Abstract
Abstract Restenosis and recurrence of symptoms after posterior choanal atresia (CA) repair is a major concern for surgeons, which leads to the use of a variety of surgical approaches and adjuvant treatment modalities to avoid restenosis. The study was designed to compare the outcome of transnasal endoscopic and transpalatal repair of CA as regards restenosis, and also to compare the effect of using topical mitomycin C (MMC) or nasal stenting with not using these modalities on the outcome of repair as regards restenosis. A systematic search was conducted on the PubMed/MEDLINE to locate and select relevant studies without applying any limits. Studies included in meta-analysis were tested for heterogeneity of the estimates. As regards comparing the transnasal endoscopic and transpalatal approaches, eight studies, involving 410 cases, met our criteria; 197cases were repaired endoscopically with 37.5% restenosed and 188 through transpalatal approach with 28.2% restenosed. Using the estimated odds ratio, no statistically significant difference was found as regards restenosis. For the use of MMC, five articles fulfilled our criteria; they involved 155 cases; MMC was used in 70 cases where 24.2% restenosed, and was not used in 85 cases where 35.2% restenosed. By estimated odds ratio, there was no statistically significant difference between the two groups as regards restenosis. For the use of stenting, four articles fulfilled our criteria; they involved 165 cases, out of which 93 cases used nasal stent after repair of CA (21.5% restenosed), whereas in 72 cases stent was not used (18% restenosed). By estimated odds ratio there was no statistically significant difference between the two groups. The available evidence suggests that there is no statistically significant difference between transnasal endoscopic and transpalatal approach in the repair of CA as regards restenosis; furthermore, there is no statistically significant difference between using intraoperative topical MMC and nasal stent and not using such modalities on the outcome of CA repair.
Highlights
Choanal atresia (CA) is a relatively rare congenital anomaly occurring in about one in 5000–8000 live births; its female to male ratio is 2: 1. Generally, 65–75% of patients with choanal atresia (CA) are unilateral, and about 30% are pure bony, whereas 70% are mixed bony-membranous [1].transnasal endoscopic approach is the method of choice and has been used successfully in newborns and infants and is suitable for membranous or very thin bony atresia, the transpalatal approach is normally reserved for the older children, thick bone, or cases with restenosis [2].Management of these patients varies and depends on the type of atresia, age, and general condition of patients
Transnasal endoscopic approach is the method of choice and has been used successfully in newborns and infants and is suitable for membranous or very thin bony atresia, the transpalatal approach is normally reserved for the older children, thick bone, or cases with restenosis [2]
We found that the rate of restenosis in cases of mitomycin C (MMC) application was 24.28%, Figure 1
Summary
Transnasal endoscopic approach is the method of choice and has been used successfully in newborns and infants and is suitable for membranous or very thin bony atresia, the transpalatal approach is normally reserved for the older children, thick bone, or cases with restenosis [2]. Management of these patients varies and depends on the type of atresia, age, and general condition of patients. Studies included in meta-analysis were tested for heterogeneity of the estimates
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