先天性後鼻孔閉鎖症のレーザー治療経験

Abstract

Recently, four patients with congenital choanal atresia were operated upon using a carbon dioxide laser, in our department. All patients were female, and patient age at the time of surgery ranged from 13-days to 4-months after birth. Three patients had bilateral choanal atresia and one had unilateral atresia and contralateral stenosis. All patients suffered from dyspnea at birth that required intubation or opening of an oral airway. The atresia plate was bony in 2 sides, membranous in 3 sides, and mixed in 2 sides. Three cases were accompanied by CHARGE association: C-coloboma, H-heart disease, A-atresia choanae, R-retarded growth and retarded development and/or CNS anomalies, G-genital hypoplasia, E-ear anomalies and/or deafness. Surgery was performed via a transnasal approach under a surgical microscope. In 2 cases, the newly created choanae closed again, and re-operation was necessary. Respiratory condition improved after surgery in all cases.We emphasize that using a carbon dioxide laser via a transnasal approach under a microscope is a valuable method for treatment of small infants requiring early treatment. The advantages of this method include excellent visualization and minimal potential for damage. To prevent re-obstruction of choanae, a tubular stent should be in place for at least 6 weeks postoperatively.