Cases Of Choanal Atresia Research Articles

Combination of the Endoscopic Septonasal Flap Technique and Silicone Stents for Repair of Congenital Choanal Atresia in Neonates and Infants: A Prospective Study

Background: Choanal atresia and stenosis are the most common craniofacial abnormalities of the nose and often require more than one corrective surgery or can lead to life-threatening airway obstruction. Objectives: To evaluate the long-term outcomes of the endoscopic septonasal flap technique combined with silicone stents for the repair of congenital choanal atresia and to determine independent predictors of surgical success. Methods: This study was designed as a review of prospectively collected data. The study included 40 patients diagnosed with choanal atresia due to congenital nasal obstruction at our hospital's otolaryngology clinic. The demographic characteristics and hospital information of the cases were recorded. Patients with congenital choanal atresia were operated on using the endoscopic septonasal flap technique combined with silicone stents. The surgical results were evaluated. Results: Out of the 40 patients, 23 (57.5%) were female and 17 (42.5%) were male, with a mean age of 90 days, ranging from 2 days to 1650 days. The atretic plate was bilateral in 23 patients (57.5%) and unilateral in 17 (42.5%). The types of atresia among the cases were 14 (35%) bony, 17 (42.5%) membranous, and 9 (22.5%) mixed atresia. Postoperative restenosis developed in 7 (17.5%) of the cases. Revision was needed in 10% (n = 4) of the operated bilateral choanal atresia cases and 7.5% (n = 3) of the unilateral choanal atresia cases. In cases diagnosed with bilateral choanal atresia, oxygen need, malnutrition, follow-up time in the intensive care unit, and follow-up time in the ward were significantly longer (P < 0.05). Conclusions: The Septonasal flap technique combined with silicone stents may be effective in preventing potential complications and restenosis after surgery.

Endoscopic Choanal Atresia Repair with Posterior Septectomy and Widening Toward Pterygoid Plate to Create a Wide Single Neochoana, Case Series

Objective: This study focuses on surgical technique, assessment of the outcomes and the recurrence rate of the disease. Patients and methods: This retrospective study was done on 18 patients with congenital choanal atresia at Azal specialized hospital and Al Kuwait University hospital, Sana’a, Yemen between 2014 and 2022. All patients underwent endoscopic repair with posterior septectomy, removal of atretic plate, lateral widening toward the pterygoid plate and creation of wide single neochoana with nasal stenting. Results: Of 18 cases, 2 cases were excluded because of short period of follow up. Of the 16 remaining cases, 13 cases (81.25%) showed good results during the period of follow up (6 months to 9 years) from the initial surgery. Restenosis occurred in 3 (18.75%) bilateral choanal atresia cases which underwent revision surgery with good results. Conclusion: Endoscopic creation of wide single neochoana with stenting followed by close follow up and family education give good success rate.

Beyond the Blockage: Unveiling Diagnosis and Management of Choanal Atresia-A Case Series.

Choanal atresia is a rare congenital disorder characterised by anatomical closure of the posterior choana in the nasal cavity due to failed recanalization during foetal development. The main aim of our study is to focus on our experience with choanal atresia and its management. In this study, we are discussing the prospective study of 12 cases of choanal atresia that came to a tertiary hospital from July 2017 to July 2022. All 12 choanal atresia cases underwent thorough evaluation, including history, blood investigations, nasal endoscopy, and CT scanning. Intra-nasal endoscopic choanoplasty with stenting was performed on all patients, followed by a 2-year follow-up, except for one case that missed follow-up after 6months. All 12 cases were female, with their ages varying from newborn to 4months old. In our study, 75% were unilateral and 25% were bilateral cases from newborn to 4months old. The right was more prevalent in unilateral choanal atresia. The mixed type was the most commonly observed. The most common symptom was difficulty breathing and a running nose. All cases achieved an adequate patent airway. No intraoperative complications were noted in any case. All cases of choanal atresia can be diagnosed by a cold spatula test, failure to pass an intra-nasal catheter, and a CT scan is confirmatory. Surgical correction with endoscopic intranasal choanoplasty and stenting has less morbidity, a high success rate, and a lower recurrence rate.

Tessier 3 and 4 Clefts and Choanal Atresia: An Unusual Association?

Craniofacial clefts are rare congenital anomalies that might involve both soft tissue and skeletal components. The association of Tessier cleft number 3 and 4 with choanal atresia appears to be unusual and only few clinical cases have been reported in published literature. Report a series of 13 cases of choanal atresia in patients with Tessier numbers 3 or 4 clefts and the literature review on this topic. A literature review was undertaken via PUBMED database before April 2020 addressing the association between Tessier numbers 3 or 4 clefts and choanal atresia. Retrospective chart review of patients diagnosed with both comorbidities at a tertiary hospital expertised in craniofacial anomalies. Literature review yielded 10 studies describing the relationship between choanal atresia and Tessier 3 and 4 facial clefts. We identified 98 patients diagnosed with medial oro-ocular facial clefts (Tessier 3 and 4) and 119 with choanal atresia at our institution over a 20 years time period. Altogether, 13 individuals were diagnosed with both malformations, 3 patients with number 3 cleft, and 10 patients with number 4 cleft. It represents 13.26% of the cases. This study highlights the features of Tessier 3 and 4 facial clefts associated with choanal atresia. Although the publications regarding this association are very scarce, the authors present the largest series of cases of Tessier number 3 and 4 clefts with choanal atresia showing that association between these conditions could be not so unusual.

Neonatal Choanal Atresia: A Series of 13 Cases

Choanal atresia is a congenital disease that Is manifested at birth when it is bilateral. Unilateral forms can be observed later in life as they are usually well tolerated. Choanal atresia’s frequency is difficult to estimate. It is estimated to be 1 case per 5000 to 8000 births [1]-[3]. Our work is a retrospective study of the cases of choanal atresia that were managed in the ENT department of the Mohamed VI University Hospital during a period of eleven years from January 2010 to December 2020. We identified 13 cases of choanal atresia. The aim of this work is to analyze the elements of the diagnosis, the indications and the surgical techniques as well as our results of the endonasal endoscopic approach in order to identify a therapeutic strategy. The average age of our patients was 21 days, with extremes ranging from 1 day to 28 days. The maximum number of cases was observed in newborns during the first week of life, with a slight female predominance of 7/6. The sex ratio was 0,85. In our series, the delay was most often short with extremes ranging from day 1 of life to day 22. There were 9 bilateral imperforations (69.23%), and 4 unilateral imperforations (30.77%), 2 on the right side (50%) and 2 on the left side (50%). The diagnosis of choanal atresia was confirmed by computed tomography (CT) and nasal endoscopy. All our patients underwent surgical treatment by endonasal endoscopic approach with calibration with a favorable evolution. Through this study, we concluded that the frequent association with other anomalies requires a clinical and paraclinical evaluation and a long-term follow-up. Nasal endoscopy and CT scan have completely revolutionized the diagnostic and therapeutic approaches of choanal atresia, and the endoscopic endonasal approach remains the best therapeutic choice.

EVALUATION OF TRANS-NASAL ENDOSCOPIC CROSS-OVER FLAP TECHNIQUE IN THE REPAIR OF CHOANAL ATRESIA

Background: Choanal atresia (CA) is a widely recognized craniofacial disorder characterized by the obliteration of the posterior nasal opening, due to the imperforation of the oronasal membrane and overgrowth of the horizontal and vertical process of the palatine bone during weeks 4-11 of the gestation process. Objective: To evaluate the efficacy of trans-nasal endoscopic cross-over flap technique in the repair of choanal atresia with long-term follow-up. Patients and methods: This study was conducted on 20 choanal atresia cases that were managed by the endoscopic transnasal approach using cross-over flap technique at the Department of Otorhinolaryngology, Bab EL-Sharia and AL-Hussein Hospitals, Faculty of Medicine, AL-Azhar University from December 2018 to January 2020. Results: The study included 20 cases: 13 females and 7 males, 5 cases were bilateral, 15 cases were unilateral. Four cases were bony atretic plate, and 16 cases were mixed atretic plate. Four cases (20%) needed post-operative revision repair due to restenosis of the choana. Revision was more common in bilateral cases than unilateral cases and in bony type than mixed type. Also, revision was common in patients with associated malformations, and in patients done before 10 days. Conclusion: Transnasal endoscopic surgery using cross-over flap technique is one of the best choices in the management of the choanal atresia. Endoscopy and CT are the methods of choice for diagnosis.

Clinical retrospective analysis of 15 cases of choanal atresia - Our experience.

ObjectiveChoanal atresia is a rare congenital disorder due to failed recanalization of the nasal fossae during fetal development. This article focuses on our experience in dealing with choanal atresia and its management. Here we discuss the varied clinical symptoms that the patients presented with, the clinical tests and investigations that were specific in diagnosing this condition and surgical management of these cases with endoscopic transnasal choanaplasty with stenting and follow up topical Mitomycin C application.Material and methodsThis is a retrospective study based on computerized medical record review of the patients born in Department of ENT of Sur Hospital between 2002 and 2017. The patients were assessed with detailed history, presentation of clinical symptoms and all underwent nasal endoscopy and CT scans for assessing the atretic type. These patients underwent transnasal endoscopic choanaplasty under general anesthesia using microdebrider and stented using endotracheal tube. The patients were regularly followed up for review with nasal endoscopy after discharge between 4th and 7th postoperative period. The parents were educated on nursing care and the stent was removed in 4 weeks, all patients had Mitomycin C applied to the neochoana and were on regular follow up for a year with no recurrence.ResultsFifteen patient records were analyzed, 10 females and 5 males, ages varying from newborns up to 14 years old. Unilateral to bilateral choanal atresia was 4:1 ratio and female-male showed 2:1 ratio. Right malformation was predominant in both sexes in unilateral atresia. Mixed imperforation (bone-membranous) was the most frequently observed type, followed by bone malformation. The commonest symptom during diagnosis was rhinorrhea and the least one was respiratory failure. Majority of cases were diagnosed by CT scans of sinuses. Around 10% patients presented with cardiac problems. None had restenosis in one year follow up.ConclusionsNeonates with acute respiratory insufficiency due to choanal atresia can be diagnosed with simple bedside tests like cold spatula test, less invasive tests like failure to pass intranasal catheter, CT scan. Surgical correction with endoscopic intranasal choanaplasty is the way to address this problem and could avoid radical palatal approach, less morbidity and high success rate.

WITHDRAWN: Novel use of a curved mastoid burr in the management of a difficult case of choanal atresia

WITHDRAWN: Novel use of a curved mastoid burr in the management of a difficult case of choanal atresia

Rare case of choanal atresia in a 54-years-old female

Introduction: Choanal atresia is a rare disorder presenting with complete separation between the nasal cavity and the nasopharynx. There are two types of this abnormal blockage of the nasal airway – congenital and acquired. Material and Methods: This paper presents the case of a 54-years-old woman administered to the clinics for septoplasty. During the preoperative diagnostic process via CT scan and endoscope examination a coincidental finding was diagnosed – unilateral congenital choanal atresia. The medical history of the patient revealed difficult nasal breathing which is absent in the right nasal airway, also frequent rhinosinusitis, moreover orthodontic problems with her dentition and malocclusion; regarding her post-birth period she was on feeding tube and with oxygen mask in a neonatal clinic for several months; no facial traumas reported during the rest of her life. Results: Septoplasty was managed and endoscopic assisted fenestration in the choanal regional was performed viatransseptal access. Seven days postoperatively before the removal of the septal splints a CT scan was performed for evaluation of the surgical treatment and three months later – endoscopy which displayed well-formed without postoperative stenosis neochoana. Conclusion: The congenital choanal atresia is a rare abnormality which determines the insufficient clinical experience with this disorder. It is possible that many cases could have been missed or misdiagnosed because of the low incidence of the condition. The conducted literature review reveals that the case report we are presenting is one of the oldest patients diagnosed with unilateral, congenital, bony choanal atresia.

Choanal Atresia: Birth Without Breath

Bilateral Choanal atresia is a medical emergency. Corrective surgery is the mainstay of the treatment. Hegar's dilator was used in all cases to break the bony/membranous atretic plate. The 22 cases of choanal atresia all operated by the first author were included in this study. Eight cases were 1-5year old with bilateral choanal atresia and all required immediate surgery as they had repeated attacks of respiratory distress and cycle of cyanosis. Eight cases were of CHARGE Syndrome. All the cases were operated under general anaesthesia. Hegar's dilators were used and nasal stents were placed in all cases. Although complete nasal patency was achieved by surgery, in 8 cases, neonates could not survive due to the CHARGE Syndrome. The mortality was unrelated to the surgery. The 14 cases which were not related to CHARGE Syndroma had a good postoperative recovery. 3 cases were above 15years old with unilateral complete bony/membranous choanal atresia and they presented with continuos nasal discharge. Hegar's dilators are a safe and simple method of surgery for choanal atresia. Nasal stenting is mandatory to prevent restenosis.

Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study.

Antithyroid drugs (ATDs) may have teratogenic effects, but more evidence is needed on the risk and types of birth defects after the use of methimazole (MMI) and propylthiouracil (PTU). This study aimed to evaluate the association between the use of ATDs in early pregnancy and birth defects. Swedish nationwide register-based cohort study. The study included 684 340 children live-born in Sweden from 2006 to 2012. Exposure groups defined by maternal ATD use in early pregnancy were MMI (n = 162); PTU (n = 218); MMI and PTU (n = 66); ATD before or after, but not in pregnancy (n = 1551) and non-exposed (never ATD (n = 682 343)). Outcome was cumulative incidence of birth defects diagnosed before two years of age. The cumulative incidence of birth defects was not significantly different in children exposed to MMI (6.8%, P = 0.6) or PTU (6.4%, P = 0.4) vs non-exposed (8.0%). For subtypes of birth defects, MMI was associated with an increased incidence of septal heart defects (P = 0.02). PTU was associated with ear (P = 0.005) and obstructive urinary system malformations (P = 0.006). A case of choanal atresia was observed after exposure to both MMI and PTU. The incidence of birth defects in children born to mothers who received ATD before or after, but not in pregnancy, was 8.8% and not significantly different from non-exposed (P = 0.3), MMI exposed (P = 0.4) or PTU exposed (P = 0.2). MMI and PTU were associated with subtypes of birth defects previously reported, but the frequency of ATD exposure in early pregnancy was low and severe malformations described in the MMI embryopathy were rarely observed.

Descriptive and risk factor analysis for choanal atresia: The National Birth Defects Prevention Study, 1997–2007

Choanal atresia causes serious posterior nasal obstruction. This defect is the leading cause of nasal surgery in newborns, although its etiology is largely unknown. Data from the National Birth Defects Prevention Study, a population-based case–control study, were used to examine associations between maternal self-reports of exposures and occurrence of choanal atresia in their offspring. Overall, 117 case and 8350 control mothers with deliveries from 1997 through 2007 provided telephone interview reports of pre-pregnancy (one year before conception) and periconceptional (one month before through three months after conception) exposures. The exposures analyzed were pre-pregnancy dietary intake, pre-pregnancy and periconceptional caffeine consumption, and periconceptional cigarette smoking, alcohol drinking, and medication use. Independent associations between each exposure and all choanal atresia cases combined (n = 117) and isolated choanal atresia cases (those without additional unrelated major defects; n = 61) were examined. Odds ratios (ORs), both unadjusted (uORs) and adjusted (aORs) for potential confounders, and 95% confidence intervals (CIs) were estimated using unconditional logistic regression analysis. For all choanal atresia cases combined, positive associations were observed with maternal pre-pregnancy intake in the highest quartile for vitamin B-12 (aOR = 1.9; CI = 1.1,3.1), zinc (aOR = 1.7; CI = 1.0,3.1), and niacin (aOR = 1.8; CI = 1.0,3.1), and intake in the lowest quartile for methionine (aOR = 1.6; CI = 1.0,2.6) and vitamin D (aOR = 1.6; CI = 1.0,2.4) compared to intake in the two intermediate quartiles combined. Further, a positive association was observed with periconceptional use of thyroid medications (uOR = 2.6; CI = 1.0,6.3) compared to no use of such medications. Among isolated choanal atresia cases, negative associations were observed for pantothenic acid (aOR = 0.4; CI = 0.2,0.9) and fat (aOR = 0.5; 95% CI = 0.2,1.0) intake in the lowest quartile compared to that in the intermediate quartiles, and positive associations were observed for periconceptional cigarette smoking (aOR = 2.3; CI = 1.1,4.7) compared to no smoking and pre-pregnancy daily coffee intake of 3 or more cups (aOR = 2.5; CI = 1.1,5.6) compared to intake of less than 1 cup per day. The positive association for periconceptional exposure to thyroid medications also persisted for isolated choanal atresia cases (uOR = 4.0; CI = 1.1,11.2). Because of the large number of associations tested, these findings may be due to chance. Alternatively, they may contribute new hypotheses regarding the etiology of choanal atresia; thus, requiring replication in additional studies.

Choanal Atresia: Surgical Management by Hegar's Dilators.

Choanal atresia is one of the more commonly observed congenital abnormalities of the nose. The condition is predominantly found in females with a M:F ratio of 1:2. 65-75% of patients with choanal atresia are unilateral, and the rest are bilateral. About 50% of the cases are associated with other congenital anomalies, the most common being coloboma, Heart disease, choanal atresia, mental and growth retardation, genital hypoplasia, ear deformities syndrome. The embryonic origin of choanal atresia is due to persistent bucco-pharyngeal or naso-buccal membrane. Our study was a retrospective study of 14 cases of choanal atresia. All the cases were operated by the first author. Each patient was investigated in detail and recorded by stratifying in sex of patient, age of presentation, type and site of atresia, and associated other congenital anomalies. Patient were operated under general anesthesia and Hegar's dilators were used to perforate the atretic plate as Hegar's dilators are believed to have ideal curvature with respect to the sloping contour of the nasal floor. Out of the total 14 cases, 9 (64%, n=14) cases were male and 5 (36%, n=14) females. The age variations varied from youngest of 3days to the oldest 31year old female. Stents were kept for a period of 6-8weeks and regular follow up nasal endoscopy was done weekly for suctioning and visualizing the size of the airway. There are five different surgical approaches that have been described for surgical treatment of choanal atresia: (1) trans-nasal, (2) trans-palatal, (3) trans-septal, (4) trans-antral and (5) sublabial-transnasal. In our study M:F ratio was 1.8:1 which is comparable Gosepath et al. (Rhinology 45:158-163, 2007) (2:1). In our study bilateral atresia was seen in 43% (6, n=14) and unilateral in 57% (8, n=14) which is comparable to Newman et al. (44% bilateral cases, n=43). Amicable and prompt referral to the ENT surgeon can be of immense value so as to buy adequate time for the surgeon to decide and act as per the patient's clinical and radiological findings. Hegar's dilator is passed along the floor of the nose, pushed against the septum so as to avoid penetrating the basal sphenoid.

Unilateral membranous choanal atresia

Images of a case of unilateral choanal atresia diagnosed in a 35-year-old woman are presented. This is an uncommon diagnosis in an adult patient, and a less frequently encountered form of the condition. In more than 90% of cases of choanal atresia, the abnormality is partly or completely osseous; pure membranous atresia is rare. It is unilateral in 50 - 60% of cases, and more than 75% are associated with syndromes and systemic anomalies.

Choanal atresia – a recurrent feature of foetal carbimazole syndrome

Choanal atresia is described as a feature of several congenital anomaly phenotypes. Most cases of choanal atresia arises as an isolated clinical finding. In utero exposure to carbimazole for maternal hyperthyroidism has been reported in five cases of choanal atresia. We report another instance of this teratogenic cause of choanal atresia. Maternal drug history is an important aspect of assessment in cases of choanal atresia.

Choanal Atresia

The use of complementary and alternative medicine (CAM) is common among patients with chronic, long-standing nasal disease. Complications resulting from inappropriate CAM practices are sometimes reported, but serious complications such as choanal atresia and stenosis are rare. We report a case of choanal atresia and stenosis due to herbal drug (ie, chemical) cauterization of the nasal cavity in a 39-year-old man. We reviewed the literature on why patients previously given conventional treatment seek alternative therapies. The patient underwent surgical intervention to relieve choanal atresia and stenosis. The postoperative course was unremarkable, and follow-up for 1 year revealed no evidence of restenosis. Choanal atresia and stenosis resulting from CAM treatment are rare. Otolaryngologists should be aware of possible complications occurring in patients receiving such treatments.

Topical mitomycin as an adjunct to choanal atresia repair.

To evaluate the use of topical mitomycin in choanal atresia repair to reduce the development of granulation tissue and cicatrix. Retrospective case series in 2 tertiary care centers. Twenty patients with either unilateral or bilateral congenital choanal atresia underwent repair using the transnasal endoscopic approach, the transpalatal approach, or both. The surgeons favor the use of the endoscopic transnasal drillout technique for all unilateral cases of choanal atresia and for selected bilateral cases. We describe our experience and treatment paradigm for these 20 patients (15 with unilateral atresia, 5 with bilateral atresia). Topical application of mitomycin was used, and in some cases postoperative stenting, for a period of 1 to 2 weeks. In 8 cases, a second application of mitomycin was used. Follow-up ranged from 3 months to 2 years (mean, 9 months). The patency of the choanae without respiratory distress or nasal drainage, as assessed by endoscopic evaluation, determined a successful repair. Of the 20 patients, 17 retained patent airways. Three patients experienced improvement from a total atresia to a narrowed, stenotic choana. The use of mitomycin as an adjunct to the surgical repair of choanal atresia may offer improved patency with a decreased need for stenting, dilatations, and revision surgery. Newer endoscopic techniques with powered instrumentation further enhance the safety and efficacy in the repair of choanal atresia.

Assessment of congenital bony nasal obstruction by 3-dimensional CT volume rendering

The nature and extent of congenital bony nasal obstruction is best determined by X-ray computed tomography (CT) imaging. Three-dimensional volume rendering of CT images provides an integrated perspective that can assist in clinical decision making and in operative planning. Clinical cases of choanal atresia and pyriform aperture stenosis are reviewed with their images. The authors propose this modality as an evolving standard for imaging of congenital bony nasal obstruction.

Bilateral choanal atresia associated with nasal dermoid cyst and sinus: a case report and review of the literature

The relationship of choanal atresia to various systemic malformations is well acknowledged by the CHARGE acronym: colobomas, heart defects, atresia choanae, retarded growth and development, genito-urinary defects, and ear defects. In the past, we have reported the finding of an isolated skull base malformation associated with choanal atresia. We report here a unique case of choanal atresia associated with a patent foramen cecum and intracranial extension of a dermoid sinus. The embryogenesis of this condition is accounted for by the mesodermal flow theory of choanal atresia formation, and implies a need for thorough imaging of the anterior skull base in cases of bilateral atresia.

A further case of choanal atresia in the deletion (9p) syndrome

A further case of choanal atresia in the deletion (9p) syndrome