Endoscopic transnasal repair of choanal atresia: clinical characteristics and outcomes from a main tertiary hospital in Syria.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral congenital choanal atresia (BCCA), because this is a life-threatening situation in newborns as they are obligate nose breathers. This article reports on an 18-month-old female child, with delayed presentation of bilateral choanal atresia, treated successfully endoscopically and stent placement postoperatively. Case report The patient is an 18-month-old female child, born full term, by cesarean section (for cephalopelvic disproportion) with birth weight 3,750 gm to a 30-year-old primigravida. There were no immediate prenatal or postnatal medical or surgical problems in the mother. The child cried immediately after birth, there was no postnatal respiratory distress, cyanosis, or any major hospital admission. On examination, microcephaly (head circumference 46 cm below 2 standard deviation of the mean), hypertelorism, ani-Mongolian slanted eyes, left side cleft lip with high arched palate with malocclusion were observed. She presented late with c/o nasal discharge and mild breathing difficulty on breastfeeding. The catheter test revealed the diagnosis of BCCA. Noncontrast computed tomography (CT) scan nose was done, which showed nonposterior choana blocked with bony plates on both the sides (Fig. 1). The paranasal sinuses, orbit, and anterior nasal cavities were within normal limits. Transnasal endoscopic repair was done under general anesthesia. Endoscopy revealed a bony atresia (Fig. 2), which was drilled out keeping the direction medially and inferiorly. Feeding tubes were fashioned as stents and placed for a period of 6 weeks. There were no postoperative complications. The patient was referred to pediatric surgery for other problems. Endoscopy confirmed bilateral patency at 12 weeks postoperatively. How to cite this article Mohindra S, Gupta AK. Bilateral Complete Congenital Choanal Atresia in an 18-month-old Female Child with Rare Clinical Presentation: Transnasal Endoscopic Repair with Stent. Clin Rhinol An Int J 2016;9(3):153-154.

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

Bilateral congenital choanal atresia in a preterm neonate - a rare neonatal emergency: A case report and review of literature

Bilateral choanal atresia is an otorhinolaryngology emergency. It is a potentially life-threatening disorder because the affected newborn is an obligate nose breather. We report clinical and radiological evaluation of a patient with congenital bilateral choanal atresia, who presented at the 20-year of age with other congenital anomalies. Patient was diagnosed as congenital bilateral choanal atresia, right accessory nasal deformity, high arched palate with congenital phthisis bulbi of his left eye. He was posted for transnasal endoscopic surgery under general anesthesia. Unique feature of this case is left congenital phthisis bulbi along with bilateral congenital choanal atresia probably the first case report having both anomalies in a single patient. While performing surgery, we should carefully study the anatomy of the basisphenoid, as in our case we did not attempt to correct atresia on right side. How to cite this article Agarwal VK, Bist SS, Mishra SK, Bharti B. Adulthood Presentation of Bilateral Complete Congenital Choanal Atresia with other Congenital Anomalies: A Case Report with Review of Literature. Clin Rhinol An Int J 2015;8(1):24-26.

Choanal atresia is the most common inborn nasal anomaly, and its definitive treatment is surgical to achieve proper bilateral nasal patency. Four main surgical approaches were used for repair: transantral, transpalatal, transseptal, and transnasal. The transnasal endoscopic approach is the most widely accepted nowadays. In this study, we aimed to evaluate the long-term results of a transnasal endoscopic repair of congenital choanal atresia started with resection of the posterior portion of the vomer and was completed without the use of stents in a large series of patients. Twenty-five patients (age range, 3-15 days) with bilateral congenital choanal atresia had surgery by using stentless endoscopic transnasal repair by starting with resection of the vomer bone. Postoperative control included office fiberoptic nasal endoscopy. During the follow-up period of 15-66 months (mean [standard deviation], 35.76 ± 16.8 months), 18 patients (72%) had a wide choana with adequate nasal breathing; Six patients (24%) had narrowing of the choana (<50%), still with adequate and satisfactory airway without feeding difficulties, and one patient (4%) developed restenosis (>50%) after 7 months, which necessitated repeated surgery. One patient (the fourth case) developed a palatal defect, which healed conservatively. No other complications were detected. The described technique proved to be effective and easier, with good long-term satisfactory results in a large series of patients. This technique allows early use of both nasal passages for simultaneous endoscope and instrument insertion to excise both atretic plates without the use of stents or flaps.

Bilateral congenital choanal atresia (CCA) is a rare, life-threatening condition in neonates. This is the first reported case of PROPEL steroid-eluting stent use in a seven-day-old bilateral CCA neonate, with a customised technique developed to overcome limitations of the standard applicator. A full-term male neonate presented with severe respiratory distress and was diagnosed with bilateral CCA. Endoscopic repair with mucoperiosteal flaps and drilling of the atretic plate was performed, followed by placement of a tailored PROPEL stent using a modified insertion with a Nelaton tube system. Recovery was uneventful. At 30 days, the stent remained well-positioned; at two, three, and six months, the neochoana was patent with no restenosis or synechiae. The PROPEL stent, combined with a customised insertion method, may offer a promising alternative for neonatal CCA repair. Further studies are needed to assess long-term outcomes and safety.

Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This paper is a case report of a 7-day-old full term girl infant presenting the history of attacks of cyanosis and having difficulty in suckling and respiration. On examination, alternating cyanosis and normal colour was observed in the patient. The application of nelaton cannulas bilaterally revealed the diagnosis of bilateral CCA. Transnasal endoscopic repair with stents was performed. Symptomatic resolution persists 6 months postoperatively.

Endoscopic bilateral congenital choanal atresia repair of 112 cases, evolving concept and technical experience

Endoscopic choanoplasty without stenting for congenital choanal atresia repair

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2days-53years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53months (range 12-111months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5-24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review

Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review

Congenital choanal atresia (CCA) is defined as a congenital failure in the development of communication between the nasal cavity and nasopharynx in newborns. It is the most common congenital anomaly of nose. Most of the patients presented with unilateral CCA. Neonates with bilateral CCA have severe respiratory distress after birth. Airway control with orotracheal intubation should be done immediately to save the life of neonate with bilateral CCA. After airway control, surgery should be performed as soon as possible. The aim of surgery is to create a patent nasal passage and to prevent restenosis with minimal morbidity. Transnasal endoscopic surgery of CCA has become the most popular treatment method. The retrospective review of 33 patients with CCA was presented in this study. The patients who were diagnosed at the neonate period and operated on in 6 months after birth were grouped as I (neonate). The patients who were diagnosed 6 months after birth were grouped as II (child-young adult). All patients were treated by transnasal endoscopic surgery. Stent were put in all patients to prevent restenosis. Although the restenosis rate was higher in group I (53.8%) than in group II (23.1%), it did not cause a statistically significant difference. Overall success rate of our surgical approach was 61.5%. Despite the surgical developments and many treatment modalities, restenosis is still the most challenging problem in CCA.

Objective To discuss the application and nursing key points of neonatal bilateral congenital choanal atresia (CCA) plasty under the treatment of improved ring-shaped nasopharyngeal tube. Methods Retrospectively analyzed clinical data of 18 neonates with bilateral CCA in otorhinolaryngology department of our hospital from August 1, 2013 to December 31, 2017, summarized the application and nursing key points of improved ring-shaped nasopharyngeal tube. Results In this group, 1 case had choanal stenosis when pulling out the catheter 1 month after operation, posterior margin of the nose in 2 cases were wounded and leaded to cicatricial stenosis because of the silk thread broken 5 months after operation, all of them had bony atresia and underwent re-operated correcting. The other 15 children recovered well when pulling out the catheter within 3 to 6 months after operation. All children had no tube plugging. Conclusion The dilatation treatment of improved ring-shaped nasopharyngeal tube can avoid the catheter coming off, which can be completely eradicated by wearing fingerless gloves, postoperative nursing and discharge guidance are the key points to prevent the catheter coming off and plugging. Key words: Congenital; Neonate; Choanal atresia; Nasophanyngeal tube; Bilateral

Evaluation of the factors affecting the necessity for revision surgery in choanal atresia