Decannulation of tracheostomized infants after choanoplasty

Abstract

Listen

Translate article

BACKGROUND: The paper outlines stages of decannulation in tracheostomized infants with congenital choanal atresia following a stentless surgery using upper septal flaps fixed with fibrin glue. AIM: The aim of the study was to optimize preparation, timing, and prognostic factors for successful decannulation in infants after choanoplasty. MATERIALS AND METHODS: The study included 11 tracheostomized children under 1 year of age with congenital choanal atresia. The treatment group included tracheostomized children who undergone standard choanoplasty with stents (n = 5). The comparison group included tracheostomized children admitted for primary surgery (n = 6). Endoscopic examination and tracheobronchoscopy were performed to evaluate treatment outcomes, and saturation was measured with a closed tracheostomy. RESULTS: In group 1, endoscopic examination of the nasal cavity and nasopharynx revealed that neochoanae were too small (less than 50% of the norm) for decannulation; revision surgery was required using a stentless technique. In group 2, patients after the stentless choanoplasty showed no signs of re-stenosis during the follow-up period (3–6 months). They underwent successful decannulation at different time points after surgery. Over the one-year follow-up, no re-stenosis was observed in either group. In 9 patients, successful decannulation was performed at various time points after surgery. In 2 patients, decannulation was delayed. CONCLUSIONS: Long-term mechanical ventilation is unsuitable in patients with bilateral choanal atresia, and tracheostomy is a common solution for respiratory failure. However, tracheostomy can have many early and late postoperative complications, so decannulation should be performed as soon as possible after nasal breathing is restored. The proposed endoscopic approach using a vascularized mucosal flap and fibrin glue appears to be the method of choice for choanoplasty in tracheostomized children. The process of decannulation in children, even with the restoration of nasal breathing after choanaplasty, is extremely complex and is associated with many risks.