Case Of Bilateral Choanal Atresia Research Articles

Bilateral Choanal Atresia in 24 Years Old Woman: A Case Report.

Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence. A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana. Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment.

Bilateral Choanal Atresia: A Case Report of a Neonate

The objective is to describe a rare case of bilateral Choanal atresia (CA). It is a congenital deformity of posterior nares where both nares are not patent at all or stenosed. While unilateral CA can remain unidentified for years, bilateral CA is typically detectable immediately after birth in neonates who prefer to breathe via their nose until they are four months old. An 18 days old male patient was admitted to the male surgery ward with complaints of respiratory distress and not taking feed for 2 days. The patient has been hospitalized after birth in a railway hospital and referred to a pediatric surgeon and he was diagnosed as a case of bilateral CA. During surgery, posterior nares were perforated, and dilated and stenting of posterior nares was performed with infant feeding tube no.8 with the help of a guide wire. Bilateral CA is a medical emergency that needs to be treated in newborns as early as possible. CT scan of the skull base and paranasal sinus can be helpful as a diagnostic tool in detecting the condition.
 Keywords: Choanal atresia, stenting, congenital deformity, infant feeding tube

Dandy-Walker syndrome with bilateral choanal atresia: A case report.

IntroductionDandy-Walker syndrome is a rare congenital brain malformation characterized by cerebellar vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa causing upward displacement of tentorium and torcula. In this paper, we present a case of bilateral choanal atresia with Dandy-Walker Syndrome in a female newborn.Case presentationWe present a case of a female patient who was born at 38th weeks of gestation via emergency cesarean section due to non-reassuring cardiotocography and abnormal antenatal ultrasounds findings. The imaging revealed the presence of Dandy-walker malformation. The patient presented with cyanosis and respiratory distress. Bedside flexible nasoendoscopy revealed bilateral choanal atresia which is confirmed by computed tomography of sinuses. Endoscopic bilateral choanal atresia repair was performed. On postoperative follow up, nasal endoscopy showed bilateral intact flap and patent neochoana.Discussion and conclusionDandy-Walker syndrome is a congenital disorder that can be diagnosed prenatally. The syndrome is associated with multiple anomalies. However, there are few published reports of bilateral choanal atresia in Dandy-Walker Syndrome. Bilateral choanal atresia is considered a life-threatening condition in newborns that requires early surgical intervention.

Operative technique and follow-up effect of endoscopic congenital choanal atresia and dilatation

Objective:To discuss the operative technique and follow-up effect of endoscopic dilatation and plasty for congenital choanal atresia in infants. Method:Clinical data of 7 children with congenital choanal atresia operative treatmented during September 2016 to January 2018 were analyzed retrospectively. the follow-up were followed closely and analyz the operative effect. Result: Seven cases were diagnosed by electronic nasopharyngoscope, nasal CT confirm the nature of atresia plate, and all 7 case successfully complete the operation. Follow-up survey ranged from 8 months to 23 months, postoperative nasal ventilation is good. The first case of bilateral choanal atresia was removed the nasal stenting after operative 3 months, and founded stenosis 1 month later. Reoperation to enlarge the choanal and retained the nasal stenting for 6 months, no restenosis or atresia after 15 months of follow-up. One patient gave up further treatment because of his own reasons and was lost to follow-up. The other 5 cases had no obvious constriction, good ventilation and no operative complications.Conclusion:Electronic nasopharyngoscope is noninvasive, convenient and accurate in the diagnosis of choanal atresia. Nasal CT confirm the nature of the atresia plate. Endoscopic dilatation and plasty of choanal atresia should be retained the nasal stenting for more than 6 months, avoid re-constriction. .

Choanal Atresia - A Rare Case Report

Choanal atresia is a rare congenital condition wherein there is unilateral or bilateral obstruction of posterior nasal passage. We report a case of bilateral choanal atresia in a two days old female presenting with chief complaints of respiratory distress since birth. Transnasal endoscopic surgery was used to obtain a patent airway.

Choanal Atresia - A Rare Case Report

Choanal atresia is a rare congenital condition wherein there is unilateral or bilateral obstruction of posterior nasal passage. We report a case of bilateral choanal atresia in a two days old female presenting with chief complaints of respiratory distress since birth. Transnasal endoscopic surgery was used to obtain a patent airway.

A Case of Bilateral Choanal Atresia without Stenting

A Case of Bilateral Choanal Atresia without Stenting

Transnasal endoscopic treatment of bilateral choanal atresia in newborns using balloon dilatation: Own results and review of literature

ObjectivesCongenital choanal atresia is a complete obliteration of the posterior nasal aperture leading to life-threatening airway emergencies. Several surgical options including sublabial, transpalatal, transseptal or external approaches have been developed for the repair of choanal atresia. So far, no gold standard has been established, but transnasal endoscopic approaches have been favored by many surgeons in recent years. MethodsSince 2008 a standard procedure for bilateral choanal atresia repair in neonates using an endoscopic transnasal approach supported by balloon dilatation has been established at the Department of Otorhinolaryngology at Ulm University Medical Center. During the last five years, six cases of bilateral choanal atresia were diagnosed and treated, including two male and four female patients aged between three days and two months, at the date of surgery. All interventions were performed in transnasal endoscopic technique. In all patients the abnormally thick posterior vomer and the atretic bony plate were resected and the mucosa was perforated. A balloon dilator was used to dilate the neochoanae and prevent restenosis. All six patients were intraoperatively stented for at least six weeks. ResultsAll six neonates with bilateral choanal atresia, who were operated in endoscopic transnasal technique had patent neo-choanae on both sides. No severe postoperative complications were found. The number of revisions depends on the age at primary surgery. ConclusionsEndonasal endoscopic approach and balloon dilatation is a safe, reproducible technique for surgical repair of choanal atresia. We recommend the use of bilateral stents, especially in very young patients, as a prerequisite to prevent early restenosis.

Bilateral Congenital Choanal Atresia in an 11-year-old Girl: An Unusual Presentation

ABSTRACT Congenital choanal atresia (CCA) is characterized by narrowing of posterior nasal apertures in newborns present with nasal obstruction and respiratory difficulty. Although unilateral obstruction goes unnoticed at birth, bilateral case is an emergency situation because newborn is an obligate nasal breather. Here, we present an unusual case of bilateral choanal atresia in an 11-year-old girl, which is a rare finding. Surgical correction was done by transnasal approach using endoscopes and otological drill. How to cite this article Chandrashekharayya SH, Handi PS, Riyas M. Bilateral Congenital Choanal Atresia in an 11-year-old Girl: An Unusual Presentation. Clin Rhinol An Int J 2012;5(3):132-134.

Bilateral Choanal Atresia: Is it Really a Surgical Emergency?

To review the need of emergency recanalization surgical procedure in cases of bilateral choanal atresia. A retrospective analysis was undertaken for the cases of bilateral choanal atresia which were recanalized between January 2000 and February 2010 in a teaching hospital. Out of 135,954 live births (0.004%), six cases of bilateral choanal atresia were diagnosed and operated during this period. Five cases were hospital deliveries from our hospital whereas one case was referred from another hospital. Three cases were recanalized with dilatation procedure whereas the other three were endoscopically recanalized with micro-drill. All the cases were operated in routine operation theatre. All were managed with orogastric tube or oropharyngeal airway during the waiting period for surgery. No neonate required emergency intubation or tracheostomy. The average age at the time of surgery was 10days (range 5-21days). As per our observations recanalization surgery for bilateral choanal atresia is not a surgical emergency. Neonates can be managed temporarily with orogastric tube/oropharyngeal airway during waiting period. Subsequently surgery can be done in routine and unhurried operation theater by experienced surgical hands thus minimizing the morbidity.

Birth defects observed with maternal carbimazole treatment: Six cases reported to Nice's Pharmacovigilance Center

Goals To report cases of embryopathy occurring following first trimester exposure to anti-thyroid drugs. Methods Retrospective screening of the database of our Pharmacovigilance Center from 1987 to date. Results We report six cases of embryopathy, all following carbimazole exposure during the first trimester: two cases of abdominal wall defect, including one associated with facial dysmorphia; one case of digestive malformation (patent omphalomesenteric duct); two cases of aplasia cutis including one with facial dysmorphism; one case of bilateral choanal atresia with aorta coarctation associated with poorly controlled insulin dependent diabetes. Four out of five patients were euthyroid with treatment during the first trimester. We found a context suggesting genetic predisposition to congenital malformation in three cases: two cases of parental cleft lip/palate, one case of consanguinity. Outcome was favorable in all cases. Conclusions We want to raise awareness about the potential teratogenicity of carbimazole, probably on a predisposed genetic background. We suggest better reporting of congenital anomalies in children of women with Graves’disease, with or without in utero exposure to anti-thyroid drugs. In light of current literature, propylthiouracil should be the first line treatment for hyperthyroid women wishing a pregnancy.

Treatment of bilateral choanal atresia in the premature infant

An innovative technique for choanal atresia repair was used for a unique case of bilateral choanal atresia in a 28-week premature newborn. Endoscopic transnasal KTP laser was employed as an alternative to standard instrumentation to reach the very small atretic plate of a premature nose, providing good visualization of the operative field, thereby avoiding damage to the adjacent structures. The successful repair allowed for early extubation and avoidance of a tracheotomy. The clinical and surgical aspects of the case are discussed. With the likelihood of encountering more premature infants with choanal atresia given the improving neonatal intensive care, we propose that KTP laser repair be considered as an alternative to conventional procedures for this particular population.

A case of congenital jejunal atresia associated with bilateral athelia and choanal atresia: new syndrome spectrum

We present a case of bilateral choanal atresia, cleft of the posterior palate. Cardiac, respiratory and central nervous system examinations were normal. An examination of the chest revealed aplasia of the bilateral absence of the bilateral nipple-areola complex. Skin, soft tissue and bilateral pectoral muscles of the chest wall were normal. The patient did not have scalp nodules or abnormal ears. Four hours after birth, an X-ray examination showed the distended intestinal loops, suggesting small bowel obstruction. Exploration was performed and congenital jejunal atresia was surgically identified. A primary anastomosis was performed. At 3 years of age, the patient had mild mental and growth retardation. Chromosome analysis was normal (46,XX). Magnetic resonance imaging showed no abnormal finding in the spinal cord; however, mild atrophy of the left cerebrum was pointed out. An abdominal echo examination showed no abnormal findings in the kidney. These associations may represent a previously undescribed syndrome spectrum.

Bilateral choanal atresia-Management with hegar’s dilator

Here we report a case of bilateral choanal atresia which is managed by transnasal perforation of atretic bony laminae using Hegar's uterine dilators The baby's airway is patent even after one yearAdvantages of using Hegar's dilator for correction of choanal atresia soon after birth are it is a blunt instrument, it's curvature fits with the curvature of the nasal cavity, dilators of increasing sizes are available, and as such injuries to the nasopharynx and surrounding areas are avoidedWe recommend this procedure as it is simple and effective in an emergency situation like bilateral choanal atresia Moreover this procedure is cheap when compared with other procedures.

Congenital Choanal Atresia and Nasal Stenosis

The most common form of nasal obstruction in neonates is soft tissue edema, but congenital bony nasal anomalies are recognized as an important cause of newborn airway obstruction. We reviewed 20 cases of congenital bony nasal abnormalties such as choanal atresia and nasal stenosis referred to National Children's Hospital between 1996 and 2001. Of the 20, 8 involved choanal atresia (6 bilateral and 2 unilateral) and 12 nasal stenosis (5 nasal cavity stenosis, 2 pyriform aperture stenosis and 5 unknown). Six cases of bilateral choanal atresia and 5 of 12 cases of the nasal stenosis presented severe airway distress. Most cases in respiratory distress required immediate surgical enlargement of nasal cavity and stenting with an endotracheal tube for 4 to 8 weeks. Of 12 with nasal stenosis, 5 with mild nasal obstruction were treated with nasal drops and 3 with mild airway distress required no treatment. Five of 7 (71%) with choanal atresia and 1 of 4 with nasal stenosis (25%) required restenosis of the nasal cavity after stent removal. Restenosis occurred more often in choanal atresia than in nasal atresia. Two of 5 with nasal restenosis required stenting for 1 to 2 months again and 1 of those was followed by stenting for more 4 months. Longer stenting did not prevent choanal from restenosis, however, no standard stenting protocol exists for neonates, highlighting the need for further study.

Endoscopic endonasal emergency management of bilateral choanal atresia in new borns.

The advent of the rigid paediatric nasal endoscope has revolutionized the management of congenital choanal atresia. This endoscopic endonasal approach is considered as a simple, safe and reliable procedure. Also, definitive surgery for choanal atresia has been quite a challenge especially regarding the fulfillment of two important objectives- complete removal of the atretic plate and assurance of wide long-term patency of the posterior nares. Several approaches to the posterior nares have been described in the past. These include: the transpalatal (English, 1981 and Owens,196S), transnasal (Singhl990 and Singh 1991), transseptal and transantral (Hall et al 1982 and Osquthorpe et al 1982) approaches. However, endoscopie endonasal surgery for choanal atresia is found to be better due to the simplicity of the surgery, better access and lesser morbidity. The objective of this presentation is to encourage the use of the rigid nasoendoscope in the management of cases of bilateral choanal atresia of the newborn.

신생아의 양측성 후비공 폐쇄증 1례

신생아의 양측성 후비공 폐쇄증 1례

Emergency management of bilateral choanal atresia in the newborn by the endoscopic endonasal approach: a clinical record and review of literature

The advent of rigid paediatric nasal endoscopy has revolutionised management of congenital choanal atresia. We believe that the endoscopic endonasal approach is a simple, safe and reliable procedure that can be employed in the management of bilateral choanal atresia in the newborn. We present here a case of bilateral choanal atresia in a 36 h old female neonate, managed by this state-of-the-art technique. A literature review of all reports using this approach has been compiled and presented.

Bilateral choanal atresia associated with malformation of the anterior skull base: embryogenesis and clinical implications.

A number of craniofacial and systemic malformations have been described in association with choanal atresia. We report a case of bilateral choanal atresia associated with congenital absence of the cribriform plate, crista galli, and perpendicular plate of the ethmoid bone. The anterior skull base defect was detected by using high-resolution computed tomography with three-dimensional reconstructions. The findings support the mesodermal flow theory of choanal atresia, in which there is excess migration of neural crest cells into the developing nasal septum and posterior choanae. This occurs at the expense of cells that would otherwise form the rest of the ethmoid complex. Clinical implications include the need for adequate preoperative imaging of the anterior skull base and consideration of potential intracranial complications during surgical repair.

Surgical Management of Bilateral Choanal Atresia

Mark A. Richardson, at the University of Washington, Seattle, and J. David Osguthorpe, at the Medical University of South Carolina, Charleston, reported on 35 cases of bilateral choanal atresia surgically corrected by either a transnasal or transpalatal approach. The authors, who presented their work at the Western Section meeting of the Triological Society in Coronado, Calif, emphasized the need for preoperative computed tomography for surgical planning. Results from the transnasal approach yielded a unilateral stenosis in 35% and the transpalatal approach, 17%. The transnasal approach was recommended for immediate correction of uncomplicated choanal atresia in the newborn to avoid problems associated with palatal growth when transpalatal procedures are used in children younger than 2 years of age.