (CCA) was admitted in the department of Otolaryngology & Head-Neck Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) with the complaints of intermittent attacks of cyanosis, dyspnea, respiratory distress and history of inability to take feeds. On examination both babies had respiratory distress, mucoid discharge from both nasal cavities. A soft rubber catheter was passed into both nares revealed the diagnosis of bilateral CCA which was confirmed by flexible nasoendoscopy. Bilateral CCA was managed with a nasopharyngeal airway. Surgery is the definitive treatment with two main approaches namely transnasal and transpalatal. We discuss successful management of two neonates with bilateral CCA by endonasal endoscopic approach. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 85-89

Highlights

Congenital choanal atresia (CCA) is a rare malformation that causes airway obstruction in newborns and infants, with an incidence of 1 in 5000-7000 births
Two male babies of bilateral CCA, one was 3.1 kg and other was 2.8 kg were admitted in the Department of Otolaryngology & Head-Neck Surgery at Bangabandhu Sheikh Mujib Medical University with the complaints of intermittent attacks of cyanosis, dyspnoea and inability to take feeds
A size 5 suction tube was passed into the both nasal cavity but failed to puss through the nares into the pharynx; flexible nesoendoscopy reveals atresia of posterior chonea of both babies

Summary

Introduction

Congenital choanal atresia (CCA) is a rare malformation that causes airway obstruction in newborns and infants, with an incidence of 1 in 5000-7000 births. Association which includes coloboma of the eyelid, heart disease retarded growth, genital hypoplasia, and ear anomalies.[2] Bilateral CCA is a medical emergency, because maintain an airway and relieving the obstruction is a priority.[3] Increased cyanosis and death may occur if appropriate treatments are not available. The immediate management of neonates presenting with intermittent cyanosis is the insertion of an oral airway and feeding via an oro-gastric tube.[2,3] There are numerous methods for correcting this condition, commonly used methods are the transnasal, transpalatal, transeptal approach[4] and the endoscopic transnasal approach.[5]

Results

Conclusion