Choanal Region Research Articles

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.

The choanal anatomy of theSebecus icaeorhinusSimpson, 1937 and the variation of the palatine shape in notosuchians (Crocodyliformes, Mesoeucrocodylia)

AbstractSebecidae is a clade of large carnivorous crocodyliforms that thrived in the Cenozoic and is the only lineage of the diverse and terrestrial group Notosuchia that survived the end-Cretaceous mass extinction event.Sebecus icaeorhinusis the best-known taxon from this clade, both in terms of its cranial and postcranial anatomy (known primarily from the holotype and specimen MPEF-PV 1776, respectively). Additional material represented by a partial skull (MMP 235) is the only specimen that has preserved a complete choanal region. We describe new information from this specimen based on an X-ray computed tomography and identify through comparisons with other taxa a large degree of variability in the palatal anatomy within Sebecidae, in particular in the shape and extension of the palatine (the bone that defines the anterior position and shape of the secondary choana). We quantify variation in the shape of the palatine bone of sebecids through a 2D morphogeometric analysis within the context of notosuchian crocodyliforms. Although traditional accounts of palatal evolution in crocodyliforms linked variation of this structure to the adaptation to the aquatic environment, our analysis allows recognition of eight palatine morphotypes among terrestrial crocodyliforms with very distinct paleoecological traits, including carnivorous, omnivorous, and possibly herbivorous taxa. Furthermore, we show that sebecids had a higher morphological disparity in the choanal region than other terrestrial groups of Notosuchia, underscoring the importance of this region for comparative, morphofunctional, and phylogenetic studies.

Features of the architectonics of the structures of the nasal cavity and choanal zone in children with congenital malformations of the eyes

The article provides data on the embryogenesis of the eyeball, nasolacrimal canal and nasal cavity. A frequent combination of congenital choanal atresia and anomalies in the development of the eyes was noted, most likely associated with the temporal and topographic parallelism of the intrauterine development of these anatomical areas. In order to assess the condition of the nasal cavity and choanal region in congenital eye pathology, 43 children with ophthalmological malformations were examined. In 32 (74.4%) children, according to endoscopic examination, changes in the anatomy of the choanal region with a change in its size in the form of incomplete atresia were revealed. The results obtained allow the authors to recommend that all children with congenital ophthalmological malformations be examined and monitored by an otolaryngologist with an endoscopic examination of the nasal cavity and nasopharynx.

New ways of solving the problem of restenosis in the surgical treatment of congenital choanal atresia in children

In order to solve the issues of prevention of the fibrosis in the postoperative period in patients with CAC, the prospects of using the carboxymethyl cellulose gel-sodium salt (CGSS) were assessed. This medicine was used in patients, who were: primarily operated, after a period of wearing a protector (n=17); primarily operated without using a protector, at the final stage of the operation and in the early postoperative period (n=15); reoperated because of the restenosis, also at the final stage of the operation and in the early postoperative period (n=12). We present our results of application of the carboxymethyl cellulose gel-sodium salt for the prevention of scar adhesions in this condition: endoscopy of the nasal cavity and choanal region in all 44 patients with follow-up observation (from 1 year to 5 years) showed no signs of restenosis. The use of sodium carboxymethyl cellulose sodium salt in the intra- and postoperative period may be one of the ways of solving the problem of restenosis after surgery in children with CAC along with the use of endoscopic techniques for performing choanotomy.

Gross morphological and ultrastructural characterization of the oropharyngeal cavity of the Eurasian hoopoe captured from Egypt.

The present study aimed to give full morphological insight into the oropharyngeal cavity of Eurasian hoopoe at the level of gross morphology in addition to ultrastructural inspection including light- and scanning electron microscopy. The oropharyngeal cavity has a triangular appearance with a very long rostrally located beak, helping the bird achieve its feeding mechanism. The floor of the oropharyngeal cavity is divided into three parts; a pre-lingual part with a pre-lingual fold, a lingual part containing a rudimentary triangular tongue, and a laryngeal part, which contains a small elevated laryngeal mound. There are four giant papillae and numerous openings of lingual salivary glands on the root. The roof is divided into the pre-choanal and the choanal region. The pre-choanal region has two parallel palatine ridges, while the choanal region had an ovoid-shaped choanal cleft rostrally, followed caudally by a narrow infundibular slit. The mechanical papillae on the roof are arranged in two rows directed caudally; one row is located on the free border of rostral half of the choanal cleft, while the other row is located between the pharynx cavity and the esophagus. The histological study showed that the tongue was covered dorsally and ventrally by keratinized stratified squamous epithelium and supported centrally by entoglossum, which extends from the root until the rostral tip of the tongue. The entoglossum was mainly cartilaginous rostrally in the apex and ossified caudally in the lingual body and root. Numerous mucous glands scattered in the sub mucosa of the lingual root as well as in the palatine region convey their secretions to the surface through a duct guarded by diffuse lymphocytic infiltration.

A new neosuchian crocodyliform from the Lower Cretaceous (late Aptian) Twin Mountains Formation of North-Central Texas

ABSTRACT A new fossil crocodyliform, Paluxysuchus newmani, gen. et sp. nov., is established on the basis of a nearly complete skull from the Lower Cretaceous (late Aptian) Twin Mountains Formation of north-central Texas. Partially articulated and disarticulated cranial material representing two individuals was recovered from the Jones Ranch locality in close association with the sauropod Paluxysaurus jonesi. The holotype skull is nearly complete, missing the premaxillae, left palatine, and pterygoids, and does not preserve the choanal region. This taxon is notable for having its frontal separated medially from the orbital margin, an extremely elongate anterolateral process of the postorbital, large and rounded supratemporal fenestrae, and a narrow, rod-like posterior ramus of the jugal. These features indicate affinities with goniopholidids, pholidosaurids, and thalattosuchians. A phylogenetic analysis places Paluxysuchus newmani deep within Neosuchia as the sister taxon to the clade that includes Goniopholididae and Eusuchia. SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVP

Choanal fungus ball mimicking a tumour

We report the first case of an isolated choanal fungus ball in a 28-year-old man with a previous history of nasopharyngeal carcinoma, who was treated with radiotherapy 14 years ago. The initial diagnosis was a recurrent tumour or a secondary neoplasm. Histopathological examination confirmed a fungal infection. There are no previous reports of a fungus ball located at the posterior choanal region. Although it has been reported that bacteriology of sinonasal region would be different in irradiated patients, there is no study reporting fungal infections in irradiated patients in English literature. In this report, the clinical presentation, relevant radiologic findings and management of sinonasal fungus ball and its relationship with previous radiotherapy were discussed with the literature knowledge.

Malignant Mesenchymoma in the Nasal Cavity of a Bull

A 4-year-old bull was presented with facial distortion and abnormal respiratory noise. Endoscopically, a proliferative mass was found obliterating the left nasal cavity and a tumour was suspected. The head was examined after slaughter and there was a well-circumscribed solid structure (15×12×6 cm) extending into the paranasal sinus, the choanal region and the bones of the orbit, with focal penetration of the nasal septum. Microscopically, the mass consisted of well-differentiated trabeculae of woven and lamellar bone, areas of chondromyxomatous, immature and mature cartilaginous tissue, and regions with irregular whorled spindle cells. Tissue differentiation of the mass was variable. Centrally, there was osseous differentiation with an outermost fibromatous area resembling a zone of endochondral ossification. There was suppurative and ulcerative inflammation where the tumour extended through the hard palate and into the pharynx. A nasal malignant mesenchymoma was diagnosed on the basis of these features.

Correlation between Fiberoptic Nasal Endoscopy and Acoustic Rhinometry in Adults without Nasal Complaints

Acoustic rhinometry indirectly calculates cross-sectional areas of the nose at various locations from the nostrils and the total volume of the nasal cavity. These parameters are calculated from an area-distance curve displayed by the device. Seventy-seven adults between the ages of 20 and 40 years who had no nasal complaints were examined by acoustic rhinometry and fiberoptic nasal endoscopy in an attempt to compare and correlate areas of nasal narrowing detected by these two methods. The comparison between the distances to the various narrowed areas revealed a statistically significant correlation between the first three constrictions detected by acoustic rhinometry and the first three areas of anatomic narrowing measured by fiberoptic nasal endoscopy in both nares but no correlation between the fourth constriction and the fourth measurement on either side. The results confirm an anatomic correlation between the two examination methods, identifying the first constriction as the nasal valve, the second constriction as the head of the inferior nasal turbinate, and the third constriction as the head of the middle turbinate. The fourth constriction did not correspond to the choanal region.

Relations of the pterygoid hamulus and hard palate in children and adults: Anatomical implications for the function of the soft palate

We investigated spatial relations of the pterygoid hamuli to the hard palate on 65 skull bases: 31 disarticulated sphenoidal bones from the newborn up to 9 years of age, 19 skulls of adult skeletons (21-59 age group), and 15 skulls aged 60-100 years. We measured: (a) width of the hard palate in the choanal region, (b) length of the hamulus, (c) inclination of the hamulus from the perpendicular line, and (d) distance between the tips of the contralateral hamuli. The width of the hard palate in the choanal region was smallest in children (mean +/- standard deviation, 21.5 +/- 2.6 mm) compared with adult skulls (26.8 +/- 2.3 mm in the 21-59 age group and 25.4 +/- 1.9 mm in the 60-100 age group; P<0.05, one-way analysis of variance (ANOVA) and Student-Newman-Keuls post hoc test). Children had the shortest hamulus (3.6 +/- 1.5mm), and its length increased in the adult age group to 6.9+1.7mm (P<0.05), and then again decreased to 5.0 +/- 1.9 mm in the 60-100 age group (P<0.05 vs. adults and children). The distance between the tips of the contralateral hamuli and their lateral inclination from the perpendicular plane were also greater in the adult age group (38.0 +/- 2.7mm and 35.9 +/- 13.7 degrees, respectively) than either in children (31.0 +/- 3.7mm and 19.6 +/- 12.1 degrees) or the elderly (32.7 +/- 3.9mm and 19.7 +/- 10.3 degrees) (P<0.05). Our study showed that the anatomical measures of the pterygoid hamulus and its relation to the surrounding structures change with age, and occur with the changes in the function of pharyngeal and palatal muscles in deglutition. These changes may have clinical relevance for sleep apnoea and snoring.

Endoscopic examination of the choanae in dogs and cats: 118 cases (1988–1998)

Objective To determine whether endoscopic examination of the choanae resulted in diagnosis of various diseases in dogs and cats with signs of respiratory tract disease. Design Retrospective study. Animals 91 dogs and 27 cats that had endoscopic examination of the choanae. Procedure Medical records were reviewed for endoscopy findings and results of examination of biopsy or cytologic specimens. Results 34 animals had neoplasia in the choanal region; in 26 animals, diagnosis was confirmed by evaluation of specimens obtained by endoscopy. Five dogs with neoplasia had an erroneous diagnosis of rhinitis made on the basis of evaluation of specimens obtained by endoscopy. Six dogs and 2 cats had foreign objects in the choanae; 7 foreign objects were removed endoscopically, whereas 1 required nasal flushing. Results of endoscopy and biopsy of the choanae provided diagnosis of cryptococcosis and aspergillosis, but did not aid in the diagnosis of pythiosis or nasal mites. Conclusions and Clinical Relevance Endoscopic examination of the choanae may assist in rapid diagnosis of nasal neoplasms, foreign objects, and certain infectious organisms. (J Am Vet Med Assoc 1999;215:1301–1305)

Possible Anatomical Base of Snoring

Variations of the medial and inferior choanal limits may facilitate snoring. These are: 1) short vomer without crista choanalis vomeris and adaptational formations, 2) extremely concave posterior margin of the hard palate leading to disproportion between the muscular and aponeurotic part of m. tensor veli palatini and hence to a flabby soft palate especially during sleep, and 3) neonatal relation of the height and width of the choane resulting in a very large choanal region instead of relative reduction of choanal width compared to its increasing height. All these variations result in a flabby soft palate especially during sleep and may lead to formation of whirles of inspired air and snoring.

Anatomic findings and management of choanal atresia and the CHARGE association.

The CHARGE association is a collection of multisystem congenital anomalies including choanal atresia. A review of the literature failed to identify any specific findings that suggested the need to alter the management of choanal atresia in these patients. Our review of 24 patients with choanal atresia managed between 1974 and 1986 identified nine patients with the CHARGE criteria. These nine patients demonstrated a higher prevalence of surgical failures than the patients without the CHARGE association. The reasons are discussed, and computed tomographic scans demonstrate the anatomic findings of a more contracted nasopharynx and narrowed posterior choanal region. Thus, successful repairs require a more radical resection of the posterior nasal septum and lateral bony walls that can be achieved only with a transpalatal approach. The preoperative airways of CHARGE association patients are also at increased risk of obstruction and may require intubation or tracheotomy during the early life of the patient.

Computed tomography in the evaluation of choanal atresia

Nine patients with choanal atresia or stenosis, ranging in age from two days to 6 years were evaluated by computer tomography (CT). The clinical, conventional radiographic and surgical findings were correlated with CT findings. In all patients, the complete anatomic abnormality and the thickness of the obstruction were better defined with CT than with a choanogram. Findings on CT included: thickening of the vomer, bowing of the lateral wall of the nasal cavity and fusion of bony elements in the choanal region. This information is essential in planning surgical correction.

Congenital Choanal Atresia

A case of bilateral congenital choanal atresia is presented. The patient was a 16-year-old girl who had suffered from thick, mucoid discharge and complete nasal obstruction since birth. Although she gradually learned to breathe through her mouth, she often encountered respiratory distress with cyanosis in the early stages of life. A diagnosis of choanal atresia was made when a catheter failed to pass through the nose into the pharynx. The nasopharyngography confirmed the posterior nasal obstruction.Surgical correction was performed by a transpalatine approach under general anesthesia. Following exposure of the posterior choanal region via the transpalatine approach, the membraneous tissue which occluded the choanae was excised. Silicon tubes were left inserted into the opened choanae for 2 weeks. No remarkable complication has been observed postoperatively. The choanae are still open and the patient breathes satisfactorily through her nose.From 1923 to 1979, 45 cases of congenital choanal atresia have been reported in the Japanese literature. These cases are analyzed in terms of sex, laterality, type and concomitant anomalies. Our present report is the 45th case of congenital choanal atresia to be reported in Japan.