Repair 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.

A Meta Analysis of Endoscopic Surgical Management of Choanal Atresia with and without Stent

Abstract Background Congenital choanal atresia is a rare abnormality, affecting approximately 1 in 7000–8000 newborns, with a female predominance. In congenital choanal atresia, the widened vomer fuses with the atretic plate, resulting in an hourglass configuration of the nasopharynx and the choanal region. Materials and Methods This meta analysis included 17 studies all were published between 2016 and 2021. Two different techniques, endoscopic management with and without stents, this study demonstrated success with no stent approach and lower rate of re stenosis when compared to stent used approach, however there are some indications and benefits of using stents. Results For our knowledge this is the second systematic review and metaanalysis to report the pooled success of endoscopic repair of choanal atresia with and without the use of nasal stents. Analysis of 5 studies that included 142 patients who were not stented demonstrated that the weighted pooled proportion of successful surgery was higher and significantly different when compared with three studies that evaluated 57 patients who were stented 86% (79%, 92%) vs 61% (40%, 81%). From an analysis of nine comparative studies including 405 patients Overall odds ratio (95% CI) = 3.56 (2.10, 6.05) with unimportant heterogeneity across studies (I-squared = 37%, Cochrane Q p = 0.12) favoring no stenting over stenting. Conclusion Success rates for management without stents is higher than using stents. The use of nasal stents may be associated with more frequent and more severe complications. Perioperative adjuncts such as nasal stenting should be considered in the context of the individual patient and surgeon preference. If the surgeon decides to stent, a duration of 1 week or shorter may be associated with better surgical outcomes; however, the evidence is limited.

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.

Choanal atresia repair in Germany : Resection of dorsal septal parts and stents in focus

Various surgical techniques using transpalatinal, transseptal, and transnasal approaches for surgical repair of choanal atresia have been developed over the past 200years. Endoscopic endonasal surgery with resection of dorsal septal parts and without the use of stents is the current scientific trend, as high success rates with low complication rates can be achieved. This study examined whether this technique has actually become standard in Germany, and also investigates the role played by stents. Atotal of 52ear, nose, and throat (ENT) hospitals in Germany, including all 39university ENT hospitals and 13non-university maximum-care ENT hospitals, were asked which surgical technique they use for choanal atresia repair and whether stents are used. For dorsal septal resection, 39of 44responding hospitals (89%) indicated that they resect dorsal septal parts, 85% of the university hospitals and 100% of the non-university hospitals. For use of stents, 20of 48responding hospitals (42%) reported not using stents, whereas 39% of the university hospitals and 50% of the non-university hospitals do use them. Endoscopic endonasal choanal atresia repair with resection of dorsal septal parts is, in most instances, used as the standard technique in large ENT hospitals in Germany. Routine use of stents is still widespread. The future aim should be to reduce the use of stents in the treatment of choanal atresia and to use this method only in difficult, individual cases.

Can a second look improve the outcome of endoscopic choanal atresia repair?

To evaluate the outcome of a routine postoperative endoscopic micro-debridement of granulation tissue after stentless transnasal endoscopic repair of choanal atresia (CA). This prospective case series included congenital CA patients who underwent stentless transnasal endoscopic repair, followed by an endoscopic second look and micro-debridement of granulation tissue at 1-2weeks post-repair. Patients were followed every three months for assessment of nasal airway symptoms and objective evaluation by flexible nasolaryngoscopy. Sixteen CA patients (8 bilateral and 8 unilateral) underwent surgical repair (12 primary and 4 revisions). The median age was 13days (range 1day-6months) in bilateral and 3years (range 7months-15years) in unilateral atresia. The mean follow-up was 1.5years (range 1year-3years). In primary procedures, the obstruction was bony-membranous in 7 cases and bony in 5 cases. The mean interval time between the CA repair and re-examination was 10.75days (range 6-18days). Clinically significant neochoanal restenosis was not encountered. Re-examination under general anesthesia with endoscopic micro-debridement of granulation tissue is a safe, potentially effective adjunct when done during the proliferative phase of neochoanal wound healing. This procedure might help in maintaining neochoanal patency by remodeling tissue healing process. Large-scale, long-term cohort studies are imperative.

Transnasal Endoscopic Piezoelectric Surgery for Repair of Choanal Atresia

Transnasal Endoscopic Piezoelectric Surgery for Repair of Choanal Atresia

Cross-over septal flap technique for choanal atresia surgery in two centres: how I do it.

Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. There were 12 patients from 2013 to 2020, aged 0.07-50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.

Endoscopic Endonasal Repair of Congenital Choanal Atresia: Predictive Factors of Surgical Stability and Healing Outcomes.

Background: To assess the long-term outcomes and independent predictors of surgical success of a one-stage minimally invasive surgical procedure for congenital choanal atresia (C.C.A.). Methods: a retrospective multicentric study was conducted between 2010 and 2022. An endonasal endoscopic approach was performed in 38 unilateral or bilateral C.C.A. children. All the patients were clinically and radiologically assessed and followed for at least 2 years. Seven outcome measures were applied. Consequently, surgical success was correlated with all the independent variables reported. Results: 18/38 (47.36%) patients presented normal postoperative healing, 8/38 (21.05) had moderate restenosis (<50%), while 12/38 (31.57%) cases were severe (>50%), requiring a surgical revision. No statistical significance was found for average hospital stay between stenosis >50% and <50% patients (p = 0.802) and postoperative pain (p = 0.075); instead, the severe restenosis group demonstrated a higher delay of breast suction (p < 0.001). Among the independent variables predictors of surgical success, the presence of Charge syndrome and rhinopharyngeal stenosis demonstrated higher risks for surgical revision (OR: 4.00, 95% CI: 0.57–28.01, and OR: 2.75, 95% CI: 0.55–13.69, respectively). On the contrary, the hypoplastic inferior turbinate and bilateral C.C.A. showed a lower risk for severe restenosis by a higher endoscopic surgical space and creating a single larger opening (OR: 0.88, 95% CI: 0.22–3.52, and OR: 0.45, 95% CI: 0.10–2.08). Conclusion: Several independent variables could influence the surgical success after C.C.A. endoscopic repair; however, more high-quality evidence is needed to generate an effective predictive model.

Off-Label Use of Ciprofloxacin/Dexamethasone Drops in the Pediatric Upper Airway: Case Presentation and Review of Adverse Effects.

This report describes a new observation of hyperglycemia in a child with Type 1 diabetes after off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage and reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients. We describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE. A 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. While the patient's airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient's continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. We also review 21 pediatric otolaryngology cases of iatrogenic Cushing's syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day. This is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions, to the best of our knowledge. Counseling families on precise dose administration and potential endocrine disturbances is critical when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes.

Safety profile and efficacy of high-dose topical mitomycin-C for choanal atresia repair: A prospective cohort study

ObjectivesTo study the effect of dose-adjusted mitomycin-c (MMC) on the recurrence rate of choanal atresia (CA), and the complication rate associated with this concentration. MethodsThis prospective cohort study was conducted between May 2012 and March 2020 at a tertiary referral center. It included patients of all ages who were diagnosed with CA and scheduled to undergo surgical repair. The MMC group received 4.0 mg/mL of topical MMC. Both groups were followed up for the surgical outcomes and complication rates. ResultsTwenty-one patients (15 females) underwent 25 CA repair procedures. The mean age was 44.85 months (standard deviation = 72.85). MMC was used in 12 (57.1%) of 21 patients. Revision CA repair was warranted in three of the nine patients who did not receive topical MMC compared to one of the 12 patients who received topical MMC. The MMC group required 1.08 ± 0.29 surgeries (range, 1–2), whereas the non-MMC group required 1.44 ± 0.73 surgeries (range, 1–3). Functional success was achieved in 17 (81%) patients who remained symptom-free until their last follow-up visit. ConclusionHigh-concentration MMC was considered safe in the pediatric and adult populations. Although high-concentration MMC could reduce the need for revision surgery, further studies are required to determine whether the effect is significant in a larger sample population.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Role of proton pump inhibitor in healing after choanal atresia repair: a randomized control trial

BackgroundChoanal atresia (CA), defined as the anatomical closure of the choanae in the nasal cavity, is relatively uncommon disease entity with an estimated incidence of 1:5000–7000 births. Post-operative restenosis remains a common complication of the endoscopic CA repair. Risk factors for restenosis include nasopharyngeal reflux and gastroesophageal reflux.ResultsForty patients who underwent choanal atresia repair were divided randomly into 2 groups. Group A patients received postoperative PPI medication compared to group B patients who acted as control who underwent the same operation without receiving postoperative proton pump inhibitor medication.Only 2 patients (10%) in group A experienced restenosis compared to 8 patients (40%) in the control group B.ConclusionThe use of esomeprazole which is a proton pump inhibitor acting as an antireflux should be considered, in postoperative treatment, to decrease the rate of choanal restenosis by preventing inflammation on choanal mucosa which can enhance good healing mechanism.

Transnasal Endoscopic Approach In Repair of Choanal Atresia

Transnasal Endoscopic Approach In Repair of Choanal Atresia

Surgical repair of choanal atresia: Retropalatal endoscopic versus endonasal endoscopic technique

Surgical repair of choanal atresia: Retropalatal endoscopic versus endonasal endoscopic technique

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.

Stenting versus stentless repair for bilateral choanal atresia: A systematic review of the literature

BackgroundBilateral choanal atresia requires prompt surgical intervention. Surgeons have historically used stents in the repair process, however their efficacy has come into question in recent years. We performed a systematic review to investigate, primarily, whether stents enjoy more favourable outcomes compared to stentless repair. We also explored the use of operative adjuncts, such as steroids, antibiotics, mitomycin C and KTP laser. MethodsWe performed a search of the Medline and Embase databases using a search strategy developed with the assistance of an academic librarian. Only full peer reviewed articles were included. Abstracts, posters, case reports and proceedings of academic conferences were excluded. ResultsWe identified 48 unique articles for inclusion, composed of a meta-analysis, two randomised control trials and 45 case series. Pooled analysis of the two randomised control trials yielded no statistically significant difference in choanal patency between stented and stentless repair, but a statistically significant reduction in complications, specifically granulation tissue formation, was found in stentless repair. Data from case series were, overall, of mixed quality, making factors contributing to successful outcomes difficult to elucidate. ConclusionOverall, there is a lack of high quality evidence to support the use of either a stented or stentless approach to bilateral choanal atresia repair, however stentless repair may experience fewer complications. Operative techniques, such as the use of mucosal flaps, are worthy of future study. Authors call for future high quality randomised control trials to investigate this uncommon but important condition.

Endoscopic Repair of Unilateral Choanal Atresia

Endoscopic Repair of Unilateral Choanal Atresia

Trans-nasal endoscopic repair without stenting in bilateral congenital bony choanal atresia: Our technique

: Choanal atresia is a commonly observed congenital nasal abnormality. Incidence of choanal atresia is 1 in 7,000 live births. There are various techniques which has been described for the choanal atresia repair. Here we are sharing step by step trans-nasal technique to get good results post-operatively.: The aim of this study to explain and share the technique to treat a bony choanal atresia without any stenting in the nasal cavity of a neonate. The purpose of this study to analyse the surgical outcome of single stage bony choanal atresia repair in terms of restenosis and revision surgery. : We have described the step by step approach for the repair of bony choanal atresia without using any stent in the nasal cavity. Pre surgery evaluation and surgical steps have been explained with photograph to understand this technique better.: Bony choanal atresia can be treated without any stent placement which was the most common method for the repair of congenital choanal atresia in neonates. Clinical significance: This technique will reduce the chances of complication which arises because of stenting in the nasal cavity. This technique is simple and easily reproducible in the practise.

Nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants

Objective: To describe and evaluate the surgical effect and prognosis of nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants. Methods: The clinical data of 38 newborns and infants with congenital choanal atresia who underwent nasal endoscopic surgery in Beijing Children's Hospital between January 2016 and May 2018 were retrospectively analysed, including 13 males and 25 females. The age ranged from 5 days to 3 years old at the time of operation (15 cases were newborns). The clinical data, imaging data, treatment effect and prognosis were collected. According to the different surgical methods, the patients were divided into the conventional operation group and the modified mucosal flap technique group. The designs of the modified mucosal flap technique were designed according to the type of congenital choanal atresia. The cross-over L-shaped flaps were performed in patients with unilateral atresia, and the mirrored L-shaped flaps were performed in patients with bilateral atresia. All the patients were followed up for 2-3 years, and the follow-up parameters included the times of operations, length of hospital stay, restenosis rate and incidence of complications. Study data was analyzed using SAS version 9.4 statistical software. Results: Sixteen cases underwent conventional operation while 22 patients underwent modified mucosal flap technique under nasal endoscope. The lightest weight (2 200 g) and the youngest age (5 days) of the patients came from the modified mucosal flap technique group. Compared with the conventional operation group under nasal endoscope, the modified mucosal flap technique group had fewer times of operations (1.14±0.47 vs 2.69±1.20, t=5.552, P<0.001), shorter hospital stay ((7.70±3.22) d vs (14.37±19.16) d, t=2.960, P=0.005), lower rate of postoperative restenosis (9.1% vs 43.8%, χ²=6.156, P=0.013), and lower rate of the incidence of complications (13.6% vs 43.8%, χ²=5.955, P=0.015), the differences were statistically significant. Conclusion: The nasal endoscopic modified mucosal flap technique is feasible for repairing congenital choanal atresia in newborns and infants, which can significantly reduce the incidence of postoperative restenosis and complications.

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.