Swinging door flap technique for endoscopic transeptal repair of bilateral choanal atresia

Abstract

We describe and evaluate the outcome of an endoscopic transeptal approach for the repair of bilateral choanal atresia in neonates. The study was a prospective case series of neonates with a confirmed diagnosis of bilateral choanal atresia who were treated by the endoscopic transeptal approach between July 2003 and December 2005. The endoscopic approach was performed using 4 mm 0 degrees telescope. A laterally based trapezoid shaped septal mucosal flap was created on each side using a radiofrequency needle. The flaps were elevated in a swinging door fashion to expose the atretic plate and the vomer. After removal of the posterior bony septum and widening of the choana, the flaps were trimmed and applied to the exposed lateral bony rim of the choana. All patients were stented bilaterally for 3-4 weeks postoperatively. Fourteen neonates (10 females and 4 males) were recruited. Their age at the time of surgery ranged from 2 to 25 days. Recovery was uneventful in all cases except for one case that developed bleeding in the immediate postoperative period and was controlled under endoscopic guidance. One case died 3 months following stent removal from uncompensated heart failure due to concomitant ventricular septal defect. Follow-up ranged from 4 to 36 months with a mean of 17.3 +/- 9.3 months. An adequate functional nasal breathing and appropriate feeding with sufficient weight gain were maintained during the entire follow-up period. The described endoscopic technique offered excellent visualization of the choana and allowed maximal widening of the choana while preserving the mucosa along the entire circumference of the newly created choana and hence less risk of postoperative stenosis.