Practical Tips for Surgical Management of Bilateral Choanal Atresia.

Abstract

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress innewborn which requires emergency surgical intervention. Various surgical methods areavailable for correction of choanal atresia and endoscopic approach is the commonlyused one. However there is risk of re-stenosis after surgery. This article focuses onsurgical refinements to improve the surgical outcome.It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initialdiagnostic work up included CT scan of paranasal sinus and Echocardiography to ruleout associated cardiac anomalies. All the newborns were treated initially in NICU withventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator.Among the 8 newborns, there were 5 males and 3 females and their gestational agewas full term. (except in one). Initial presentation included respiratory distress on day 1of life with difficulty in inserting feeding tube through the nose. Imaging showedbilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of themunderwent atresia surgery using endoscopic approach. One newborn required revisionsurgery. Remaining newborns remained symptom free during the follow up period.Currently endoscopic approach remains a safer method for correction of choanalatresia with very minimal chance of re-stenosis. Surgical refinements like adequatewidening of neo-choana and usage of mucosal flaps to cover the raw area has beenfound to improve the surgical outcome.